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Zhao Y, Nzekwu S, Boga M, Mbuthia D, Nzinga J, English M, Molyneux S, McGivern G. Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: Findings from an empirical study of medical and nurse interns in Kenya. Soc Sci Med 2024; 357:117226. [PMID: 39146903 DOI: 10.1016/j.socscimed.2024.117226] [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: 12/06/2023] [Revised: 06/12/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
We examine new doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. Liminality is a stage of 'in-betweenness', involving uncertainty and ambiguity as people leave one social context and reintegrate into a new one. Surprisingly little research has explored new health professionals' experiences of liminality during role and career transitions, particularly in precarious and resource-constrained settings. Drawing on 146 qualitative interviews and seven focus groups, involving 121 new graduate medical doctors and nurses transitioning through internship training in Kenya, we describe three aspects of liminality. First, liminal professional practice, where interns realise that best practices learned during medical and nursing schools are often impossible to implement in resource constrained health care settings; instead they learn workarounds and practical norms. Second, liminal relational identities, where interns leave behind being students and adopt the identities and responsibilities of qualified professionals within pre-existing professional hierarchies of status and expertise. We explain how these new doctors and graduate nurses negotiate their liminal status, including in relation to more experienced but less qualified professional colleagues. We also discuss how interns cope with liminality due to disappointing and inadequate supervision and role modelling from senior colleagues but then find peer support and their place within their own professions. Finally, we discuss how new doctors and nurses come to terms with the precarity of working in resource constrained health systems, abandon expectations of secure, permanent employment and careers, and accept the realities of liminal professional careers. We explain how all three forms of liminality influence professionals' developing practices, identities, and careers. We call for further studies with a specific liminality lens to explore this critical period in health workers' careers, to inform policy and practice responding to global transformations in healthcare professions and practice.
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Affiliation(s)
- Yingxi Zhao
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | | | | | | | - Mike English
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sassy Molyneux
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gerry McGivern
- King's Business School, King's College London, London, UK
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Cevik AA, Cakal ED, Kwan J, Chu S, Mtombeni S, Anantharaman V, Jouriles N, Peng DTK, Singer A, Cameron P, Ducharme J, Wai A, Manthey DE, Hobgood C, Mulligan T, Menendez E, Jakubaszko J. IFEM model curriculum: emergency medicine learning outcomes for undergraduate medical education. Int J Emerg Med 2024; 17:98. [PMID: 39103797 DOI: 10.1186/s12245-024-00671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/04/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The International Federation for Emergency Medicine (IFEM) published its model curriculum for medical student education in emergency medicine in 2009. Because of the evolving principles of emergency medicine and medical education, driven by societal, professional, and educational developments, there was a need for an update on IFEM recommendations. The main objective of the update process was creating Intended Learning Outcomes (ILOs) and providing tier-based recommendations. METHOD A consensus methodology combining nominal group and modified Delphi methods was used. The nominal group had 15 members representing eight countries in six regions. The process began with a review of the 2009 curriculum by IFEM Core Curriculum and Education Committee (CCEC) members, followed by a three-phase update process involving survey creation [The final survey document included 55 items in 4 sections, namely, participant & context information (16 items), intended learning outcomes (6 items), principles unique to emergency medicine (20 items), and content unique to emergency medicine (13 items)], participant selection from IFEM member countries and survey implementation, and data analysis to create the recommendations. RESULTS Out of 112 invitees (CCEC members and IFEM member country nominees), 57 (50.9%) participants from 27 countries participated. Eighteen (31.6%) participants were from LMICs, while 39 (68.4%) were from HICs. Forty-four (77.2%) participants have been involved with medical students' emergency medicine training for more than five years in their careers, and 56 (98.2%) have been involved with medical students' training in the last five years. Thirty-five (61.4%) participants have completed a form of training in medical education. The exercise resulted in the formulation of tiered ILO recommendations. Tier 1 ILOs are recommended for all medical schools, Tier 2 ILOs are recommended for medical schools based on perceived local healthcare system needs and/or adequate resources, and Tier 3 ILOs should be considered for medical schools based on perceived local healthcare system needs and/or adequate resources. CONCLUSION The updated IFEM ILO recommendations are designed to be applicable across diverse educational and healthcare settings. These recommendations aim to provide a clear framework for medical schools to prepare graduates with essential emergency care capabilities immediately after completing medical school. The successful distribution and implementation of these recommendations hinge on support from faculty and administrators, ensuring that future healthcare professionals are well-prepared for emergency medical care.
