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Aggarwal M, Abdelhalim R, Fowler N, Oandasan I. Conceptualizing "Preparedness for Practice": Perspectives of Early-Career Family Physicians. Fam Med 2023; 55:667-676. [PMID: 37643091 PMCID: PMC10741718 DOI: 10.22454/fammed.2023.294689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada. METHODS This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis. RESULTS Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability. CONCLUSIONS Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of TorontoToronto, ONCanada
| | - Reham Abdelhalim
- Institute of Health Policy, Management and Evaluation, University of TorontoToronto, ONCanada
| | - Nancy Fowler
- Department of Family Medicine, McMaster UniversityHamilton, ONCanada
| | - Ivy Oandasan
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
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Soares A, Fink A, Salles A, Lee K, Zhong L, Bhayani RK. Perceptions of Gender Stereotypes among Women Residents in Surgical and Nonsurgical Specialties. South Med J 2023; 116:496-501. [PMID: 37263613 DOI: 10.14423/smj.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether and to what degree residents experience stereotype perception by gender and specialty type (surgical vs nonsurgical). METHODS A cross-sectional survey was sent to resident physicians across all specialties at a single academic institution in February 2021. The survey items asked whether participants believe residents, faculty, and the public expect men or women to be better physicians on a numerical scale from 1 to 7. A χ2 test compared the calculated mean and standard error for each survey item. This study took place at Washington University School of Medicine in St. Louis, Missouri, a large academic tertiary care center. RESULTS A total of 411 (46% of total) residents participated; 13 were excluded because of nonbinary gender or missing demographic information, for a final sample of 398. Participants perceived all three groups to expect men to be better physicians than women. Regression analysis showed a significant effect of gender on stereotype perception, with women reporting stronger stereotype perceptions than men. There were no significant differences in stereotype perceptions by specialty type. CONCLUSIONS Women resident physicians in both surgical and nonsurgical fields reported higher levels of gender stereotype perception compared with men, making it imperative that graduate medical education leadership support changes to the current learning environment.
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Affiliation(s)
- Andrea Soares
- From the Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Angela Fink
- Center for Integrative Research on Cognition, Learning, and Education, Washington University, St. Louis, Missouri
| | - Arghavan Salles
- Stanford University School of Medicine, Palo Alto, California
| | - Koeun Lee
- Washington University School of Medicine, St. Louis, Missouri
| | - Lydia Zhong
- Washington University School of Medicine, St. Louis, Missouri
| | - Rakhee K Bhayani
- From the Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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de Wit TN, Taks N, van der Zee-van den Berg AI, Sadrzadeh S. [Resident and supervisor perception of learning climate in public health resident training in the Netherlands]. TSG : TIJDSCHRIFT VOOR GEZONDHEIDSWETENSCHAPPEN 2022; 100:163-169. [PMID: 36405353 PMCID: PMC9643892 DOI: 10.1007/s12508-022-00367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the perceived quality of the learning climate by public health residents in the Netherlands and compare residents' and supervisors' perceptions. METHODS Residents of five public health subfields, who started their residency programs in 2019 and onwards, as well as supervisors involved in the residency program, were invited to complete a web-based survey based on an adapted version of the D‑RECT questionnaire. Answers of residents and supervisors of the same training site and public health subfield were matched to compare perceived quality of the learning climate. RESULTS One hundred fourteen residents responded (response rate 50.9%). Residents' overall assessment of the learning climate showed a mean score of 4.19 on a 5-point-scale. Thirty-eighth supervisor-resident matches were formed. There were no notable differences in the perception of residents and supervisors. CONCLUSION Residents' overall assessment of the learning climate was positive. Supervisors and residents' perception of learning climate is equal. Our adapted version of D‑RECT seems to be suitable to evaluate the learning climate for public health residency programs in the Netherlands. Further research is necessary to validate our questionnaire and to confirm our findings.
