Impact of personal goals on the internal medicine R4 subspecialty match: a Q methodology study

Exploring US internal medicine resident career preferences: a Q-methodology study

Career selection in medicine is a complex and underexplored process. Most medical career studies performed in the U.S. focused on the effect of demographic variables and medical education debt on career choice. Considering ongoing U.S. physician workforce shortages and the trilateral adaptive model of career decision making, a robust assessment of professional attitudes and work-life preferences is necessary. The objective of this study was to explore and define the dominant viewpoints related to career choice selection in a cohort of U.S. IM residents. We administered an electronic Q-sort in which 218 IM residents sorted 50 statements reflecting the spectrum of opinions that influence postgraduate career choice decisions. Participants provided comments that explained the reasoning behind their individual responses. In the final year of residency training, we ascertained participating residents' chosen career. Factor analysis grouped similar sorts and revealed four distinct viewpoints. We characterized the viewpoints as "Fellowship-Bound-Academic," "Altruistic-Longitudinal-Generalist," "Inpatient-Burnout-Aware," and "Lifestyle-Focused-Consultant." There is concordance between residents who loaded significantly onto a viewpoint and their ultimate career choice. Four dominant career choice viewpoints were found among contemporary U.S. IM residents. These viewpoints reflect the intersection of competing priorities, personal interests, professional identity, socio-economic factors, and work/life satisfaction. Better appreciation of determinants of IM residents' career choices may help address workforce shortages and enhance professional satisfaction.

Addressing the Nationwide Shortage of Child and Adolescent Psychiatrists: Determining Factors that Influence the Decision for Psychiatry Residents to Pursue Child and Adolescent Psychiatry Training

OBJECTIVE

This study aimed to identify factors that influence whether adult psychiatry residents choose to pursue fellowship training, particularly in child psychiatry. The study also assessed how child psychiatry is perceived among adult psychiatry residents as a subspecialty.

METHODS

Electronic surveys were administered to all adult psychiatry residents at the University of Michigan, Henry Ford Health System, and Authority Health. These three programs were selected for geographic convenience. The survey included demographic questions as well as Likert-scale statements that assessed the importance of various factors in determining future career choice. The survey also assessed the agreeability of various statements pertaining to the field of child psychiatry.

RESULTS

The most important factor for residents in deciding their specialty choice was personal interest, followed by work-life balance, the ability to work directly with patients, and the location of their future job. Over half of residents rated length of training as being "extremely important" or "very important," and fewer than 30% of residents surveyed felt that child psychiatry fellowship was too long. Child psychiatry is widely recognized by residents as having ample job opportunities. However, fewer than 30% of psychiatry residents surveyed rated a high level of interest in child psychiatry.

CONCLUSION

The knowledge of psychiatry residents' views on specialty selection could inform decision making around recruitment efforts. It may also gauge the efficacy and impact of different propositions made to increase child psychiatry recruitment, such as shortening fellowship training in child psychiatry and sponsoring mentorships and interest groups.

Q-Methodology: A Technique to Assess Perceptions in Simulation Research

SUMMARY STATEMENT

Learner perceptions of simulation can be challenging to assess and are usually limited to qualitative strategies. Q-methodology is an exploratory, systematic research technique that combines quantitative and qualitative procedures to measure differences in subjectivity. This article briefly reviews Q-methodology, provides an example of how it could be applied to assess the affective domain of simulation-based learning, and discusses implications for the use of Q-methodology in future simulation scholarship.

A scoping review of Q-methodology in healthcare research

BACKGROUND

Q-methodology is an approach to studying complex issues of human 'subjectivity'. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes.

METHODS

A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items.

RESULTS

Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained.

CONCLUSIONS

Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.

Attitudes About Coping With Fatigue in Patients With Gastric Cancer: A Q-Methodology Study

Cancer-related fatigue is the most common symptom in patients with cancer. Coping methods for cancer-related fatigue differ from those of patients without cancer, as the situations faced by patients with cancer are unique. This study aimed to identify subjectivity concerning coping with fatigue in Korean patients with gastric cancer. Q-methodology was used to examine subjective perceptions regarding coping with fatigue among Korean patients with gastric cancer. A convenience sample of 33 participants, who had been hospitalized in 2 university hospitals in South Korea, was recruited to participate in the study and 37 selected Q-samples were classified into a normal forced distribution using a 9-point bipolar grid. The obtained data were analyzed by using PC-QUANL for Windows. Three factors representing distinct attitudes about coping with fatigue emerged among Korean patients with gastric cancer: an optimistic mind, dependency on medicine, and exercise preference. The 3 factors explained 39.4% of the total variance (23.7%, 7.9%, and 7.8%, respectively). Based on the study findings, it is important to develop customized nursing interventions that consider the characteristics of each patient group with gastric cancer. Health professionals should assess the attitudes of patients with gastric cancer about coping with fatigue, explore their situation, and consider their lifestyle.