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Affiliation(s)
- Arif Alper Cevik
- Emergency Medicine Section, Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
- Department of Emergency Medicine, Tawam Hospital, Al Ain, UAE.
| | - Elif Dilek Cakal
- Emergency Department, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Kwan
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Simon Chu
- University of Adelaide, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Sithembile Mtombeni
- Department of Emergency Medicine, University of Namibia, Northern Campus, Oshakati, Namibia
| | | | - Nicholas Jouriles
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Andrew Singer
- Australian Government Department of Health and Aged Care, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- The Alfred Hospital, Emergency and Trauma Centre, Melbourne, Australia
| | | | - Abraham Wai
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - David Edwin Manthey
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Cherri Hobgood
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Terrence Mulligan
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edgardo Menendez
- Department of Emergency Medicine, Churruca Hospital UBA, Buenos Aires, Argentina
| | - Juliusz Jakubaszko
- Department of Emergency Medicine, Wroclaw University of Medicine, Wroclaw, Poland
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Zhao Y, Jalloh S, Lam PK, Kwarshak YK, Mbuthia D, Misago N, Namedre M, Phương NTB, Qaloewa S, Summers R, Tang K, Tweheyo R, Wills B, Zhang F, Nicodemo C, Gathara D, English M. Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries. BMJ Glob Health 2023; 8:e013399. [PMID: 37940205 PMCID: PMC10632816 DOI: 10.1136/bmjgh-2023-013399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in low-income and middle-income countries (LMICs) where working conditions and resource constraints are challenging. We describe our process developing and validating a 'medical internship experience scale' to address this gap, work involving nine LMICs that varied in geographical locations, income-level and internship training models. We used a scoping review of existing tools, content validity discussions with target populations and an expert panel, back-and-forth translations into four language versions and cognitive interviews to develop and test the tool. Using data collected from 1646 interns and junior medical doctors, we assessed factor structure and assessed its reliability and validity. Fifty items about experiences of medical internship were retained from an initial pool of 102 items. These 50 items represent 6 major factors (constructs): (1) clinical learning and supervision, (2) patient safety, (3) job satisfaction, (4) stress and burnout, (5) mental well-being, and (6) fairness and discrimination. We reflect on the process of multicountry scale development and highlight some considerations for others who may use our scale, using preliminary analyses of the 1646 responses to illustrate that the tool may produce useful data to identify priorities for action. We suggest this tool could enable LMICs to assess key metrics regarding intern straining and initial work experiences and possibly allow comparison across countries and over time, to inform better internship planning and management.
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Affiliation(s)
- Yingxi Zhao
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Phung Khanh Lam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yakubu Kevin Kwarshak
- Department of Surgery, Division of Urology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | | | - Nadine Misago
- Interdisciplinary Research Group in Public Health / Doctoral School, University of Burundi, Bujumbura, Burundi
| | | | - Nguyễn Thị Bé Phương
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sefanaia Qaloewa
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Richard Summers
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, People's Republic of China
| | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre for Health Systems Research and Development (CHSRD), The University of Free State, Bloemfontein, South Africa
| | - Bridget Wills
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Fang Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, People's Republic of China
| | - Catia Nicodemo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Economics, Verona University, Verona, Italy
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Zhao Y, Mbuthia D, Gathara D, Nzinga J, Tweheyo R, English M. 'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda. BMJ Glob Health 2023; 8:e013398. [PMID: 37940204 PMCID: PMC10632815 DOI: 10.1136/bmjgh-2023-013398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors' internship experiences in Kenya and Uganda. METHODS Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. FINDINGS Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being 'treated like we are nobody'. CONCLUSION We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors' well-being and provide standardised supervision, support systems and conducive learning environments.
