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Stephens GC, Brand G, Yahalom S. Whose voices are heard in health professions education validity arguments? MEDICAL EDUCATION 2024. [PMID: 39252578 DOI: 10.1111/medu.15528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 09/11/2024]
Affiliation(s)
| | - Gabrielle Brand
- School of Nursing & Midwifery, Monash University, Frankston, Australia
| | - Sharon Yahalom
- Communication in Health Professions Education Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
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Kim K, Hornor E, Zarrabi AJ. The Museum as a Shared Space: Developing Contextual and Cross-Disciplinary Approaches to Arts-Based Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:761-769. [PMID: 39157535 PMCID: PMC11330253 DOI: 10.2147/amep.s464634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024]
Abstract
Introduction Despite the growing evidence favoring use of context-based interdisciplinary pedagogies in medical education, museum learning remains underutilized as a low-cost, replicable tool for introducing such constructs. We describe a novel approach to museum-based education building off the existing pedagogy of Visual Thinking Strategies that heightens the role of context. Methods Outside the Frame, an optional elective at Emory University School of Medicine, was piloted in two iterations for a total of 7 second-year medical students who voluntarily enrolled in the course for the fall 2022 and 2023 semesters. Participating students were transitioning from the preclinical classroom environment to clinical clerkships, a period associated with feelings of personal and professional instability that may particularly benefit from critical reflection. The course included didactic components, hands-on crafting activities, presentations, and discussion groups. Student feedback was collected through anonymous pre- and post-course surveys, as well as written narrative reflections. Results All post-course responses ranked their experience of the course as being "valuable" or "very valuable". Narrative reflections were overall positive and highlighted the role of context and cross-disciplinary input in shaping metacognitive awareness and cultivating comfort with uncertainty. Discussion This pilot innovation demonstrates that a methodical framework to arts-based learning can elevate the role of context in a standardized museum education curriculum. Future visual arts and medicine courses may incorporate this framework to chart more active collaborations with museum educators and humanities faculty, as well as engage a broader range of communities and professional disciplines beyond medicine.
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Affiliation(s)
- Kain Kim
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ali-John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
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Stephens GC, Lazarus MD. Twelve tips for developing healthcare learners' uncertainty tolerance. MEDICAL TEACHER 2024; 46:1035-1043. [PMID: 38285073 DOI: 10.1080/0142159x.2024.2307500] [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: 01/21/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Uncertainty is pervasive throughout healthcare practice. Uncertainty tolerance (i.e. adaptively responding to perceived uncertainty) is considered to benefit practitioner wellbeing, encourage person-centred care, and support judicious healthcare resource utilisation. Accordingly, uncertainty tolerance development is increasingly referenced within training frameworks. Practical approaches to support healthcare learners' uncertainty tolerance development, however, are lacking. AIMS Drawing on findings across the literature, and the authors' educational experiences, twelve tips for promoting healthcare learners' uncertainty tolerance were developed. RESULTS Tips are divided into 1. Tips for Learners, 2. Tips for Educators and Supervisors, and 3. Tips for Healthcare Education Institutions and Systems. Each tip summarises relevant research findings, alongside applications to educational practice. CONCLUSIONS Approaches to developing uncertainty tolerance balance factors supporting learners through uncertain experiences, with introducing challenges for learners to further develop uncertainty tolerance. These tips can reassure healthcare education stakeholders that developing learner uncertainty tolerance, alongside core knowledge, is achievable.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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Belhomme N, Lescoat A, Launey Y, Robin F, Pottier P. "With Great Responsibility Comes Great Uncertainty". J Gen Intern Med 2024:10.1007/s11606-024-08954-w. [PMID: 39085579 DOI: 10.1007/s11606-024-08954-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Uncertainty is inherent in medicine, and trainees are particularly exposed to the adverse effects of uncertainty. Previous work suggested that junior residents seek to leverage the support of supervisors to regulate the uncertainty encountered in clinical placements. However, a broader conceptual framework addressing uncertainty experience, from the sources of uncertainty to residents' responses, is still needed. OBJECTIVE To capture the spectrum of uncertainty experiences in medical residents, providing an integrative framework that considers the influence of specialties and training stages on their experience with clinical uncertainty. DESIGN We used Hillen's uncertainty tolerance framework to conduct a thematic template analysis of individual and focus group interviews, identifying themes and subthemes reflecting residents' experience of clinical uncertainty. PARTICIPANTS Medical residents from diverse medical specialty training programs, across five French medical schools. APPROACH Qualitative study driven by an interpretivist research paradigm. RESULTS Twenty residents from all years of medical residency and diverse medical specialties were interviewed during three focus groups and five individual interviews. They described managing treatments, making ethical decisions, and communicating uncertainty, as their major sources of uncertainty. We identified residents' delayed response to uncertainty as a key theme, fostering the development of experiential learnings. Prior clinical experience was a key determinant of uncertainty tolerance in medical residents. Entrusting residents with responsibilities in patient management promoted their perception of self-efficacy, although situations of loneliness resulted in stress and anxiety. CONCLUSION Residents face significant uncertainty in managing treatments, ethical decisions, and communication due to limited clinical experience and growing responsibilities. Scaffolding their responsibilities and clearly defining their roles can improve their comfort with uncertainty. To that extent, effective supervision and debriefing are crucial for managing emotional impacts and fostering reflection to learn from their uncertain experiences.
