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Çelik C, Ata U, Kamalak M, Saka NE. Relationship between forensic medicine education, stress factors, and mobbing perception from the perspective of specialists in Turkey's universities. J Forensic Leg Med 2024; 106:102729. [PMID: 39137514 DOI: 10.1016/j.jflm.2024.102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/24/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The current situation needs to be presented with scientific data to ensure and improve the quality of specialist training. This study examined the quality of education, instructor competence, stress factors, mobbing, and their interconnections in the domain of forensic medicine specialty education in Turkey. MATERIALS AND METHODS This cross-sectional study was conducted through an anonymous, web-based survey targeting forensic medicine specialists who have completed their specialist training in university forensic medicine departments within the last three years. The survey consisted of questions regarding issues included in the core education curriculum, educator characteristics, and perceptions of stress and mobbing. Based on the responses provided, the relationships between these factors were statistically analysed. RESULTS 72.7 % of the study population completed the survey. Nearly half of the participants (46.3 %) did not consider the number of instructors adequate. The quality of instructors (scientific competence, educational and teaching skills, interpersonal relations, accessibility, management, and problem-solving abilities) was determined to be partially sufficient (mean = 3.36). Approximately one-third of the respondents indicated that instructors made the greatest contribution to their specialist training, whereas the proportion of those who said otherwise was much higher. Education received for topics included in the core curriculum was partially sufficient level (mean = 3.04). It was observed that there was a significant relationship between the instructor characteristics, sufficiency score of the taught topics, and perception of mobbing (p < 0.01). The sufficiency scores of instructor characteristics had a 1.02-fold impact on sufficiency ratings of the topics covered in residency training. Among the respondents, 76.9 % reported encountering stress factors during their specialty training, with the most frequently exposed stress factor (52.2 %) being disorganisation within the training program. Among the participants, 22.8 % reported experiencing mobbing. CONCLUSIONS Education and instructor qualifications were correlated; however, stress factors and mobbing adversely affected education. A close association was observed between education, instructors, stressors, and mobbing. Thus independent and objective auditors tasked with verifying whether institutions meet the established educational standards need to be established.
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Affiliation(s)
- Cemil Çelik
- Department of Forensic Medicine, Council of Forensic Medicine, Kahramanmaraş, Turkey.
| | - Uğur Ata
- Department of Forensic Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Murat Kamalak
- Forensic Medicine, Council of Forensic Medicine, Gaziantep, Turkey
| | - Naile Esra Saka
- Department of Forensic Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
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Sierocinski E, Mathias L, Freyer Martins Pereira J, Chenot JF. Postgraduate medical training in Germany: A narrative review. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc49. [PMID: 36540556 PMCID: PMC9733474 DOI: 10.3205/zma001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 06/17/2023]
Abstract
The structure and content of the training phase following completion of medical school, referred to in most countries as postgraduate medical training, varies between countries. The purpose of this article is to give national and international readers an overview of the organisation and structure of postgraduate medical training in Germany. The content and duration of postgraduate training in Germany are stipulated by state medical boards, officially termed associations (Landesärztekammer). In a periodically updated decree, the federal German medical association (Bundesärztekammer) provides a template for postgraduate medical training structure (Musterweiterbildungsordnung), which is adapted by the state medical associations. Admission to postgraduate medical training in Germany takes place by way of open, free-market selection. Based on the traditional assumption that junior doctors acquire all necessary clinical skills "on the job", formal education in the form of seminars, lectures, or preorganised, detailed rotation plans through various specialties or wards is largely absent. Requirements for postgraduate medical training focus on the fulfilment of broad categories of rotations rather than specific content or gaining competencies. With few exceptions, no structured educational programs with curricular learning objectives exist. Limited funding impedes program development and expansion. Junior doctors bear the primary organisational responsibility in their training, which often results in extended training times and dissatisfaction. Structured training programs which prioritise skill-building and formal education are needed to support junior doctors and ensure their competence in primary and specialty care.