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Affiliation(s)
- Yingxi Zhao
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre for Health Systems Research and Development (CHSRD), The University of Free State, Bloemfontein, South Africa
| | - Mike English
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Kuehl SE, Spicer JO. Using entrustable professional activities to better prepare students for their postgraduate medical training: A medical student's perspective. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:359-364. [PMID: 36441351 PMCID: PMC9743878 DOI: 10.1007/s40037-022-00731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
THE PROBLEM Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, a medical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes. A SOLUTION The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work. These factors combined with grading schemes rewarding improvement could contribute to a growth mindset that reprioritizes clinical skill acquisition. The authors explore how medical schools have begun implementing the EPA framework, highlight insights from these efforts, and describe barriers that must be addressed. THE FUTURE Incorporating EPAs into medical school curricula could better prepare students for postgraduate training while also alleviating issues that contribute to student burnout by defining students' roles, improving feedback, and aligning assessments with desired learning outcomes.
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Affiliation(s)
- Sarah E Kuehl
- Emory University School of Medicine and Goizueta Business School, Atlanta, GA, USA.
| | - Jennifer O Spicer
- J. Willis Hurst Internal Medicine Residency Program, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Akinpelu AO, Oyewole OO, Okunade O, Odunaiya N, Odole AC, Bamgboye EA. Nigerian physiotherapists’ perception of physiotherapy internship: perceived expectations, experience, and outcomes. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Physiotherapy internship in Nigeria was inaugurated in 1994 to allow continuous learning in the clinical setting, connecting theoretical knowledge and workplace practice. The internship program has not been evaluated over the years. The aim of study was to assess physiotherapists’ perceptions of the internship in Nigeria in terms of expectations, experiences, and outcomes.
Methods
A mixed method design of a cross-sectional survey and focus group discussion (FGD) was utilized. An adapted questionnaire was used for the survey. Data was assessed using descriptive statistics and content thematic analysis.
Results
The mean age of the physiotherapists who participated in the survey (147 males; 116 females) and FGD (7 males; 2 females) were 27.4 ± 2.5 and 28.8 ± 2.3 years, respectively. Most participants in the survey perceived their internship experience as good (97.7%), the supervision received as adequate (76%), and the outcomes of internship in terms of usefulness as useful (76%). The overall perception of physiotherapy internship in Nigeria was rated as good by 51% and fair by 47% of participants. However, responders in the FGD reported negative experiences including inadequate or lack supervision. They also reported that they were not formally prepared for internship by their training institutions or receiving health institutions before beginning internship.
Conclusion
Physiotherapy internship in Nigeria was perceived as deficient in structural organization and supervision of the interns. The outcome of internship program was perceived as good even though the experiences were negative.
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Zhao Y, Osano B, Were F, Kiarie H, Nicodemo C, Gathara D, English M. Characterising Kenyan hospitals' suitability for medical officer internship training: a secondary data analysis of a cross-sectional study. BMJ Open 2022; 12:e056426. [PMID: 35523483 PMCID: PMC9083393 DOI: 10.1136/bmjopen-2021-056426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To characterise the capacity of Kenya internship hospitals to understand whether they are suitable to provide internship training for medical doctors. DESIGN A secondary data analysis of a cross-sectional health facility assessment (Kenya Harmonized Health Facility Assessment (KHFA) 2018). SETTING AND POPULATION We analysed 61 out of all 74 Kenyan hospitals that provide internship training for medical doctors. OUTCOME MEASURES Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall capacity index was calculated as the mean of 12 domain-specific scores for each facility. RESULTS The average overall capacity index is 69% (95% CI 66% to 72%) for all internship training centres. Hospitals have moderate capacity (over 60%) for most of the general domains, although there is huge variation between hospitals and only 29 out of 61 hospitals have five or more specialists assigned, employed, seconded or part-time-as required by the national guideline. Quality and safety score was low across all hospitals with an average score of 40%. As for major specialties, all hospitals have good capacity for surgery and obstetrics-gynaecology, while mental health was poorest in comparison. Level 5 and 6 facilities (provincial and national hospitals) have higher capacity scores in all domains when compared with level 4 hospitals (equivalent to district hospitals). CONCLUSION Major gaps exist in staffing, equipment and service availability of Kenya internship hospitals. Level 4 hospitals (equivalent to district hospitals) are more likely to have a lower capacity index, leading to low quality of care, and should be reviewed and improved to provide appropriate and well-resourced training for interns and to use appropriate resources to avoid improvising.
