Professional Identity Development Through Service Learning: A Qualitative Study of First-Year Medical Students Volunteering at a Medical Specialty Camp

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

INTRODUCTION

Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore.

METHODS

A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used.

RESULTS

A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms.

CONCLUSION

The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.

National survey of educational impact on pharmacy learners by volunteering at camps for children with diabetes

INTRODUCTION

Current literature on pharmacy students' and residents' experience attending camps for children with diabetes focuses on the experience at an individual campsite. The objective of this study was to examine the demographics and gains in understanding that pharmacy learners achieve when volunteering as medical staff at camps for children with type 1 diabetes (T1D).

METHODS

National listservs were used to identify pharmacists who precept pharmacy students and residents at diabetes camps. These self-identified pharmacists shared pre- and post-camp electronic surveys with their respective pharmacy learners. Statistical analysis was completed using SPSS Version 25 (IBM, Corp.).

RESULTS

Eighty-six pharmacy learners completed the pre-camp survey and 69 completed the post-camp survey. Most were Caucasian, in their fourth professional year, and participated in residential camps that lasted six and one-half days on average. Learners consistently engaged in patient care activities including: carbohydrate counting (87%), bolus insulin dose calculations (86%), treatment of hypo/hyperglycemic episodes (86%), blood glucose testing (83%), blood sugar trend evaluation (78%), basal insulin dosing calculations (74%), and insulin pump site changes (72%). Learners demonstrated statistically significant gains in every index measured with the exception of glucometer use. Eighty-seven percent indicated they learned how to appropriately manage T1D, 37% gained empathy for those living with T1D, and 13% learned how to work in a medical team.

CONCLUSIONS

Pharmacy learners who volunteered at diabetes camps experienced large gains in their understanding of concepts and devices, comfort with performing patient care tasks, and compassion for children and their families living with T1D.

"I loved it, absolutely loved it" a qualitative study exploring what student podiatrists learn volunteering as part of an interprofessional medical team at a marathon

BACKGROUND

Final year podiatry students volunteer annually as part of the wider interprofessional medical team at both the Brighton and London Marathon race events, supervised by qualified podiatrists, allied health professionals and physicians. Volunteering has been reported to be a positive experience for all participants and a way of developing a range of professional, transferable, and where appropriate, clinical skills. We sought to explore the lived experience of 25 students who volunteered at one of these events and aimed to: i) examine the experiential learning reported by students while volunteering in a dynamic and demanding clinical field environment; ii) determine whether there were elements of learning that could be translated to the traditional teaching environment in a pre-registration podiatry course.

METHODS

A qualitative design framework informed by the principles of interpretative phenomenological analysis, was adopted to explore this topic. We used IPA principles to enable analysis of four focus groups over a two-year period to generate findings. Focus group conversations were led by an external researcher, recorded, independently transcribed verbatim and anonymised prior to analysis by two different researchers. To enhance credibility, data analysis was followed by independent verification of themes, in addition to respondent validation.

RESULTS

In total, five themes were identified: i) a new inter-professional working environment, ii) identification of unexpected psychosocial challenges, iii) the rigors of a non-clinical environment, iv) clinical skill development, and v) learning in an interprofessional team. Throughout the focus group conversations, a range of positive and negative experiences were reported by the students. This volunteering opportunity fills a gap in learning as perceived by students, particularly around developing clinical skills and interprofessional working. However, the sometimes-frantic nature of a Marathon race event can both facilitate and impede learning. To maximize learning opportunities, particularly in the interprofessional environment, preparing students for new or different clinical settings remains a considerable challenge.

Potential of Volunteering in Formal and Informal Medical Education-A Theory-Driven Cross-Sectional Study with Example of the COVID-19 Pandemic

Students' volunteering is an effective way to manage health crises, including pandemics. Due to the limited capacity of the healthcare system at the time of the COVID-19 outbreak, the engagement of students in volunteering services seemed invaluable. Based on different teaching-learning theories, in this survey study, we aimed to evaluate the potential of the volunteering service project launched by the Poznan University of Medical Sciences during the COVID-19 pandemic as a learning opportunity for undergraduate healthcare students. The results indicate the potential of involving students in volunteering activities for educational purposes, as well as other values, including attitudes and professional identity development, which could be difficult to realize using traditional teaching methods. However, stimulating students' reflectiveness seems necessary to reach its full educational effectiveness. Medical teachers should provide students with more opportunities for volunteering and service learning and consider making these a constant element of the curriculum beyond the COVID-19 pandemic.