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Affiliation(s)
- Elizabeth Sierocinski
- Greifswald University Medical Center, Institute for Community Medicine, Department of General Practice, Greifswald, Germany
| | - Leonard Mathias
- Greifswald University Medical Center, Institute for Community Medicine, Department of General Practice, Greifswald, Germany
| | - Julia Freyer Martins Pereira
- Greifswald University Medical Center, Institute for Community Medicine, Department of General Practice, Greifswald, Germany
| | - Jean-François Chenot
- Greifswald University Medical Center, Institute for Community Medicine, Department of General Practice, Greifswald, Germany
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Eickelmann AK, Waldner NJ, Huwendiek S. Teaching the technical performance of bronchoscopy to residents in a step-wise simulated approach: factors supporting learning and impacts on clinical work - a qualitative analysis. BMC MEDICAL EDUCATION 2021; 21:597. [PMID: 34856967 PMCID: PMC8641234 DOI: 10.1186/s12909-021-03027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The ability to perform a bronchoscopy is a valuable clinical skill for many medical specialities. Learning this skill is demanding for residents, due to the high cognitive load. Lessons learned from cognitive load theory might provide a way to facilitate this learning. The aim of this study was to investigate residents' perception of factors that support and hinder learning, as well as outcome and acceptance of a workshop on flexible bronchoscopy. METHODS Three half-day workshops were designed to teach 12 residents the basics of handling a flexible bronchoscope. They consisted of four phases that alternated between short theoretical aspects and longer practical situations. The practical phases focussed initially on manoeuvring a bronchoscope through holes in panels inside a box, and then on examination and practice using a three-dimensional printed model of the bronchial tree. Afterwards, three audio- and video-recorded focus groups were conducted, transcribed and coded, and underwent reflexive thematic analysis. RESULTS Analysis of the focus groups defined two themes: (1) factors that supported a safe and positive learning environment were optimised for intrinsic load, simulated setting, absence of pressure, dyad practice (working in pairs), small group sizes and playful learning; and (2) impacts on clinical work were perceived as high levels of learning and improved patient safety. The residents did not report factors that hindered their learning. Some suggestions were made to improve the set-up of the wooden box. CONCLUSIONS The half-day workshop was designed according to several factors, including cognitive load theory in a simulated setting, and creation of a safe and positive learning environment. The residents perceived this as supporting learning and patient safety. Further studies can be designed to confirm these results in a quantitative setting. TRIAL REGISTRATION This study was not interventional, therefore was not registered.
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Affiliation(s)
- Anne Kathrin Eickelmann
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University Bielefeld, Bielefeld, Germany
| | - Noemi Jelena Waldner
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Butt AS, Shamim MS, Ali MA, Qamar F, Khan IQ, Tariq S, Hashmi SA, Hafeez Q, Tariq M. Applying a Mixed-Method Approach to Improve On-the-Job Learning and Job Satisfaction in a Cohort of Interns at a University Hospital. Cureus 2021; 13:e15905. [PMID: 34336418 PMCID: PMC8312773 DOI: 10.7759/cureus.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern’s work-based learning and satisfaction in a university hospital setting. Methods: Using Kern’s six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome the identified gaps. In phase 2 (2014-2016) the impact of these developmental strategies was assessed. Results: A total of 65 interns, 30 residents, and 22 faculty members participated in phase I, while 71 interns participated in phase II. The reformation of orientation sessions, including practical exposure and content of sessions, opportunities to enhance hands-on experience and supervision in inpatient areas, operating rooms, supervision by fellows, supervision for hands-on procedures, career counseling, and mentorship, led to significant improvement in satisfaction. It was identified that the lack of hands-on opportunities can be overcome by surgical skills-based workshops. These reforms led to an overall rise in intern satisfaction (50% vs 75.4%, p=0.02). Conclusion: Periodic restructuring of an existing program helps to improve the work-based learning experience and overall satisfaction among interns. This not only maximizes learning but also eases interns into their postgraduate life and workload subsequently enabling them to become more competent and well-rounded health practitioners.