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Affiliation(s)
- Tessa N. de Wit
- Netherlands School of Public and Occupational Health, Utrecht, Nederland
| | - Nadieh Taks
- Netherlands School of Public and Occupational Health, Utrecht, Nederland
| | | | - Sheda Sadrzadeh
- Netherlands School of Public and Occupational Health, Utrecht, Nederland
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Sartori E, Ghezzi F, Cromi A, Laganà AS, Garzon S, Raffaelli R, Scambia G, Franchi M, Candiani M, Casarin J, Ciavattini A, Paola RD, Greco P, Guaschino S, Marchesoni D, Milani R, Rizzo N, Venturini PL, Valente E, Vizza E, Zanconato G, Zullo F. Learning climate and quality of Italian training courses in gynecology and obstetrics. Eur J Obstet Gynecol Reprod Biol 2019; 241:13-18. [DOI: 10.1016/j.ejogrb.2019.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/06/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
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van Boekholt TA, Duits AJ, Busari JO. Health care transformation in a resource-limited environment: exploring the determinants of a good climate for change. J Multidiscip Healthc 2019; 12:173-182. [PMID: 30881009 PMCID: PMC6400125 DOI: 10.2147/jmdh.s194180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose In a continued effort to improve the health care services, a project was set up to develop and implement a care pathway for the effective management of pressure ulcers in the St Elisabeth Hospital in Curaçao, the Dutch Caribbean. To ensure the effective implementation of our intervention, we decided to investigate what factors define the implementation climate of a health care institution within a resource-limited environment. Methods We used a participatory tool approach in this study, where a mixed team of health professionals worked on two parts of a health improvement project, namely: 1) workforce leadership development through a clinical leadership training program; and 2) health care quality improvement through the pressure ulcer care pathway development. In-depth interviews were held with ten participants to gain insight into their experiences of the implementation climate in the hospitals and inductive analysis was used to identify the (sub)themes. Results Identified themes that described the implementation climate included: 1) the attitude of staff toward policy changes; 2) vision of the organization; 3) collaboration; 4) transparency and communication; 5) personal development; and 6) resources. These factors were interrelated and associated with several potential consequences such as loss of motivation among staff, loss of creativity to solve issues, the emergence of the feeling “us” vs “them”, short-term solutions to problems, and a sense of suspicion/frustration among staff members. Conclusion From this study, positive subconstructs for a favorable implementation climate in a hospital organization were lacking and those that were identified were suboptimal. The inability to satisfy all the subconstructs seemed to be the consequence of insufficient resources and infrastructure within the current health system. A favorable implementation climate in a resource-limited environment is closely tied to the availability of health care resources and infrastructure.
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Affiliation(s)
- Tessa A van Boekholt
- Department of Public Health, United Nations High Commissioner for Refugees Uganda Operation, Arua, Uganda
| | - Ashley J Duits
- Department of Medical Education, St. Elisabeth Hospital, Willemstad, Curaçao.,Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands.,Red Cross Blood Bank Foundation, Willemstad, Curaçao
| | - Jamiu O Busari
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands, .,Department of Pediatrics, Zuyderland Medical Center, Heerlen, The Netherlands,
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Busari JO, Moll FM, Duits AJ. Understanding the impact of interprofessional collaboration on the quality of care: a case report from a small-scale resource limited health care environment. J Multidiscip Healthc 2017; 10:227-234. [PMID: 28652761 PMCID: PMC5472431 DOI: 10.2147/jmdh.s140042] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A critical assessment of current health care practices, as well as the training needs of various health care providers, is crucial for improving patient care. Several approaches have been proposed for defining these needs with attention on communication as a key competency for effective collaboration. Taking our cultural context, resource limitations, and small-scale setting into account, we researched the applicability of a mixed focus group approach for analysis of the communication between doctors and nurses, as well as the measures for improvement. Study objective Assessment of nurse-physician communication perception in patient care in a Caribbean setting. Methods Focus group sessions consisting of nurses, interns, and medical specialists were conducted using an ethnographic approach, paying attention to existing communication, risk evaluation, and recommendations for improvement. Data derived from the focus group sessions were analyzed by thematic synthesis method with descriptive themes and development of analytic themes. Results The initial focus group sessions produced an extensive list of key recommendations which could be clustered into three domains (standardization, sustainment, and collaboration). Further discussion of these domains in focus groups showed nurses’ and physicians’ domain perspectives and effects on patient care to be broadly similar. Risks related to lack of information, knowledge sharing, and professional respect were clearly described by the participants. Conclusion The described mixed focus group session approach for effectively determining current interprofessional communication and key improvement areas seems suitable for our small-scale, limited resource setting. The impact of the cultural context should be further evaluated by a similar study in a different cultural context.