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Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Boniface Osano
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
- Kenya Paediatric Research Consortium (KEPRECON), Nairob, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Helen Kiarie
- Division of Monitoring & Evaluation, Ministry of Health, Nairobi, Kenya
| | - Catia Nicodemo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Gathara
- Wellcome Trust Research Program, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
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Choudry ZA, Ayub A, Badar SE. Preparedness of Medical Graduates to serve in clinical settings independently: An exploratory qualitative study. Pak J Med Sci 2022; 38:785-790. [PMID: 35634596 PMCID: PMC9121949 DOI: 10.12669/pjms.38.4.5517] [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] [Received: 10/20/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To assess the preparedness of fresh medical graduates to perform the duties of an effective house officer in clinical settings independently. Methods A qualitative exploratory descriptive study was conducted at a public sector tertiary care teaching hospital from September to October, 2021. A total of 14 interviews of the serving house officers were conducted (7 were from Medicine and Allied and seven were from Surgical and Allied). A verbatim Thematic analysis was done. Results Initial analysis revealed 45 codes which were ultimately reduced to five main themes namely 1. Transition from studentship to house officers with sub-themes (1a) Sense of responsibility, (1b) Hectic and long duty hours, (1c) Proper orientation and guidance, 2. Deficient skill Training during educational journey with, (2a) Deficiency of practical and applied aspects, (2b) inconsistent and varying training patterns, (2c) self-perception and evaluation of preparedness, 3. Lack of awareness about Hospital settings and working system with sub-themes (3a) Support from other doctors, (3b) Being recognized as a doctor in hospital, 4. Inter-professional co-ordination gaps having sub-themes (4a) Communication gap, (4b) Mutual respect as a team and 5. Impact of COVID-19 with sub-theme (5a) Online teaching with no interaction and (5b) segue and progressive skill training. Conclusion Medical graduates are not confident and well prepared to take the responsibility of patient care independently in clinical settings. Reforms in undergraduate curricula regarding skill training, hospital setup and workings and inter-professional education are advocated by young doctors to enhance their competencies for professional life.
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Affiliation(s)
- Zafar Ali Choudry
- Prof. Dr. Zafar Ali Choudry, FCPS, FRCS. Vice Chancellor, Faisalabad Medical University, Faisalabad, Pakistan
| | - Ayesha Ayub
- Dr. Ayesha Ayub, MBBS, MME/MHPE. Demonstrator, HPERD Department, Faisalabad Medical University, Faisalabad, Pakistan
| | - Sumera Ehsan Badar
- Dr. Sumera Ehsan Badar, MBBS, M.Phil., MME, Assistant Professor and HOD HPERD Department, Faisalabad Medical University, Faisalabad, Pakistan
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Fant C, Olwala M, Laanoi GM, Murithi G, Otieno W, Groothuis E, Doobay Persaud A. Virtual Faculty Development in Simulation in Sub-Saharan Africa: A Pilot Training for Pediatricians in Kisumu, Kenya. Front Pediatr 2022; 10:957386. [PMID: 36210954 PMCID: PMC9538528 DOI: 10.3389/fped.2022.957386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Simulation is an effective educational tool increasingly being utilized in medical education globally and across East Africa. Globally, pediatric patients often present with low frequency, high acuity disease and simulation-based training in pediatric emergencies can equip physicians with the skills to recognize and intervene. Northwestern University (NU) in Chicago, IL, USA, and Maseno University (MU), in Kisumu, Kenya launched a predominantly virtual partnership in 2020 to utilize the Jaramogi Oginga Odinga Teaching & Referral Hospital (JOOTRH) simulation center for MU faculty development in simulation based medical education (SBME) for medical students. MATERIALS AND METHODS Educational goals, learning objectives, and educational content were collaboratively developed between MU and NU faculty. Virtual sessions were held for didactic education on simulation pedagogy, case development, and debriefing. Mixed educational methods were used including virtual mentored sessions for deliberate practice, piloted case facilitation with medical students, and mentored development of MU identified cases. Trained faculty had the summative experience of an intensive simulation facilitation with graduating MU students. MU faculty and students were surveyed on their experiences with SBME and MU faculty were scored on facilitation technique with a validated tool. RESULTS There were four didactic sessions during the training. Seven cases were developed to reflect targeted educational content for MU students. Six virtually mentored sessions were held to pilot SBME with MU students. In July 2021, fifty students participated in a week-long SBME course led by the MU trained faculty with virtual observation and mentorship from NU faculty. MU faculty reported positive experience with the SBME training and demonstrated improvement in debriefing skills after the training. The overwhelming majority of MU students reported positive experiences with SBME and endorsed desire for earlier and additional sessions. DISCUSSION AND CONCLUSIONS This medical education partnership, developed through virtual sessions, culminated in the implementation of an independently run simulation course by three trained MU faculty. SBME is an important educational tool and faculty in a resource constrained setting were successfully, virtually trained in its implementation and through collaborative planning, became a unique tool to address gaps for medical students.