Motivation to Impact: Medical Student Volunteerism in the COVID 19 Pandemic

OBJECTIVE

Volunteerism represents an important mechanism to promote resilience, empathy, and general well-being in medical students, a group that stands to benefit. Medical students report feelings of fatigue, burnout, exhaustion, and stress that correlates with poor academic performance, and significant decline in empathy over the 3^rd year of both MD and DO programs. Volunteer motivations have been shown to mediate participant well-being. The relationship between medical student volunteer motivations and specific outcomes during the COVID-19 pandemic has not been addressed.

METHODS

We characterized features of medical student volunteers during the COVID-19 pandemic in 2020, including volunteering motivation using the Volunteer Functions Inventory, the types of activities in which they participated, and the physical, psychosocial, and emotional outcomes they experienced following volunteering.

RESULTS

Altruistic and humanitarian values-centric motivation predicts positive volunteering outcomes including increased resilience, ability to deal with disappointment and loss, and ability to cope with the COVID-19 pandemic. Values-centric motivation also increases volunteer empathy independent of educational stage. Values-centric participants were more likely to select volunteering activities with patient contact, which promotes student empathy and resilience. Conversely, career-centric motivation does not predict positive outcomes. These students are more likely to engage in research-oriented activities.

CONCLUSIONS

The efficacy of integrating volunteerism into medical school curricula may be limited by professional pressure that manifests as career-oriented motivation. We propose that practical integration should promote altruistic and humanitarian values-centric participant orientation to the volunteering process, which is associated with enhanced recruitment, preservation of empathy, and additional positive volunteering outcomes of interest.

Service-Learning Programs and Projects for Medical Students Engaged With the Community

Introduction

The medical school curriculum has changed from using the term “pedagogy” to framing adult learning theories with the goal of applying knowledge to a clinical situation or real-life experiences. Service-learning programs (SLPs) in medical schools illustrate one of several adult learning principles and practices now used in today’s curriculum that better prepare medical students for working with a variety of patients. 

Objective

The researchers’ aim was to assess medical students’ learning experiences while participating with nonprofit organizations during a curricula-designed SLP.

Method

The authors analyzed 60 reflective essays over a three-year academic period from 192 medical students placed in teams of two to four. A qualitative study with a thematic analysis research design was employed in our study. This iterative approach allowed the researchers to identify themes and interpret meaning. The study was completed in 2020 using data from 2017-2020.

Results

Four major themes and one overarching theme emerged that reflect adult learning theories including: (1) transfer learning of one’s skills and knowledge to community and practice; (2) articulate a variety of ways to communicate with multiple, diverse community audiences; (3) employ a creative process for quality improvement strategies; (4) create positive trusting and rewarding relationships that highlight an enhanced level of conduct and professionalism. An overarching theme found was: collaboration emerges almost without forethought. Medical educators may find that replicating this SLP into the curriculum infrastructure provides agency and student buy-in. We established an SLP as part of the medical school curriculum that brings privilege and reward to students and to the community. Reflection provides for meaningfulness from SLP and helps students identify how experiential learning affects their professional development as members of the community and future health care providers.

Conclusion

Implementing SLPs into any medical school curriculum strengthens the adult learning theoretical delivery approach. Disseminating projects and lessons learned to and from the community also showcases experiential learning opportunities for medical students and other professionals. Many aspects of awareness from the medical students’ engagement during the SLP emerged. They learned about specific aspects of community engagement and found it a privilege to give and take many lessons from the experiences and opportunities.

A Scoping Review of Professional Identity Formation in Undergraduate Medical Education

BACKGROUND

Professional identity formation (PIF) in medical students is a multifactorial phenomenon, shaped by ways that clinical and non-clinical experiences, expectations and environmental factors merge with individual values, beliefs and obligations. The relationship between students' evolving professional identity and self-identity or personhood remains ill-defined, making it challenging for medical schools to support PIF systematically and strategically. Primarily, to capture prevailing literature on PIF in medical school education, and secondarily, to ascertain how PIF influences on medical students may be viewed through the lens of the ring theory of personhood (RToP) and to identify ways that medical schools support PIF.

