Defining Learning Communities in Undergraduate Medical Education: A National Study

How do medical students' expectations shape their experiences of well-being programmes?

INTRODUCTION

Medical schools have a duty of care to support their students' health and well-being. Student support studies have tended to focus on outcomes in respect of effectiveness and satisfaction. In contrast, little is known about how student expectations of support may shape their experiences and engagement with support mechanisms, as well as the relationships students have with those offering support (including the institution itself). To address this gap in knowledge, we explore how medical students' expectations of student support systems shape, and are shaped by, institutional rules and processes.

METHODS

We employed a qualitative case study approach using an institutional ethnography informed methodology. Our context was a medical school that provides a well-advertised, formal institutional support system where students are assigned a personal tutor. Data collection included interviews with medical students (n = 13) plus document analysis (public facing artefacts and internal policies/guidelines related to the support system). We applied the lens of psychological contract theory to guide abductive analysis of interview and text data.

RESULTS

Students expected a strong support system to be provided by the medical school and the personal tutors. However, their experiences did not always align with their expectations. Some felt excluded by the system while others regarded the relationship with their personal tutor as more transactional than relational. Where their expectations were unmet, students responded by reducing their engagement with the formal support system and creating their own peer-support network that supplemented existing formal support.

DISCUSSION

Student expectations matter in shaping their experiences of support systems. Where expectations are unmet, students may disengage and/or find alternatives. This may be easier for some students compared with others. More understanding of the relationship between expectations and engagement with support can inform the development of institutional support structures that meet the needs of all students across time.

Beyond theoretical courses - A study of Swedish psychiatric residents' collegial learning through conversations in the workplace

BACKGROUND

Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry.

METHODS

Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings.

RESULTS

The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses.

CONCLUSIONS

This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.

Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory

PURPOSE

Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes.

METHOD

This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation.

RESULTS

We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system.

CONCLUSIONS

Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

Defining Learning Communities in the Veterinary Medicine Curriculum

Learning communities (LCs) are a type of high-impact, collaborative educational practice where students cooperate with other students in two or more classes to improve learning. Additional criteria used for defining LCs vary across the literature and have focused on high school and undergraduate programs. Similar benefits may also be experienced in professional programs; however, before further studies can investigate and describe these benefits, the structure for LCs in the veterinary curriculum must first be defined. To accomplish this, a survey instrument was developed and distributed to veterinary students attending Iowa State University College of Veterinary Medicine during the 2019 to 2020 academic year. The survey focused on a number of criteria and included both qualitative and quantitative questions. Criteria included demographics, prior experiences, and structure of an ideal LC. Recurring themes in the qualitative responses were identified, reviewed, and categorized based on an established coding theme. Significant correlations included an association between respondents' opinions on the ideal number of people in a LC and prior participation in LCs; age and preference for LC focus; ideal number of LC members and LC focus; and gender identity and thoughts on LC diversity. Based on the survey results, the typical veterinary student would consider an ideal LC to (1) be selected by the students of the LC, (2) have faculty mentors, (3) have a focus on coursework with some social aspects, (4) have fewer than seven members, (5) be composed of friends, (6) meet both during and after class, and (7) be diverse.

Thinking of Learning Communities? Here Are Some of the Ways They May Benefit Your Medical Students

Learning communities are designed to bring together students, faculty, and potentially other healthcare professionals, to learn with and from each other formally in teaching activities but also in the social domain. In recent years, learning communities have gained some recognition as an effective educational strategy but their use is still not widely seen in all medical schools. Numerous benefits of learning communities have been reported and these include improved academic performance, enhanced critical thinking and problem-solving abilities, increased student confidence, and improved communication skills. Learning communities also provide opportunities for personal growth, mentorship, and self-reflection, all of which contribute to a students' professional development.

It's "not black and white": Students' perceptions of "altruism" content in preclinical medical education

OBJECTIVE

This study investigated how students as stakeholders viewed behavioral and social science (BSS) content in a preclinical longitudinal course entitled "Medicine, Body, and Society" (MBS) at UT Health San Antonio Long School of Medicine (LSOM). We present students' perceptions of successes and challenges tied to "altruism" and other non-biomedical objectives outlined by this institution.

METHODS

We conducted a qualitative thematic analysis of MBS course evaluation data. Two researchers independently performed initial coding followed by interrater reliability checks to revise codes and a final MAXQDA lexical search to refine three themes.

RESULTS

Three major themes emerged: (1) Students shared pedagogical preferences strongly favoring stories. (2) Students detected deficits in the module content tied to identities. (3) Students labelled BSS content as "soft," "subjective," and "siloed" which confounded its role in the course.