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Affiliation(s)
- Nicolas Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Université Rennes, Rennes, France.
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
- LISEC (Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication) - UR_2310, Université de Strasbourg, Strasbourg, France.
| | - Alain Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Université Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Yoann Launey
- Réanimation chirurgicale, Département d'Anesthésie-Réanimation-Médecine Périopératoire, CHU Rennes, Université Rennes, Rennes, France
| | - François Robin
- Service de Rhumatologie, CHU Rennes, Université Rennes, INSERM, U 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France
| | - Pierre Pottier
- Service de Médecine Interne et Immunologie Clinique, CHU Nantes, 1 Place Alexis-Ricordeau, 44000, Nantes, France
- Faculté de Médecine-Pôle Santé, Nantes Université, Nantes, France
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Stephens GC, Sarkar M, Lazarus MD. 'I was uncertain, but I was acting on it': A longitudinal qualitative study of medical students' responses to uncertainty. MEDICAL EDUCATION 2024; 58:869-879. [PMID: 37963570 DOI: 10.1111/medu.15269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Uncertainty is ubiquitous within medical practice. Accordingly, how individuals respond to uncertainty, termed uncertainty tolerance (UT), is increasingly considered a medical graduate competency. Despite this, aspects of the UT construct are debated, which may relate to research focused on measuring UT, rather than understanding students' experiences. Therefore, we asked (1) how do medical students describe their responses to uncertainty, (2) how (if at all) do described responses change over time and (3) how do described responses contribute to understanding the UT construct. METHODS Engaging an interpretivist worldview, we conducted a longitudinal qualitative study throughout 2020 with 41 clinical medical students at an Australian medical school. Participants completed reflective diary entries across six in-semester time-points (n = 41, 40, 39, 38, 37 and 35) and semi-structured interviews at the end of both semesters (n = 20 per semester). We analysed data using framework analysis. RESULTS Although participants communicated accepting health care uncertainties, described cognitive appraisals of uncertainty ranged from threatening (e.g. challenging credibility) to opportunistic (e.g. for learning and growth). Emotions in response to uncertainty were predominately described in negative terms, including worry and anxiety. Participants described a range of maladaptive and adaptive behavioural responses, including avoiding versus actively engaging with uncertainty. Despite describing typically negative emotions across time, participants' cognitive and behavioural response descriptions shifted from self-doubt and avoidance, towards acceptance of, and engagement despite uncertainty. CONCLUSIONS Students' descriptions of responses to uncertainty suggest existing UT conceptualisations may not holistically reflect medical students' experiences of what it means to be uncertainty 'tolerant', especially pertaining to conceptualisations of 'tolerance' centred on emotions (e.g. stress) rather than how uncertainty is ultimately managed. Extending from this study, the field could consider redefining characteristics of uncertainty 'tolerance' to focus on adaptive cognitive and behavioural responses, rather than emotional responses as key indicators of 'tolerance'.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education Director and Monash Centre for Scholarship in Health Education Deputy Director, Monash University, Clayton, Victoria, Australia
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Lazarus MD, Gouda-Vossos A, Ziebell A, Parasnis J, Mujumdar S, Brand G. Mapping Educational uncertainty stimuli to support health professions educators' in developing learner uncertainty tolerance. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10345-z. [PMID: 38869782 DOI: 10.1007/s10459-024-10345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/19/2024] [Indexed: 06/14/2024]
Abstract
Uncertainty is a feature of healthcare practice. In recognition of this, multiple health profession governing bodies identify uncertainty tolerance as a healthcare graduate attribute and evaluate uncertainty tolerance within new graduate cohorts. While it is clear that uncertainty tolerance development for healthcare learners is valued, gaps remain for practically addressing this within healthcare curricula. Guiding frameworks for practical approaches supporting uncertainty tolerance development in healthcare learners remains sparse, particularly outside of medicine and in certain geographical locations. As uncertainty tolerance is increasingly recognised as being, at least in part, state-based (e.g. contextually changeable)- a broader understanding of teaching practices supporting uncertainty tolerance development in diverse health professions is warranted. This study explored educators' teaching practices for purposefully stimulating learners' uncertainty tolerance. Semi-structured interviews investigated how academics at a single institution, from diverse fields and health professions, stimulate uncertainty across multiple learning contexts. Framework analysis identified three themes for stimulating uncertainty: Purposeful questioning, Forecasting uncertainty, and Placing learners in unfamiliar environments, with characterisation of these themes (and related subthemes) also described. Many of the identified themes align with aspects of existing learning theories suggesting that curricular frameworks supporting learner uncertainty tolerance development may be informed by theories beyond the boundaries of health professions education research.