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Affiliation(s)
- Colleen Fant
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Center for Global Health Education, Feinberg School of Medicine, Havey Institute for Global Health, Northwestern University, Chicago, IL, United States
| | - Macrine Olwala
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Grace M Laanoi
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya.,Maseno University School of Medicine, Kisumu, Kenya
| | | | - Walter Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya.,Maseno University School of Medicine, Kisumu, Kenya
| | - Elizabeth Groothuis
- Center for Global Health Education, Feinberg School of Medicine, Havey Institute for Global Health, Northwestern University, Chicago, IL, United States.,Division of Hospital-Based Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ashti Doobay Persaud
- Center for Global Health Education, Feinberg School of Medicine, Havey Institute for Global Health, Northwestern University, Chicago, IL, United States.,Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Undergraduate Surgical Education: a Global Perspective. Indian J Surg 2021; 84:153-161. [PMID: 34177158 PMCID: PMC8219345 DOI: 10.1007/s12262-021-02975-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.
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Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
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Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Prozesky DR, Molwantwa MC, Nkomazana O, Kebaetse MB. Intern preparedness for the CanMEDS roles and the Dunning-Kruger effect: a survey. BMC MEDICAL EDUCATION 2019; 19:422. [PMID: 31727028 PMCID: PMC6854771 DOI: 10.1186/s12909-019-1836-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/03/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether the first cohort of graduates from a new undergraduate medical programme in Botswana were adequately prepared for internship. METHODS The authors surveyed 27 interns and 13 intern supervisors on site, who rated intern preparedness for 44 tasks using a previously validated instrument. Tasks were grouped according to the seven roles of the physician in the CanMEDS framework and Cronbach α values confirmed internal consistency. To determine the direction of differences between intern and supervisor ratings for tasks Likert scale ratings were treated as interval data and mean scores calculated. Rating frequencies for each role were compared using the χ2 statistic. Reasons for differences between intern and supervisor ratings were explored by determining correlations between scores using the Spearman ρ statistic, and analysing qualitative data generated by the questionnaire. RESULTS Preparedness for all seven roles and the majority of tasks was found to be between 'Fairly well prepared' and 'Well prepared'. The ratings for four roles (Medical expert, Communicator, Collaborator, Professional) differed statistically, but not for the three others (Leader, Health advocate, Scholar). Interns rated their proficiency higher than their supervisors for the tasks in six roles; for the 'Professional' role intern ratings were mostly lower. Correlations between intern and supervisors scores were only significant for three roles (Medical expert, Communicator, Collaborator). Qualitative data provided further insights into the reasons for these associations. CONCLUSIONS Intern preparedness for tasks and roles varied but was generally satisfactory. Based on the analysis of the data seeming discrepancies in between interns and supervisor ratings were investigated and explanations are offered. For three roles the data indicate that their component tasks are understood in the same way by interns and supervisors, but not for the other roles. The Dunning-Kruger effect offers a plausible explanation for higher intern scores for tasks in six of the roles. For the 'Professional' role differences between interns' internal, individual understanding and supervisors' external, group understanding may explain lower intern scores. The fact that respondents may understand the tasks they rate differently has implications for all research of this nature.