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Affiliation(s)
- Amna S Butt
- Gastroenterology, Aga Khan University Hospital, Karachi, PAK
| | | | - M Asghar Ali
- Anaesthesiology, Aga Khan University Hospital, Karachi, PAK
| | - Farah Qamar
- Pediatrics, Aga Khan University Hospital, Karachi, PAK
| | - Irum Q Khan
- Emergency Medicine/General Surgery, Aga Khan University Hospital, Karachi, PAK
| | - Swaleha Tariq
- Family Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | | | - Muhammed Tariq
- Internal Medicine, Aga Khan University Hospital, Karachi, PAK
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Huq AJ, Healy L, Gorelik A, Forrest LE, Winship IM. Mainstreaming genomics: training experience of hospital medical officers at the Royal Melbourne Hospital. Intern Med J 2021; 51:268-271. [PMID: 33631848 DOI: 10.1111/imj.15185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 01/09/2023]
Abstract
The rapid evolution and wide applicability of genomic testing means that medical practitioners outside the field are not appropriately skilled to understand the utility of genomics for their patients. Rotating junior doctors through genomic medicine provides them with the hands-on experience necessary to understand the complexities in this field. In this study, we analysed the training experience of 12 hospital medical officers who rotated through genomic medicine at the Royal Melbourne Hospital. Here, we demonstrate that immersion in clinical genomics aids in mainstreaming genomics knowledge.
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Affiliation(s)
- Aamira J Huq
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Lachlan Healy
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Laura E Forrest
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid M Winship
- Department of Genomic Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Entrustable professional activities (EPAs) are characterized as self-contained units of work in a given typical clinical context, which may be entrusted to a trainee for independent execution at a certain point of training. An example could be the intraoperative anesthesia management of an ASA 1 patient for an uncomplicated surgical intervention as an EPA in early postgraduate anesthesia training. The EPAs can be described as an evolution of a competency-based medical educational concept, applying the concept of the competencies of a person to specific workplace contexts. In this way the expected level of skills and supervision at a certain stage of training have a more practical meaning and the danger of fragmentation of individual competencies in the competence-based model is avoided. It is a more holistic view of a trainee. Experience with this new concept is so far limited, therefore, further studies are urgently needed to determine whether and how EPAs can contribute to improvements in further training.
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Tanaka P, Hasan N, Tseng A, Tran C, Macario A, Harris I. Assessing the Workplace Culture and Learning Climate in the Inpatient Operating Room Suite at an Academic Medical Center. JOURNAL OF SURGICAL EDUCATION 2019; 76:644-651. [PMID: 30824232 DOI: 10.1016/j.jsurg.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/27/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to elicit perspectives from operating room (OR) personnel on the workplace culture and learning climate in the surgical suite, and to identify behaviors associated with a positive culture and learning climate. DESIGN Qualitative analyses using survey methodology. SETTING Main hospital OR suite at a large academic medical center. PARTICIPANTS Nurses, faculty, and residents who work in the OR suite. RESULTS To improve the OR environment, survey respondents (n = 60) recommended: (1) promoting a respectful "no blame" culture; (2) promoting social cohesion and cross-collaboration; (3) improving communication regarding performance feedback and patient safety; (4) building small interdisciplinary teams working toward common goals; and (5) improving learning opportunities that support professional growth. CONCLUSIONS Opportunities exist to improve the OR workplace culture and thereby the learning environment.