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Affiliation(s)
- Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Amany Gouda-Vossos
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Angela Ziebell
- School of Life and Environmental Science, Deakin University, 221 Burwood Hwy, Burwood, Vic, 3125, Australia
| | - Jaai Parasnis
- Department of Economics, Monash University, Wellington Rd, Clayton, VIC, 3180, Australia
| | - Swati Mujumdar
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, Vic, 3180, Australia
| | - Gabrielle Brand
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
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Belhomme N, Lescoat A, Dion L, Pottier P, Triby E, Pelaccia T. The culture of doubt: Do medical students really experience clinical uncertainty when they should? MEDICAL TEACHER 2024:1-3. [PMID: 38460188 DOI: 10.1080/0142159x.2024.2323181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/11/2024]
Abstract
Uncertainty is a fundamental aspect of medical practice, necessitating incorporation into undergraduate medical training. The integrative model of uncertainty tolerance (UT) developed by Hillen and Han serves as a comprehensive framework for exploring clinical uncertainty. While studies have extensively examined UT dimensions, including sources, responses, and moderators, the factors influencing the perception of uncertainty stimuli remain underexplored. However, students' ability to perceive uncertainty and their approach to uncertain stimuli play a crucial role in enabling them to develop adaptive responses to uncertainty, necessary for their comfort in these situations. Defining uncertainty as a metacognitive state suggests significant variability in its perception among individuals and within an individual over time. Moreover, several studies have demonstrated the substantial influence of various individual and contextual factors on how individuals perceive and respond to uncertainty. In this paper, the authors present multiple hypotheses to address the question of whether students genuinely perceive uncertainty stimuli when they should. The authors argue that students' personal relationship with their knowledge is essential in their ability to identify clinical uncertainty, particularly concerning the limits of medical knowledge. Therefore, they propose that an academic culture fostering doubt, through exposing students to a variety of perspectives, would enhance their ability to identify uncertainty zones in a clinical situation at an early stage. Drawing on Dewey's situational theory, the authors emphasize the importance of better understanding, in a work setting, the influence of contextual and situational characteristics on individual perceptions of uncertainty. In line with this idea, ethnographic studies would offer valuable insights into identifying the relationship between the students, their work environment, and their perception of clinical uncertainty.