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Affiliation(s)
| | | | - Oathokwa Nkomazana
- Faculty of Medicine, University of Botswana, Private Bag UB, 0022 Gaborone, Botswana
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Mohan M, Ravindran TS. Conceptual Framework Explaining “Preparedness for Practice” of Dental Graduates: A Systematic Review. J Dent Educ 2018; 82:1194-1202. [DOI: 10.21815/jde.018.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/27/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Malu Mohan
- Achuta Menon Centre for Health Science Studies; Sree Chitra Tirunal Institute of Biomedical Sciences and Technology; Thiruvananthapuram Kerala India
| | - T.K. Sundari Ravindran
- Achuta Menon Centre for Health Science Studies; Sree Chitra Tirunal Institute of Biomedical Sciences and Technology; Thiruvananthapuram Kerala India
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Yardley S, Westerman M, Bartlett M, Walton JM, Smith J, Peile E. The do's, don't and don't knows of supporting transition to more independent practice. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:8-22. [PMID: 29383578 PMCID: PMC5807269 DOI: 10.1007/s40037-018-0403-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Transitions are traditionally viewed as challenging for clinicians. Throughout medical career pathways, clinicians need to successfully navigate successive transitions as they become progressively more independent practitioners. In these guidelines, we aim to synthesize the evidence from the literature to provide guidance for supporting clinicians in their development of independence, and highlight areas for further research. METHODS Drawing upon D3 method guidance, four key themes universal to medical career transitions and progressive independence were identified by all authors through discussion and consensus from our own experience and expertise: workplace learning, independence and responsibility, mentoring and coaching, and patient perspectives. A scoping review of the literature was conducted using Medline database searches in addition to the authors' personal archives and reference snowballing searches. RESULTS 387 articles were identified and screened. 210 were excluded as not relevant to medical transitions (50 at title screen; 160 at abstract screen). 177 full-text articles were assessed for eligibility; a further 107 were rejected (97 did not include career transitions in their study design; 10 were review articles; the primary references of these were screened for inclusion). 70 articles were included of which 60 provided extractable data for the final qualitative synthesis. Across the four key themes, seven do's, two don'ts and seven don't knows were identified, and the strength of evidence was graded for each of these recommendations. CONCLUSION The two strongest messages arising from current literature are first, transitions should not be viewed as one moment in time: career trajectories are a continuum with valuable opportunities for personal and professional development throughout. Second, learning needs to be embedded in practice and learners provided with authentic and meaningful learning opportunities. In this paper, we propose evidence-based guidelines aimed at facilitating such transitions through the fostering of progressive independence.
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Affiliation(s)
- Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK.
| | | | | | - J Mark Walton
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Ed Peile
- St Catherine's College, Oxford, UK
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Al Sinawi H, Al Alawi M, Al Qubtan A, Al Lawati J, Al Habsi A, Jose S. Perception of Preparedness for Clinical Work Among New Residents: A Cross-sectional Study from Oman. Oman Med J 2017; 32:201-206. [PMID: 28584600 DOI: 10.5001/omj.2017.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate new residents' perceptions of their own preparedness for clinical practice and examine the associated factors. METHODS This is a cross-sectional study conducted on August 20-23, 2016. New residents accepted for postgraduate training by Oman Medical Specialty Board were asked to complete the Preparation for Hospital Practice Questionnaire (PHPQ). Data was analyzed using the Statistical Package for the Social Sciences version 22. RESULTS A total of 160 residents were invited to participate in this study. Out of 160, 140 residents participated (87.5%), 70.7% were female and 59.3% were graduates from Sultan Qaboos University (SQU). Ninety-nine percent of the graduates were either 'well prepared' or 'fairly well prepared' for hospital practice. Male residents scored higher in the confidence scale, while residents who did a post-internship general practice placement scored higher in understanding science. Graduates from Oman Medical College felt more prepared compared to graduates from SQU. CONCLUSIONS Most of the new residents were well prepared to clinical work. Factors such as place of undergraduate study, training, and duration of internship significantly influenced the residents' perception of preparedness. Addressing these factors will enhance residents' preparedness for clinical work.
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Affiliation(s)
- Hamed Al Sinawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Al Alawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al Qubtan
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Jaber Al Lawati
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Assad Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sachin Jose
- Department of Research, Oman Medical Specialty Board, Muscat, Oman
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Gyedu A, Agbedinu K, Dalwai M, Osei-Ampofo M, Nakua EK, Oteng R, Stewart B. Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care. Pan Afr Med J 2016; 24:294. [PMID: 28154649 PMCID: PMC5267868 DOI: 10.11604/pamj.2016.24.294.8728] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/02/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction The incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage. Methods Sixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard. Results Fifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric. Conclusion Although the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwabena Agbedinu
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mohammed Dalwai
- Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel Kweku Nakua
- Department of Population, Family and Reproductive Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rockefeller Oteng
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI, USA
| | - Barclay Stewart
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
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