Connected, attracted, and concerned: A Q study on medical crossborder curriculum partnerships

INTRODUCTION

A new form of internationalization has been trending upward in the medical education realm: crossborder medical curriculum partnerships established to deliver the same, or adapted, curriculum to groups of geographically separated students. This study aims to investigate crossborder medical curriculum partnerships by exploring the experiences of teachers at the recipient institution who have a key role in delivering the program.

METHODS

From four pioneering recipient medical schools, 24 teachers participated in a Q-sort study. Each participant rank-ordered 42 statements about teaching in a crossborder medical curriculum on a scale from -5 (indicating strong disagreement) to +5 (indicating strong agreement). The authors conducted a "by-person" factor analysis to uncover distinct patterns in the ranking of statements, using the statistical results and participants' comments about their Q sorts to interpret these patterns and translate them into distinct viewpoints.

RESULTS

Three viewpoints emerged, reflecting: (1) a feeling of connectedness with the partner institution, trust in the quality of the curriculum, and appreciation of interinstitutional relationships; (2) the partnership's attractiveness because of the career opportunities it offers; and (3) concerns over the quality of graduates because of doubts about the appropriateness of the didactic model and insufficient attention to local healthcare needs, and over the practical feasibility of such partnerships.

CONCLUSIONS

The three viewpoints identified revealed a pallet of views on how host teachers might experience their work. It shows the heterogeneous features of this group and seems to counterbalance reports that they are feeling "deprived" from their role as teacher. Two viewpoints featured an appreciation of interinstitutional relationships and of the partnership, especially when perceiving a degree of autonomy. Partners can capitalize on all different viewpoints by deploying procedure and policies to raise the quality of education delivery.

The Evolution of General Internal Medicine (GIM)in Canada: International Implications

General internal medicine (GIM), like other generalist specialties, has struggled to maintain its identity in the face of mounting sub-specialization over the past few decades. In Canada, the path to licensure for general internists has been through the completion of an extra year of training after three core years of internal medicine. Until very recently, the Royal College of Physicians and Surgeons of Canada (RCPSC) did not recognize GIM as a distinct entity. In response to a societal need to train generalist practitioners who could care for complex patients in an increasingly complex health care setting, the majority of universities across Canada voluntarily developed structured GIM training programs independent of RCPSC recognition. However, interest amongst trainees in GIM was declining, and the GIM workforce in Canada, like that in many other countries, was in danger of serious shortfalls. After much deliberation and consultation, in 2010, the RCPSC recognized GIM as a distinct subspecialty of internal medicine. Since this time, despite the challenges in the educational implementation of GIM as a distinct discipline, there has been a resurgence of interest in this field of medicine. This paper outlines the journey of the Canadian GIM to educational implementation as a distinct discipline, the impact on the discipline, and the implications for the international GIM community.

Undergraduate nursing students' subjective attitudes to curriculum for Simulation-based objective structured clinical examination

BACKGROUND

The objective structured clinical examination (OSCE) is an effective educational method to evaluate the clinical competencies of students.

OBJECTIVE

To identify undergraduate nursing students' subjective attitudes to a curriculum for simulation-based OSCE (C-SOSCE).

DESIGN

Q methodology was used since it integrates the use of quantitative and qualitative methods.

PARTICIPANTS

A convenience P-sample consisting of 44 third-year nursing students.

METHODS

Forty selected Q-statements were obtained from each participant and were classified into a normal distribution by using a 9-point bipolar scale. The collected data were analyzed using the pc-QUANL program.

RESULTS

Three discrete factors emerged: Factor I (C-SOSCE stimulates self-study; self-directed learning perspectives), Factor II (C-SOSCE promotes self-confidence; practical learning perspectives), and Factor III (C-SOSCE needs proficient personnel; constructive learning perspectives).

CONCLUSIONS

Subjective positions of the three factors that were identified can be applied during the planning stages of an effective C-SOSCE. These findings establish a baseline that will lead to further research.