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Kanwel S, Ma Z, Li M, Hussain A, Erum N, Ahmad S. The influence of hospital services on patient satisfaction in OPDs: evidence from the transition to a digital system in South Punjab, Pakistan. Health Res Policy Syst 2024; 22:93. [PMID: 39103868 DOI: 10.1186/s12961-024-01178-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Pakistani's health services delivery system has been rarely evaluated regarding patient satisfaction. This study examined the performance of the Pakistani health system from the perspective of doctor services (DS), digital payment system (DPS), nurses' services (NS), laboratory services (LS), pharmacy services (PHS), registration services (RS), physical services (environmentally and tangible) and doctor-patient communication (DPC) about patient satisfaction. A random sampling technique was adopted for data collection. METHODOLOGY The Social Science Statistical Package (SPSS), analysis of moment structures (AMOS), and structural equation modeling were used to analyze the data for reliability, validity, correlations, and descriptive findings. The 879 responses were used for study analysis. RESULTS The study revealed that patient satisfaction was found to be significantly affected positively by LS, PHS, DS, NS, and DPS, while DPC, RS, and PF were impacted non-significantly. Consequently, there is a considerable communication gap in the doctor-patient interaction, and Pakistan's healthcare system is confronted with a shortage of physical infrastructure and challenges in the digital system. CONCLUSION Furthermore, the insufficient emphasis on registration services necessitates immediate action to improve the entire patient experience and satisfaction. Identifying these shortcomings has the potential to result in a healthcare system that is more efficient and focused on the needs of the patients.
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Affiliation(s)
- Shahida Kanwel
- School of Management, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Zhiqiang Ma
- School of Management, Jiangsu University, Zhenjiang, 212013, People's Republic of China.
| | - Mingxing Li
- School of Management, Jiangsu University, Zhenjiang, 212013, People's Republic of China
| | - Abid Hussain
- School of Management, Jiangsu University, Zhenjiang, 212013, People's Republic of China.
| | - Naila Erum
- Accounting Research Institute (HiCOE), Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
| | - Saif Ahmad
- Department of Public Administration, The Islamia University, Bahawalpur, Pakistan
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Chang Chan AYC, van Leeuwen M, Custers E, Bleys R, Ten Cate O. Anatomy education in low-resourced countries: What are challenges and effective and affordable educational strategies? A qualitative study. MEDICAL TEACHER 2024:1-11. [PMID: 39096213 DOI: 10.1080/0142159x.2024.2383373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/18/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE With limited means, resource-deprived countries must find ways to organize education to meet standards. Few reports exist about anatomical education in LLMICs. This study explores how anatomy teaching is sustained in countries with few resources and which affordable educational strategies are applied to uphold quality. METHODS A mixed-methods study with anatomy teachers from public medical schools in low or lower-middle income countries (LLMICs) in Africa, Asia, Europe, and Latin-American was performed through survey via email combined with semi-structured online interview with teachers, exploring survey results at a deeper level. RESULTS LLMICs available to be surveyed, 13 and 8 were found to respond to a written survey and oral interview invitation, face significant teaching challenges, primarily due to lack of funds. These are faculty shortages (low salaries and high student-to-teacher ratio) and inadequate infrastructure (internet, electricity, poor classroom conditions). Solutions were associated with didactic strategies (social media, e-learning, image-based learning, applied anatomy), expanding teaching capacity with less qualified and part-time faculty, student-organized education, and self-financing (teaching resources subsidized by teachers and students). Which was triking was teacher commitment despite difficult circumstances. Teachers propose better faculty management, increased anatomy staff recruitment, and collaboration with other institutions. CONCLUSIONS Anatomical education in LLMIC is forced to adapt to the socio-economic context, rather than to trends in medical education worldwide. These adaptations are supported mainly by the teachers 'commitment.'
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Affiliation(s)
- Ana Yoe Cheng Chang Chan
- Independent, Formerly Department of Morphological Sciences, Faculty of Medical Sciences, National Autonomous University of Leon, Leon, Nicaragua
| | - Maarten van Leeuwen
- Independent, Formerly Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eugene Custers
- Faculty of Education Sciences, Open University, Heerlen, the Netherlands
| | - Ronald Bleys
- Anatomy Department, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olle Ten Cate
- Education Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Ramani S, Kusurkar RA, Lyon-Maris J, Pyörälä E, Rogers GD, Samarasekera DD, Taylor DCM, Ten Cate O. Mentorship in health professions education - an AMEE guide for mentors and mentees: AMEE Guide No. 167. MEDICAL TEACHER 2024; 46:999-1011. [PMID: 37909275 DOI: 10.1080/0142159x.2023.2273217] [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] [Indexed: 11/03/2023]
Abstract
This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.