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Affiliation(s)
- N Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - A Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Rennes, France
| | - L Dion
- Service de Gynécologie, CHU Rennes Hôpital Sud, Rennes, France
- Irset - Inserm UMR_S 1085, Rennes, France
| | - P Pottier
- Service de Médecine Interne et Immunologie Clinique, CHU Nantes, Nantes, France
- Faculté de Médecine-Pôle Santé, Nantes Université, Nantes, France
| | - E Triby
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
| | - T Pelaccia
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication, LISEC_UR2310, Université de Strasbourg, Strasbourg, France
- Service d'Urgences (SAMU 67), CHU Strasbourg, Strasbourg, France
- Centre de Formation et de Recherche en Pédagogie des Sciences de la Santé, faculté de Médecine, Université de Strasbourg, Strasbourg, France
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Schroeder H, Shacham A, Amar S, Weissman C, Schroeder JE. Comparison of medical students' considerations in choosing a specialty: 2020 vs. 2009/10. HUMAN RESOURCES FOR HEALTH 2024; 22:5. [PMID: 38191435 PMCID: PMC10773044 DOI: 10.1186/s12960-023-00885-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Workforce shortage in healthcare and particularly in physicians poses a threat to healthcare delivery and its quality. In comparison to other OECD countries, Israel currently has a small number of medical graduates relative to its number of physicians, naturally emphasizing the importance of ensuring that this population chooses to remain in medicine. Understanding what is most important to medical students can help improve working conditions in residency. Such information is particularly needed to facilitate policy planning that will encourage the next generation of physicians to specialize in medical fields that are experiencing shortages. We hypothesized that between 2009/2010 and 2020, there were significant changes in medical students' preferences regarding their considerations for choosing a medical specialty. METHODS We compared cross-sectional data from questionnaire-based surveys of 5th year medical students performed in 2009-2010 and 2020 at two Israeli universities. RESULTS Of the 335 medical students who responded (237 and 98 in 2009/2010 and 2020, respectively) those in 2020 were 2.26 less likely vs. those in 2009/2010, to choose a residency for its high-paying potential (P < 0.05), and had significantly more interest in residencies with greater teaching opportunity (98.8% vs 82.9%, P < 0.05), increased responsibility and chances to make clinical decisions on their own (67.9% vs 51.6%, P < 0.05). Criteria important to both the 2009/2010 and 2020 students were choosing a bedside specialty (70.2%vs 67.9%, NS), and an interesting and challenging specialty (95.2%v s 91.3%, NS). CONCLUSIONS These results partially supported our hypothesis that medical students' preferences have changed over the years, though there are fundamental factors that apparently reflect medical students' nature that do not change over time.
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Affiliation(s)
- Hanna Schroeder
- Policy Planning Division at the Israel Ministry of Health, Jerusalem, Israel.
- Henrietta Szold School of Nursing, Hebrew University - Hadassah Faculty of Medicine, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Alon Shacham
- Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shimon Amar
- Joyce and Irving Goldman School of Medicine and Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Charles Weissman
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Josh E Schroeder
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Gormley GJ, Carr D, Murphy P, Tallentire VR, Smith SE. Unlocking the learning potential of simulation-based education. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 38153022 DOI: 10.12968/hmed.2023.0353] [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] [Indexed: 12/29/2023]
Abstract
Simulation is ubiquitous in the training of hospital-based doctors worldwide, often focusing on an individual level in traditional 'skills and drills'-based training. However, there has been an expansion in the use of simulation in healthcare practice and training. Simulation is being adopted into many disciplines that traditionally have not used this form of experiential learning. Moreover, simulation is increasingly being harnessed to enhance team and organisational learning in hospital-based practice. This article shares some insights into simulation-based education and makes the 'familiar unfamiliar' about this important method of learning. The aim is to broaden readers' outlook about what simulation has to offer beyond the classic notion of skills and drills-based training.
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Affiliation(s)
- Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- InterSim, Faculty of Medicine, Health and Life Sciences, Queens' University Belfast, Belfast, UK
| | - Davina Carr
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Paul Murphy
- Drama Studies, School of Arts, English and Languages, Queen's University Belfast, Belfast, UK
| | | | - Samantha E Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
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Stephens GC, Lazarus MD, Sarkar M, Karim MN, Wilson AB. Identifying validity evidence for uncertainty tolerance scales: A systematic review. MEDICAL EDUCATION 2023; 57:844-856. [PMID: 36576391 DOI: 10.1111/medu.15014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Uncertainty tolerance (UT) is increasingly valued as a medical graduate attribute and broadly measured among medical student populations. However, the validity evidence underpinning UT scale implementation has not been summarised across studies. The present work evaluates UT scale validity evidence to better inform when, why and how UT scales ought to be used and to identify remaining validity evidence gaps. METHODS A literature search for psychometric studies of UT scales was completed in 2022. Records were included if they implemented one of the four most cited UT scales (i.e. Physicians' Reactions to Uncertainty scale 1990 [PRU1990] or 1995 [PRU1995], Tolerance for Ambiguity [TFA] scale or Tolerance of Ambiguity in Medical Students and Doctors scale [TAMSAD]) in a population of physicians and/or medial students and presented validity evidence according to the Standards for Educational and Psychological Testing framework. Included studies were rated and analysed according to evidence for test content, response processes, internal structure, relations to other variables and consequences of testing. RESULTS Among the investigated scales, 'relations to other variables' and 'internal structure' were the most commonly reported forms of validity evidence. No evidence of 'response processes' or 'consequences of testing' was identified. Overall, the PRU1990 and PRU1995 demonstrated the strongest validity evidence, although evidence primarily related to physician populations. CONCLUSIONS None of the studied scales demonstrated evidence for all five sources of validity. Future research would benefit from assessing validity evidence for 'response processes' and 'consequences of testing' among physicians and medical students at different training/career stages to better understand UT construct conceptualisation in these populations. Until further and stronger validity evidence for UT scales is established, we caution against implementing UT scales outside of research settings (e.g. for higher stakes decision making).