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Affiliation(s)
- Pedro Tanaka
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
| | - Natalya Hasan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Anita Tseng
- Stanford University Graduate School of Education, Stanford, California
| | - Chinh Tran
- UC Irvine School of Medicine, Irvine, California
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ilene Harris
- Department of Medical Education, University of Illinois College of Medicine, Urbana, Illinois
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Holmboe ES. Work-based Assessment and Co-production in Postgraduate Medical Training. GMS JOURNAL FOR MEDICAL EDUCATION 2017; 34:Doc58. [PMID: 29226226 PMCID: PMC5704603 DOI: 10.3205/zma001135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/15/2017] [Accepted: 05/09/2017] [Indexed: 05/24/2023]
Abstract
Assessment has always been an essential component of postgraduate medical education and for many years focused predominantly on various types of examinations. While examinations of medical knowledge and more recently of clinical skills with standardized patients can assess learner capability in controlled settings and provide a level of assurance for the public, persistent and growing concerns regarding quality of care and patient safety worldwide has raised the importance and need for better work-based assessments. Work-based assessments, when done effectively, can more authentically capture the abilities of learners to actually provide safe, effective, patient-centered care. Furthermore, we have entered the era of interprofessional care where effective teamwork among multiple health care professionals is now paramount. Work-based assessment methods are now essential in an interprofessional healthcare world. To better prepare learners for these newer competencies and the ever-growing complexity of healthcare, many post-graduate medical education systems across the globe have turned to outcomes-based models of education, codified through competency frameworks. This commentary provides a brief overview on key methods of work-based assessment such as direct observation, multisource feedback, patient experience surveys and performance measures that are needed in a competency-based world that places a premium on educational and clinical outcomes. However, the full potential of work-based assessments will only be realized if post-graduate learners play an active role in their own assessment program. This will require a substantial culture change, and culture change only occurs through actions and changed behaviors. Co-production offers a practical and philosophical approach to engaging postgraduate learners to be active, intrinsically motivated agents for their own professional development, help to change learning culture and contribute to improving programmatic assessment in post-graduate training.
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Affiliation(s)
- Eric S. Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, USA
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Al-Yassin A, Long A, Sharma S, May J. How can general paediatric training be optimised in highly specialised tertiary settings? Twelve tips from an interview-based study of trainees. BMJ Paediatr Open 2017; 1:e000101. [PMID: 29637130 PMCID: PMC5862162 DOI: 10.1136/bmjpo-2017-000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Both general and subspecialty paediatric trainees undertake attachments in highly specialised tertiary hospitals. Trainee feedback suggests that mismatches in expectations between trainees and supervisors and a perceived lack of educational opportunities may lead to trainee dissatisfaction in such settings. With the 'Shape of Training' review (reshaping postgraduate training in the UK to focus on more general themes), this issue is likely to become more apparent. We wished to explore the factors that contribute to a positive educational environment and training experience and identify how this may be improved in highly specialised settings. METHODS General paediatric trainees working at all levels in subspecialty teams at a tertiary hospital were recruited (n=12). Semistructured interviews were undertaken to explore the strengths and weaknesses of training in such a setting and how this could be optimised. Appreciative inquiry methodology was used to identify areas of perceived best practice and consider how these could be promoted and disseminated. RESULTS Twelve best practice themes were identified: (1) managing expectations by acknowledging the challenges; (2) educational contracting to identify learning needs and opportunities; (3) creative educational supervision; (4) centralised teaching events; (5) signposting learning opportunities; (6) curriculum-mapped pan-hospital teaching programmes; (7) local faculty groups with trainee representation; (8) interprofessional learning; (9) pastoral support systems; (10) crossover weeks to increase clinical exposure; (11) adequate clinical supervision; and (12) rota design to include teaching and clinic time. CONCLUSIONS Tertiary settings have strengths, as well as challenges, for general paediatric training. Twelve trainee-generated tips have been identified to capitalise on the educational potential within these settings. Trainee feedback is essential to diagnose and improve educational environments and appreciative inquiry is a useful tool for this purpose.
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Affiliation(s)
- Amina Al-Yassin
- Department Postgraduate Medical Education, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Andrew Long
- Department of General Paediatrics, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Sanjiv Sharma
- Department Postgraduate Medical Education, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Joanne May
- Department Postgraduate Medical Education, Great Ormond Street Hospital For Children NHS Trust, London, UK
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