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Affiliation(s)
- Subha Ramani
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rashmi A Kusurkar
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johnny Lyon-Maris
- GP Education Unit, University Hospitals Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Eeva Pyörälä
- Centre for University Teaching and Learning, University of Helsinki, Helsinki, Finland
| | - Gary D Rogers
- School of Medicine, Deakin University Faculty of Health, Waurn Ponds, Australia
| | | | - David C M Taylor
- Gulf Medical University, Ajman, United Arab Emirates
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Olle Ten Cate
- Centre for Research and Development of Education, UMC Utrecht, Utrecht, The Netherlands
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Hafferty FW, Hamstra SJ. Rethinking Informed Consent as an EPA in Surgery. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:824-827. [PMID: 38602892 DOI: 10.1097/acm.0000000000005735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
ABSTRACT Over the past decade, entrustable professional activities (EPAs) have become an important element in the competency-based medical education movement. In this Commentary, the authors explore informed consent as an EPA within resident surgical training. In doing so, they foreground the concept of culture and reexamine the nature of trust and entrustment decisions from within a cultural framework. The authors identify role modeling and professional identity formation as core elements in the training process and suggest that faculty are sometimes better off using these tools than uncritically adopting a formal EPA framework for what is, in essence, a professionally oriented and values-based moral enterprise. They conclude that EPAs work best when they are developed at a local level, stressing the unique culture of specialty and program as well as the care that must be taken when attempting to transfer notions of entrustment from the undergraduate medical education level to graduate medical education settings.
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Ryan MS, Gielissen KA, Shin D, Perera RA, Gusic M, Ferenchick G, Ownby A, Cutrer WB, Obeso V, Santen SA. How well do workplace-based assessments support summative entrustment decisions? A multi-institutional generalisability study. MEDICAL EDUCATION 2024; 58:825-837. [PMID: 38167833 DOI: 10.1111/medu.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Assessment of the Core Entrustable Professional Activities for Entering Residency requires direct observation through workplace-based assessments (WBAs). Single-institution studies have demonstrated mixed findings regarding the reliability of WBAs developed to measure student progression towards entrustment. Factors such as faculty development, rater engagement and scale selection have been suggested to improve reliability. The purpose of this investigation was to conduct a multi-institutional generalisability study to determine the influence of specific factors on reliability of WBAs. METHODS The authors analysed WBA data obtained for clerkship-level students across seven institutions from 2018 to 2020. Institutions implemented a variety of strategies including selection of designated assessors, altered scales and different EPAs. Data were aggregated by these factors. Generalisability theory was then used to examine the internal structure validity evidence of the data. An unbalanced cross-classified random-effects model was used to decompose variance components. A phi coefficient of >0.7 was used as threshold for acceptable reliability. RESULTS Data from 53 565 WBAs were analysed, and a total of 77 generalisability studies were performed. Most data came from EPAs 1 (n = 17 118, 32%) 2 (n = 10 237, 19.1%), and 6 (n = 6000, 18.5%). Low variance attributed to the learner (<10%) was found for most (59/77, 76%) analyses, resulting in a relatively large number of observations required for reasonable reliability (range = 3 to >560, median = 60). Factors such as DA, scale or EPA were not consistently associated with improved reliability. CONCLUSION The results from this study describe relatively low reliability in the WBAs obtained across seven sites. Generalisability for these instruments may be less dependent on factors such as faculty development, rater engagement or scale selection. When used for formative feedback, data from these instruments may be useful. However, such instruments do not consistently provide reasonable reliability to justify their use in high-stakes summative entrustment decisions.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Katherine A Gielissen
- Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dongho Shin
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Robert A Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Maryellen Gusic
- Departments of Pediatrics, Biomedical Education and Data Science, Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gary Ferenchick
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Allison Ownby
- McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - William B Cutrer
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Vivian Obeso
- Department of Medical Education, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sally A Santen
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Emergency Medicine and Medical Education at University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Boudreau D, Fuks A. Transformations in medical education: A prudential perspective. HEALTH CARE SCIENCE 2024; 3:73-77. [PMID: 38939616 PMCID: PMC11080854 DOI: 10.1002/hcs2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Donald Boudreau
- Faculty of Medicine and Health SciencesInstitute of Health Sciences EducationMcGill UniversityMontrealQuébecCanada
| | - Abraham Fuks
- Department of MedicineFaculty of Medicine and Health SciencesMcGill UniversityMontrealQuébecCanada
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Pusic M, Crampton PES, Eva KW. Embracing the future: Technological developments and sustainability in health professional education. MEDICAL EDUCATION 2024; 58:2-4. [PMID: 37860920 DOI: 10.1111/medu.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
Pusic, Crampton, and Eva announce the release of Medical Education's 15th annual State of the Science issue: Embracing the Future
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Affiliation(s)
- Martin Pusic
- Harvard University, Cambridge, Massachusetts, USA
| | | | - Kevin W Eva
- The University of British Columbia, Vancouver, Canada
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Born MP, Stegers-Jager KM. Contemplating the future of competency assessment. MEDICAL EDUCATION 2024; 58:17-19. [PMID: 37984843 DOI: 10.1111/medu.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
Health education's competency models are evolving to balance universal skills with those that are job‐ and organization‐specific. These authors argue that a three‐layer framework emphasizing person‐organization fit will create better outcomes.
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Affiliation(s)
- Marise Ph Born
- Department of Pyschology, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Optentia and Faculty of Economic and Management Sciences North-West University, Potchefstroom, South Africa
| | - Karen M Stegers-Jager
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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