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education Director and Monash Centre for Scholarship in Health Education Curriculum Integration Lead, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - M Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam B Wilson
- Department of Anatomy and Cell Biology, Rush University, Chicago, Illinois, USA
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Lee C, Hall KH, Anakin M. Finding Themselves, Their Place, Their Way: Uncertainties Identified by Medical Students. TEACHING AND LEARNING IN MEDICINE 2023:1-11. [PMID: 37435723 DOI: 10.1080/10401334.2023.2233003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/19/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
Phenomenon: Navigating uncertainty is a core skill when practicing medicine. Increasingly, the need to better prepare medical students for uncertainty has been recognized. Our current understanding of medical students' perspectives on uncertainty is primarily based on quantitative studies with limited qualitative research having been performed to date. We need to know from where and how sources of uncertainty can arise so that educators can better support medical students learning to respond to uncertainty. This research's aim was to describe the sources of uncertainty that medical students identify in their education. Approach: Informed by our previously published framework of clinical uncertainty, we designed and distributed a survey to second, fourth-, and sixth-year medical students at the University of Otago, Aotearoa New Zealand. Between February and May 2019, 716 medical students were invited to identify sources of uncertainty encountered in their education to date. We used reflexive thematic analysis to analyze responses. Findings: Four-hundred-sixty-five participants completed the survey (65% response rate). We identified three major sources of uncertainty: insecurities, role confusion, and navigating learning environments. Insecurities related to students' doubts about knowledge and capabilities, which were magnified by comparing themselves to peers. Role confusion impacted upon students' ability to learn, meet the expectations of others, and contribute to patient care. Navigating the educational, social, and cultural features of clinical and non-clinical learning environments resulted in uncertainty as students faced new environments, hierarchies, and identified challenges with speaking up. Insights: This study provides an in-depth understanding of the wide range of sources of medical students' uncertainties, encompassing how they see themselves, their roles, and their interactions with their learning environments. These results enhance our theoretical understanding of the complexity of uncertainty in medical education. Insights from this research can be applied by educators to better support students develop the skills to respond to a core element of medical practice.
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Affiliation(s)
- Ciara Lee
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Katherine Helen Hall
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Megan Anakin
- Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Riboldi I, Capogrosso CA, Piacenti S, Calabrese A, Lucini Paioni S, Bartoli F, Crocamo C, Carrà G, Armes J, Taylor C. Mental Health and COVID-19 in University Students: Findings from a Qualitative, Comparative Study in Italy and the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4071. [PMID: 36901083 PMCID: PMC10001873 DOI: 10.3390/ijerph20054071] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION COVID-19 restrictions introduced several changes in university academic and social experience. Self-isolation and online teaching have amplified students' mental health vulnerability. Thus, we aimed to explore feelings and perspectives about the impact of the pandemic on mental health, comparing students from Italy and the UK. METHODS Data were collected from the qualitative portion of "the CAMPUS study", longitudinally assessing mental health of students at the University of Milano-Bicocca (Italy) and the University of Surrey (UK). We conducted in-depth interviews and thematically analysed the transcripts. RESULTS The explanatory model was developed from four themes identified across 33 interviews: anxiety exacerbated by COVID-19; putative mechanisms leading to poor mental health; the most vulnerable subgroups; and coping strategies. Generalised and social anxiety resulted from COVID-19 restrictions by being associated with loneliness, excessive time online, unhealthy management of time and space and poor communication with the university. Freshers, international students, and people on the extremes of the introversion/extroversion spectrum, were identified as vulnerable, while effective coping strategies included taking advantage of free time, connection with family and mental health support. The impact of COVID-19 was mostly related to academic issues by students from Italy, whereas to the drastic loss of social connectedness by the UK sample. CONCLUSIONS Mental health support for students has an essential role, and measures that encourage communication and social connectedness are likely to be beneficial.