CONCLUSIONS

Advancing altruism aligned with BSS content in preclinical medical education remains a challenge. A closer review of student evaluations framed as learner-centeredness is key to a greater understanding and resolution of competency issues in preclinical curriculum and its impact on mastery in subsequent clinical education and practice.

A social network perspective on peer relationship formation of medical undergraduates within large-scale learning communities

INTRODUCTION

Students' formal networks, which are formed by a formal curriculum design, such as formally organized study groups within learning communities (LCs), may benefit students' interactions and learning. It is unclear how large-scale LCs contribute to the formation of different informal peer relationships, which refers to student self-organized out-of-class relationships. Two mechanisms can explain relationship formation in LCs. Propinquity within formal networks and homophily of students' characteristics (nationality, sex, academic performance) may promote students' peer relationships. This study explores to what extent the formation of students' informal networks was determined by their formal networks (LCs) while controlling for students' characteristics and which mechanisms play an important role.

METHODS

With online surveys, data were collected about five informal networks (help-seeking, collaboration, information sharing, friendship, and learn-from) from 69 first- and 51 second- bachelor year medical students (2890 relationships). Students were divided into four LCs in the formal curriculum. We compared students' five informal network structures between first- and second-year students, domestic and international students, within and between formal networks. Besides, we used Quadratic Assignment Procedure (QAP) Regression Analysis in Ucinet to investigate the associations between students' informal and formal networks (LCs) and students' characteristics.

RESULTS

Propinquity (in the same LC) plays a role since students have more informal connections within LCs than between LCs. Furthermore, it seems to play a greater role for second-year students than for first-year students. Homophily of nationality is important in informal networking since students are more likely to connect with others of similar nationalities.

CONCLUSION

Students become more connected within the LC when they remain in the same LC for a longer period. Formal networks enhance the students' informal interactions within LCs but seem to restrict the interactions among students from other LCs. International students need support in order to integrate with domestic students in LCs.

Key Attributes of a Medical Learning Community Mentor at One Medical School: The Mentee Perspective

To assess the elements necessary to be a successful learning community (ClinCalc) mentor to medical students from the mentee's perspective. Few such studies have utilized the in-depth and richness of detail obtained in qualitative studies. This qualitative study analyzed four focus group discussions lasting 45-90 min conducted at the University of Texas Southwestern Medical School, which has an established LC, in the year 2018. The groups included 14 pre-clerkship and 8 clerkship students. Investigators evaluated transcriptions of the focus group discussions using ATLAS.ti software. Three overarching categories of discussion emerged from the group discussions: (1) Relationship Competence, (2) Teaching Competence, and (3) Ethical and Compassionate Medical Practice Competence. Relationship Competence themes included "walk with me," relationship is most important, and one-on-one. Teaching Competence themes included above and beyond, recognize and address mentor limitations, and safe and enriching environment. Ethical and Compassionate Medical Practice Competence themes included ethical decision making and compassionate care for diverse patient populations. Mentees focused on various aspects of the mentor-mentee relationship as the single most essential competence. Themes mentees discussed as important qualities of a successful mentor may denote qualities to be prioritized in faculty development and mentor recruitment. Future studies could investigate how the LC environment informs former medical students and promotes patient outcomes.

Utilizing learning communities to deliver an integrated undergraduate medical education curriculum

AIM

Learning communities (LCs) have been identified as a structure to support student wellness as well as create a positive learning environment and have been increasingly adopted in undergraduate medical education (UGME). In 2016, Michigan State University College of Human Medicine made curricular changes which integrated basic, social, and clinical sciences. One of the major strategies adopted to deliver this integrated curriculum was to create LCs that served as a central scaffold for students' academic development. Our primary aim is to describe how the school utilized LC faculty to deliver this core integrated curriculum.

METHODS

Students were surveyed about their perceptions of the effectiveness of the LCs in delivering an integrated science curriculum. Student academic performance in the new curriculum was compared to that of students from the legacy curriculum as a measure of the effectiveness of the curricular changes.

RESULTS

The percentage of students in each class who responded to surveys ranged between 78.7% and 95.8%. Mean Likert responses (1 = strongly disagree; 5 = strongly agree) for statements 'the Faculty Fellow is effective in helping me learn the scholar group content', 'the Faculty Fellow is an effective teacher in our scholar group', and 'the Faculty Fellow is well prepared for our scholar group' ranged from 4.37 to 4.78, 4.72 to 4.76, and 4.81 to 4.86, respectively. In addition, a comparison of summative exam scores of the new curriculum's students to the legacy curriculum's students demonstrated comparable or better performances in the new curriculum.

CONCLUSIONS

Utilizing LCs to deliver an integrated science curriculum is an underutilized strategy in UGME. Surveys on student satisfaction and academic performance are encouraging. Additional outcome measures are planned to continually evaluate this innovative multifaceted integration.