METHODS

A systematic scoping review was conducted using the systematic evidence-based approach. Articles published between 1 January 2000 and 1 July 2020 related to PIF in medical students were searched using PubMed, Embase, PsycINFO, ERIC and Scopus. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. Concurrent thematic and directed content analyses were used to evaluate the data.

RESULTS

A total of 10443 abstracts were identified, 272 full-text articles evaluated, and 76 articles included. Thematic and directed content analyses revealed similar themes and categories as follows: characteristics of PIF in relation to professionalism, role of socialization in PIF, PIF enablers and barriers, and medical school approaches to supporting PIF.

DISCUSSION

PIF involves iterative construction, deconstruction and inculcation of professional beliefs, values and behaviours into a pre-existent identity. Through the lens of RToP, factors were elucidated that promote or hinder students' identity development on individual, relational or societal levels. If inadequately or inappropriately supported, enabling factors become barriers to PIF. Medical schools employ an all-encompassing approach to support PIF, illuminating the need for distinct and deliberate longitudinal monitoring and mentoring to foster students' balanced integration of personal and professional identities over time.

Empathy in MedicineCultivating an Empathetic Professional Identity in Osteopathic Medical Students Through Service Learning: A Qualitative Analysis of Reflective Essays

Context

The role of professional identity development has been established as a significant element of the "hidden curriculum" in medical education. While most programs do not contain explicit instruction on that topic, service learning initiatives are a popular trend in medical education that offer medical students early clinical experience and an opportunity to develop professional identity. Through intentional reflective practices, service learning can also promote empathy development, a critical component missing from current models.

Objective

To determine the role of service learning participation on the development of empathy and professional identity among osteopathic medical students.

Methods

Using a grounded theory method, the authors analyzed reflective essays from students who voluntarily participated in a service learning project that provided medical care to patients who are homeless. Essays were completed within 1 week of volunteer experience.

Results

The authors collected and analyzed 64 reflective essays from 55 students in this study. A review of the 64 texts yielded 5 coding domains and several subdomains. The codes revealed 4 major themes: (1) incoming attitudes, (2) transformative experiences, (3) empathy development, and (4) professional identity formation.

Conclusions

Structured service learning experiences provide students with an opportunity to develop an empathetic professional identity in the preclinical stage of medical education. This form of volunteer service is a transformative experience that challenges students' incoming perceptions and leads to the development of both empathy and professional identity.

Medical students as service learners: opportunities, risks and recommendations

Service learning is a form of experiential education that is being implemented internationally within undergraduate primary care, with the potential to significantly enhance clinical practice whilst simultaneously facilitating medical students' learning. Though the benefits of service learning are widely acknowledged within the literature, there is little documentation of the associated challenges. Drawing on reflections from our own practice, and those of colleagues from a variety of institutions across the UK, we propose four key areas of risk associated with the integration of service learning into undergraduate medical education: unsafe encounters, patient disempowerment, inequality of experience and misalignment of service and learning priorities. Considering each area in turn, we identify contributory factors alongside practical recommendations to mitigate these risks. Acknowledgement of this subject is timely as medical schools develop their curricula to reflect evolving service and patient priorities in light of the COVID-19 pandemic. We aim to encourage discussion and debate amongst the medical education community at a time where emphasis is being increasingly placed on medical students as being active participants in the delivery of patient care. In doing so, faculty may reduce associated risks and maximise the benefit of opportunities for all stakeholders.

Nursing Home Education During the COVID-19 Pandemic

OBJECTIVE

To help older adults living in nursing homes (NHs) while educating medical and physician assistant (MD/PA) students during the COVID-19 pandemic.

METHODS

Using a multicomponent iterative process, we piloted multiple student led service-learning projects in 2 NHs and 1 hospice agency in the Midwest. Pre-post online student surveys were completed to match student interests with facility needs and to assess learning and obtain feedback regarding their experiences.