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Affiliation(s)
- Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | | | - Susanna Piacenti
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Susanna Lucini Paioni
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
| | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
| | - Cath Taylor
- Faculty of Health and Medical Sciences, School of Health and Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK
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Moffett J, Cassidy D, Collins N, Illing J, de Carvalho Filho MA, Bok H. Exploring Medical Students' Learning Around Uncertainty Management Using a Digital Educational Escape Room: A Design-based Research Approach. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:86-98. [PMID: 36969324 PMCID: PMC10038110 DOI: 10.5334/pme.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
Introduction Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement. Methods We used design-based research to explore the design, build, and test of a DEER, as well as gain insight into how these novel learning environments work, using Community of Inquiry (CoI) as a guiding conceptual framework. This study represented a mixed methods pilot test of a prototype DEER. Twenty-two medical students agreed to participate, and data were collected through qualitative (i.e., focus groups, game-play observations) and quantitative (i.e., questionnaires) methods. Results Eighty-two per cent of participants agreed or strongly agreed that the DEER supported their learning around uncertainty. Participants offered diverse examples of how the game had facilitated new insights on, and approaches to, uncertainty. With respect to the learning environment, multiple indicators and examples of the three domains of CoI - cognitive, teaching and social presence - were observed. Discussion Our findings suggested that DEERs offer a valuable online learning environment for students to engage with complex and emotion-provoking challenges, such as those experienced at transitions. The study also suggested that CoI can be applied to the design, implementation, and evaluation of DEER learning environments, and we have proposed a set of design principles that may offer guidance here.
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Affiliation(s)
- Jenny Moffett
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Dara Cassidy
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Naoise Collins
- Department of Visual and Human-Centred Computing, Dundalk Institute of Technology, Dublin Rd, Marshes Upper, Dundalk, Ireland
| | - Jan Illing
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Marco Antonio de Carvalho Filho
- Wenckebach Institute, Health Profession Education Research, Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Bok
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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14
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Richmond A. The chicken and the egg: Clinical reasoning and uncertainty tolerance. MEDICAL EDUCATION 2022; 56:696-698. [PMID: 35467035 PMCID: PMC9324099 DOI: 10.1111/medu.14814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 06/14/2023]
Abstract
Richmond aruges that clinical reasoning and uncertainty tolerance development occur simultaneously and that deficit in either domain will affect the development of the other. Implications for curriculum design are offered.
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Affiliation(s)
- Anna Richmond
- Department of Medical EducationUniversity of NottinghamNottinghamUK
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15
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Stephens GC, Sarkar M, Lazarus MD. Medical Student Experiences of Uncertainty Tolerance Moderators: A Longitudinal Qualitative Study. Front Med (Lausanne) 2022; 9:864141. [PMID: 35547203 PMCID: PMC9083353 DOI: 10.3389/fmed.2022.864141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Uncertainty tolerance (UT), a construct explicating individuals' response to perceived uncertainty, is increasingly considered a competency for effective medical practice. Lower UT among physicians is linked with negative outcomes, including less favorable attitudes toward patient-centered care, and increased burnout risk. Despite decades of research, as yet few have engaged methodological approaches aiming to understand the factors that may influence medical students' UT (so-called moderators). Such knowledge, though, could inform teaching practices for fostering learners' skills for managing uncertainties. Accordingly, we asked “What factors do medical students in their clinical years perceive as moderating their perceptions of, and responses to, uncertainty?” Methods We conducted a qualitative study with forty-one medical students in clinical years at an Australian medical school, with data collected throughout 2020. Participants described their experiences of uncertainty through both in-semester reflective diary entries (n = 230) and end of semester group or individual semi-structured interviews (n = 40). Data were analyzed using a team-based framework analysis approach. Results Four major themes of UT moderators were identified: (1) Individual factors, (2) Sociocultural factors, (3) Academic factors and (4) Reflective learning. Aspects of individual, sociocultural and academic factors were perceived as having either positive or negative influences on students' perceptions of uncertainty. By contrast, reflective learning was described as having a predominantly positive influence on students' perceptions of uncertainty, with students noting learning opportunities and personal growth afforded through uncertain experiences. Conclusions As healthcare becomes increasingly complex, a future challenge is equipping our medical students with strategies and skills to manage uncertainties. Our study identified multiple moderators of medical students' UT, key among them being reflective learning. We also identified UT moderators that contemporary and future medical educators may be able to harness in order to develop learner UT as a healthcare graduate attribute, especially through teaching practices such as intellectual candor. Further research is now required to evaluate the impact of proposed educational interventions, and to develop effective assessments of students' skills for managing clinical uncertainties.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, Australia.,Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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