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Affiliation(s)
- Jamiu O Busari
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands.,Department of Pediatrics, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Franka M Moll
- Department of Medical Education, St. Elisabeth Hospital, Willemstad, Curaçao
| | - Ashley J Duits
- Department of Medical Education, St. Elisabeth Hospital, Willemstad, Curaçao.,Institute for Medical Education, University Medical Center Groningen, Groningen, the Netherlands.,Red Cross Blood Bank Foundation, Willemstad, Curaçao
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Focus on Quality: Investigating Residents' Learning Climate Perceptions. PLoS One 2016; 11:e0147108. [PMID: 26765742 PMCID: PMC4713097 DOI: 10.1371/journal.pone.0147108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
Background A department’s learning climate is known to contribute to the quality of postgraduate medical education and, as such, to the quality of patient care provided by residents. However, it is unclear how the learning climate is perceived over time. Objectives This study investigated whether the learning climate perceptions of residents changed over time. Methods The context for this study was residency training in the Netherlands. Between January 2012 and December 2014, residents from 223 training programs in 39 hospitals filled out the web-based Dutch Residency Educational Climate Test (D-RECT) to evaluate their clinical department’s learning climate. Residents had to fill out 35 validated questions using a five point Likert-scale. We analyzed data using generalized linear mixed (growth) models. Results Overall, 3982 D-RECT evaluations were available to investigate our aim. The overall mean D-RECT score was 3.9 (SD = 0.3). The growth model showed an increase in D-RECT scores over time (b = 0.03; 95% CI: 0.01–0.06; p < 0.05). Conclusions The observed increase in D-RECT scores implied that residents perceived an improvement in the learning climate over time. Future research could focus on factors that facilitate or hinder learning climate improvement, and investigate the roles that hospital governing committees play in safeguarding and improving the learning climate.
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Berkenbosch L, Bax M, Scherpbier A, Heyligers I, Muijtjens AMM, Busari JO. How Dutch medical specialists perceive the competencies and training needs of medical residents in healthcare management. MEDICAL TEACHER 2013; 35:e1090-e1102. [PMID: 23137237 DOI: 10.3109/0142159x.2012.731544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The Dutch postgraduate medical training has been revised to focus on seven competencies. The role as manager is one of these competencies. Recent studies show that this competency receives little attention during the residency training. In an earlier study, we discovered that residents perceived their competency as managers to be moderate. AIM In this study, we investigated how medical specialists perceived the managerial competencies of medical residents and their need for management education. METHODS In September 2010, a 46-item questionnaire was designed which examined medical specialists' perceptions of the competency and needs of residents in the field of medical management. Two hundred ninety-eight specialists were invited via email to participate. RESULTS Hundred twenty-nine specialists (43.3%) responded to our survey. They rated the residents' competencies in contract negotiating skills, knowledge of the healthcare system, and specialist department poorly. They felt that residents were competent in updating their medical knowledge. Ninety-four percent reported a need for training in management among residents. Preferred topics were time management and healthcare organization. The preferred training method was a workshop given during residency by an extramural expert. CONCLUSION Dutch medical specialists perceive the management competencies of residents in some areas to be inadequate. They feel that training in medical management during residency is necessary.
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Affiliation(s)
- L Berkenbosch
- Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands.