RESULTS

All 12 interested students completed the initial survey; n = 23 ultimately volunteered (word of mouth); n = 11 (48%) completed the follow-up survey. Opportunities were medical record transfer, grounds beautification, resident biographies, window entertainment, and No-One-Dies-Alone program. Students averaged 9.2 volunteer hours; stated the opportunities were enjoyable, clinically applicable, and socially distanced; and reported learning about unique experiences of older adults in NHs.

DISCUSSION

Despite limitations created by the pandemic, mutually beneficial and safe opportunities remain for education in the NH setting.

Beyond simulation - Extracurricular volunteering in nursing education: A focus group

BACKGROUND

A reduction in clinical placement hours has seen alternative teaching methods being explored in nursing education in Australia. The use of simulated patients in academic laboratories is highly utilised, however, may still be limiting learning opportunities.

OBJECTIVE

The objective of this research was to describe the learning experiences of nursing students who participated in supervised extracurricular, volunteering opportunities during their nursing studies.

DESIGN

A descriptive qualitative design was used to discover and understand learning experiences of a volunteering encounter, described from the nursing student perspective.

SETTING

The Pit Stop men's health check program is a collaboration of local health organisations, volunteering their time to provide free health checks at a farming Field Day event in regional Victoria, Australia.

PARTICIPANTS

Twelve second year undergraduate nursing students volunteered at the 2019 Pit Stop event, over a four day period and outside their normal study requirements. Seven volunteers then participated in post event research, sharing experiences and providing feedback.

METHODS

One semi-structured focus group interview was conducted at University campus, using reflective and open ended questioning. Interviews were audio recorded and transcribed. Thematic analysis identified common themes.

RESULTS

Students unanimously recommended the real life learning experiences and reported an increased confidence and competence in basic communication and clinical skills, not always provided in the simulated environment of the academic laboratory. Their motivation to attend was driven by wanting more real life contact with patients, having time to practice skills and experience diversity within their practice. Students also recommended future volunteering ideas that would potentially provide additional learning opportunities.

CONCLUSIONS

Experiential learning such as simulation is highly valued in current nursing education, however, students still crave the real life learning experiences from working with human patients. With limited clinical exposure currently offered to students within nursing education programs, additional opportunities such as supervised volunteering may be worth considering when preparing confident and competent nurse graduates.

Teaching the affective domain in community-based medical education: A scoping review

Background: The affective domain is one of the essential areas in the assessment of the learning outcomes of medical students, apart from the cognitive and psychomotor domains. Community-based medical education (CBME) is a common instructional program for medical students in learning about these domains. However, preceptors and researchers pay less attention to the affective domain as compared to the other two learning domains.Aim: To describe the state of the literature on teaching the affective domain through CBME and to develop an initial model for instructional purposes.Methods: A scoping review of the literature was conducted. Out of the 971 references initially retrieved, 22 published references were selected. Relevant data from these references were extracted and analyzed through thematic analysis.Results and Conclusion: The various affective outcomes of CBME in the literature are commonly taught through role modelling and mentoring, providing opportunity to apply knowledge, and immersing in local organizations and communities. However, these teaching strategies will be optimized through a structured and rigorous process of reflection. Reflection is central to the learning experience of medical students, especially that affective outcomes are commonly less apparent. The findings of this review resulted to a proposed initial model in teaching the affective domain in CBME.

How does medical education affect empathy and compassion in medical students? A meta-ethnography: BEME Guide No. 57

Background: Empathy and compassion are important in healthcare delivery, and are necessary qualities in medical students. Aims: To explore medical students', patients' and educators' perceptions of what affects empathy and the expression of compassion; and to address gaps in knowledge, attitudes and skills on how education affects empathy and the expression of compassion in medical students. Methods: The seven steps by Noblit and Hare were used for this meta-ethnography. Databases were searched for studies in English, published from 2007 to 2017 with outcomes of empathy and compassion. Key themes and concepts were identified, and accounts from the studies were used to build interpretations. Findings: Thirty-three qualitative studies were included and four main themes were derived: seeing the patient as a person; appreciating the elements of empathy and compassion; navigating in the training environment; and being guided by ideals. Interactions between the patient, the medical student and training environment which affect the development of empathy and compassion are illustrated in a conceptual model. Conclusions: This meta-ethnography extends our understanding of how medical education affects the expression of empathy and compassion in medical students. The results provide important considerations for medical educators and faculty developers in further developing and improving medical curricula.