Implementation of Learning Communities at Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates

Learning community programs have been widely implemented in higher education institutions, including many accredited medical schools in North America. Learning communities have been shown to create a sense of belonging, enhance teaching and learning, and promote an inclusive educational environment that reinforces collaboration, professionalism, and wellbeing. Based on their demonstrated success, a learning community program was included in the development of Khalifa University College of Medicine and Health Sciences (KU CMHS), the first medical school in the capital city of Abu Dhabi and the first to offer a postbaccalaureate, Doctor of Medicine (MD) degree in the United Arab Emirates (UAE). Named the Falcon Learning Communities (FLCs), the program adopted the core values of the Learning Communities Institute and integrated them into curricular, co-curricular, and extra-curricular programming. This paper presents an overview on the development of the FLC program, its implication for both students and faculty, preliminary feedback from teachers and learners, and considerations for future work.

Fireside Chats: A Novel Wellness Initiative for Medical Students in the COVID-19 Era

To supplement preexisting wellness programming for the surgery clerkship, a faculty surgeon at Vanderbilt initiated Fireside Chats (FC) in 2015. Inspired by Franklin Roosevelt’s Depression-era radio broadcasts, FC features small group sizes, off-campus excursions, and a reimagining of the mentor–mentee relationship that eschews hierarchy in favor of deep, mutualistic connections in both personal and professional domains. Here we describe the rationale and implementation of FC and present survey data that demonstrate the warm reception of FC and its efficacy in stewarding the mental health of medical students. Moreover, unlike large group activities such as “learning communities,” FC continues to meet in-person during COVID-19 and preserves social engagement opportunities that may alleviate pandemic-induced isolation and distress.

A Better Learning Community: Mixed-Methods Reveal Medical Student Preferences with Implications for Learning Community Design and Implementation

BACKGROUND

Medical school learning communities benefit students. The College of Medicine (COM) at the University of Arkansas for Medical Sciences (UAMS) provides medical students with academic, professional, and personal support through a learning community (LC) made of 7 academic houses.

OBJECTIVES

To evaluate the effectiveness of the academic house model at UAMS utilizing a mixed-methods survey. The aims were to: (1) assess student experience and satisfaction with academic houses, (2) describe the realms of advising and guidance, and (3) identify areas for improvement.

METHOD

An online survey was assigned to 723 COM students (all students enrolled, first through fourth years) at UAMS in March 2019. The survey was comprised of 25 items (10 multiple-choice, 8 on the Likert scale, and 7 open-ended questions). Data was depicted using frequency and percentages and/or thematic review of free-form responses.

RESULTS

The survey response rate was 31% (227 students). The majority of students responding (132, 58.1%) attended 2 or more face-to-face meetings with the faculty advisor within the preceding year. However, 27 (11.9%) students did not have any meetings. Approximately two-thirds of the respondents were satisfied or very satisfied with the guidance and direction provided by their advisors [very satisfied (n = 83; 36.6%); satisfied (n = 77; 33.9%)]. Themes that emerged from student generated areas for improvement include time constraints, advisor/advisee interest mismatch, and perceived inadequacy of advising content/connections.

CONCLUSIONS

This study confirms the effectiveness of the LC model for advising and mentoring in the COM at UAMS. Uniquely, this study identifies not only learners' satisfaction with their LC but also highlights areas for improvement which are widely generalizable and important to consider for institutions with or planning to start an LC.

Use of Mobile Technologies in Personal Learning Environments of Intercultural Contexts: Individual and Group Tasks

This paper presents the results of the analysis of the personal learning environments (PLE) used individually and in groups by fifth grade primary education students. The main objective was to determine if the use of mobile technologies in the students’ PLEs encouraged their school integration and learning in intercultural communities. For this, a content analysis of the students’ responses to an ad hoc interview was carried out, with a content validity index of 0.89. The students represented their answers using 41 concept maps in the individual tasks and 5 in the group tasks, which were analyzed with the Nvivo software in its latest version. The results show the categorization of the students’ responses in three dimensions: read, make/reflection and relationship. Among the main conclusions, it was obtained that, in both types of tasks, the strategies and tools that fostered intercultural relationships, intercultural education and communication between the students, and therefore school integration, are mostly linked to the use of mobile technologies applications, such as Wikipedia, the internet, Word, PowerPoint, social networks and YouTube, although it is essential to develop more studies to have more data to understand the phenomenon in depth.

Effects of a vocational program on professional orientation

Students that enroll in a vocational orientation program develop an early interest in the profession. Their involvement generates a higher sense of personal wellbeing, as well as positive academic and professional outcomes. A program was developed for high school students to experience first-hand what it means to work on health sciences. Two years after, the effects of the vocational program were assessed to analyze students’ motivation and satisfaction with their professional orientation.