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Moore A, O'Brien K. Confidence in clinical practice of Chinese medicine degree graduates 1 year after graduation: a pilot study. J Altern Complement Med 2012; 18:270-80. [PMID: 22420739 DOI: 10.1089/acm.2010.0614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The issue of transition from student to practitioner of Chinese medicine (CM) in Australia and other Western countries has received little formal attention. Workforce studies, while not up to date nationally in Australia, suggest that the majority of CM practitioners practice as sole practitioners or in small practices. Data from the state of Victoria suggest that a significant proportion of the CM workforce is relatively new to the profession. It is not known how many graduates successfully enter the workforce and importantly, remain in it. OBJECTIVES An initial survey of final-year bachelor degree CM students in Australian education institutions in 2008 suggested that students felt "somewhat" prepared for clinical practice in eight dimensions of clinical practice. The authors conducted a follow-up study to this initial one, seeking to investigate perceptions of confidence in CM graduates in various aspects of clinical practice within the first year of completing their degree. METHODS A content-validated survey based on the previous study was distributed to a subset of 30 graduates from the original study cohort who had indicated a willingness to participate in this follow-up survey. RESULTS There were a small number of responses (n=12), limiting the usefulness of the quantitative questions. However, some interesting qualitative outcomes from the long-answer part of the survey support findings from the previous study that recent practitioners would like more clinical experience, as well as support in developing their business and interpersonal skills, and the option to participate in a professional mentoring arrangement. CONCLUSIONS Results of this study suggest that both education providers and professional associations may be able to play important and complementary roles in assisting CM students to successfully transition into the workforce. If CM is to continue to develop as a profession in Australia, it will be important that more attention be given to how to assist new graduates to successfully transition into and remain in clinical practice.
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Affiliation(s)
- Amber Moore
- Department of Medicine, Monash University, Commercial Road, Prahran, Victoria, Australia
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Barbosa J, Severo M, Fresta M, Ismail M, Ferreira MA, Barros H. How students perceive medical competences: a cross-cultural study between the medical course in Portugal and African Portuguese speaking countries. BMC MEDICAL EDUCATION 2011; 11:24. [PMID: 21612609 PMCID: PMC3123652 DOI: 10.1186/1472-6920-11-24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 05/25/2011] [Indexed: 05/27/2023]
Abstract
BACKGROUND A global effort has been made in the last years to establish a set of core competences that define the essential professional competence of a physician. Regardless of the environment, culture or medical education conditions, a set of core competences is required for medical practice worldwide. Evaluation of educational program is always needed to assure the best training for medical students and ultimately best care for patients. The aim of this study was to determine in what extent medical students in Portugal and Portuguese speaking African countries, felt they have acquired the core competences to start their clinical practice. For this reason, it was created a measurement tool to evaluate self-perceived competences, in different domains, across Portuguese and Portuguese-speaking African medical schools. METHODS The information was collected through a questionnaire that defines the knowledge, attitudes and skills that future doctors should acquire. The Cronbach's Alpha and Principal Components Analysis (PCA) were used to evaluate the reliability of the questionnaire. In order to remove possible confounding effect, individual scores were standardized by country. RESULTS The order of the domain's scores was similar between countries. After standardization, Personal Attitudes and Professional Behavior showed median scores above the country global median and Knowledge alone showed median score below the country global median. In Portugal, Clinical Skills showed score below the global median. In Angola, Clinical Skills and General Skills showed a similar result. There were only significant differences between countries in Personal Attitudes (p < 0.001) and Professional Behavior (p = 0.043). CONCLUSIONS The reliability of the instrument in Portuguese and Portuguese-speaking African medical schools was confirmed. Students have perceived their level of competence in personal attitudes in a high level and in opposite, knowledge and clinical skills with some weaknesses.
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Affiliation(s)
- Joselina Barbosa
- Center for Medical Education, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
| | - Milton Severo
- Center for Medical Education, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
| | - Mário Fresta
- Center for Advanced Studies in Medical Education, Faculty of Medicine, University Agostinho Neto, (Av. Hoji ya Henda), Luanda, (116), Angola
| | - Mamudo Ismail
- Faculty of Medicine, University Eduardo Mondlane, (Av. Salvador Allende), Maputo, (257), Mozambique
| | - Maria Amélia Ferreira
- Center for Medical Education, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
- Institute of Anatomy, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
| | - Henrique Barros
- Department of Hygiene and Epidemiology, Faculty of Medicine, University of Porto, (Al. Prof. Hernâni Monteiro), Porto, (4200-319), Portugal
- Institute of Public Health, University of Porto, (Rua das Taipas), Porto (4050-600), Portugal
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