Student pharmacists' service-oriented learning at a camp for children with type 1 diabetes mellitus

BACKGROUND AND PURPOSE

To describe advanced pharmacy practice experience (APPE) students' active learning engagement and changes in self-reported comfort with diabetes care activities by attending an overnight camp for children with type 1 diabetes mellitus (T1DM).

EDUCATIONAL ACTIVITY AND SETTING

Fourth-year pharmacy students spend one or two weeks at an overnight camp for children ages six to 18 years with T1DM as part of their APPE and assist with diabetes care activities while participating in daily living activities. Students complete a survey one week before and one week after camp where they self-report their comfort level performing 16 different diabetes-related tasks.

FINDINGS

Students (n = 21) participate in hands-on active learning while volunteering at a camp for children with diabetes. Before camp, 40-61% of students reported comfort with diabetes care activities related to pharmacotherapy, monitoring, and lifestyle management. After camp, the percent of students reporting comfort with these tasks increased to 78-96%. Specific items with greatest improvement were: when to monitor ketone levels (+79%), use of insulin pens and pumps (+64%), treatment of hypoglycemia (+50%), and carbohydrate counting (+50%).

SUMMARY

By attending and participating at an overnight camp for children with T1DM, APPE students self-report gain in comfort in performing many diabetes care-related tasks.

Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis

OBJECTIVE

Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions.

METHODS

The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles.

RESULTS

A total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles.

CONCLUSION

The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socio-economic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.

Several Ways Generation Z May Shape the Medical School Landscape

Just as medical colleges have adapted to the Millennial generation of students, a new generation is poised to enter as matriculants. Learner attributes of this generation, Generation Z, are in stark contrast to previous ones, but more than that, they provide new challenges that undergraduate universities are already facing. This article aims to highlight some of these challenges, including those relating to student counseling services, volunteering activities, learning environments, and learner perspectives. These challenges are framed and discussed within the context of medical education.

Interpersonal social responsibility model of service learning: A longitudinal study

BACKGROUND

Service-learning (SL) is commonly used in Occupational Therapy (OT) programs worldwide as a community placement educational strategy. However, most SL models are not clearly defined in terms of both methodology and learning outcomes.

OBJECTIVES

This longitudinal study explores a structured model of Service-Learning (Interpersonal Social Responsibility-Service Learning: ISR-SL) aimed towards the development of professional identity among OT students. Based on OT students experiences from the end of the course through later stages as mature students and professionals.

MATERIAL AND METHODS

A qualitative research design was used to explore the perceptions and experiences of 150 first, second, and third-year OT students and graduates who have participated in ISR-SL during their first academic year.

RESULTS

Our findings suggest that the structured, long-term relationship with a person with a disability in the natural environment, which is the core of the ISR-SL, allowed students to develop a professional identity based on seeing the person as a whole and recognizing his/her centrality in the therapeutic relationship.

CONCLUSIONS AND SIGNIFICANCE

This study suggests ISR-SL as future direction or next step for implementing SL in OT and other healthcare disciplines programs.

Volunteering as medical staff at a diabetes summer camp as a component of a pharmacy residency program

A number of summer camps across the country have been developed specifically for children with diabetes, most of whom would not be able to attend a traditional summer camp due to the extensive medical attention and scheduling considerations required to continually maintain appropriate glycemic control. These camps rely on the service of various medical practitioners to ensure the safety of the children. In addition to providing an important service to the campers, volunteering at such camps offers both personal and professional rewards for the practitioners. Furthermore, such experiences provide tremendous learning opportunities for medical trainees. However, while a limited number of articles were identified discussing the experience of nurses, physicians, and pharmacy students volunteering at diabetes camps, no such accounts from the perspective of pharmacy residents were found in the medical literature. This educational case report briefly describes the recent experience of ambulatory care pharmacy residents serving as diabetes camp medical staff.