1
|
Fantaye AW, Gnyra C, Lochnan H, Wiesenfeld L, Hendry P, Whiting S, Kitto S. Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:204-210. [PMID: 36007518 DOI: 10.1097/ceh.0000000000000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Abstract:
There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.
Collapse
Affiliation(s)
- Arone Wondwossen Fantaye
- Mr. Fantaye: Research Associate, Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Ms. Gnyra: Medical Student, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Dr. Lochnan: Assistant Dean, Office of Continuing Professional Development, Faculty of Medicine; Professor, Department of Medicine, University of Ottawa; Head, Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, ON, Canada. Dr. Wiesenfeld: Vice-Dean, Postgraduate Medical Education, Faculty of Medicine; Assistant Professor, Department of Emergency Medicine, University of Ottawa; Attending Staff, Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada. Dr. Hendry: Vice-Dean, Office of Continuing Professional Development, Faculty of Medicine; Professor, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. Dr. Whiting: Vice-Dean, Faculty Affairs, Faculty of Medicine; Associate Professor, Department of Pediatrics, University of Ottawa; Staff Physician, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. Dr. Kitto: Professor, Department of Innovation in Medical Innovation; Director of Research, Office of Continuing Professional Development, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
2
|
Fantaye AW, Kitto S, Hendry P, Wiesenfeld L, Whiting S, Gnyra C, Fournier K, Lochnan H. Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:57-72. [PMID: 35572019 PMCID: PMC9099178 DOI: 10.36834/cmej.73241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards. METHODS We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature. RESULTS We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers. CONCLUSIONS The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.
Collapse
Affiliation(s)
| | - Simon Kitto
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ontario, Canada
| | - Paul Hendry
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ontario, Canada
| | - Lorne Wiesenfeld
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada
- Postgraduate Medical Education, University of Ottawa, Ontario, Canada
| | - Sharon Whiting
- Children's Hospital of Eastern Ontario, Ontario, Canada
- Office of Faculty of Affairs, University of Ottawa, Ontario, Canada
| | | | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ontario, Canada
| | - Heather Lochnan
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario
| |
Collapse
|
3
|
Stein GH, Tokunaga H, Ando H, Obika M, Miyoshi T, Tokuda Y, Bautista M, Kataoka H, Terasawa H. Preliminary report of a Web-based instrument to assess and teach knowledge and clinical thinking to medical student. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:1-6. [PMID: 25341203 PMCID: PMC4207184 DOI: 10.5116/ijme.52a7.7280] [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: 03/26/2013] [Accepted: 12/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE We report the preliminary development of a unique Web-based instrument for assessing and teaching knowledge and developing clinical thinking called the "Sequential Questions and Answers" (SQA) test. Included in this feasibility report are physicians' answers to the Sequential Questions and Answers pre- and posttests and their brief questionnaire replies. METHODS The authors refined the SQA test case scenario for content, ease of modifications of case scenarios, test uploading and answer retrieval. Eleven geographically distant physicians evaluated the SQA test, taking the pretest and posttest within two weeks. These physicians completed a brief questionnaire about the SQA test. RESULTS Eleven physicians completed the SQA pre- and posttest; all answers were downloaded for analysis. They reported the ease of website login and navigating within the test module together with many helpful suggestions. Their average posttest score gain was 53% (p=0.012). CONCLUSIONS We report the successful launch of a unique Web-based instrument referred to as the Sequential Questions and Answers test. This distinctive test combines teaching organization of the clinical narrative into an assessment tool that promotes acquiring medical knowledge and clinical thinking. We successfully demonstrated the feasibility of geographically distant physicians to access the SQA instrument. The physicians' helpful suggestions will be added to future SQA test versions. Medical schools might explore the integration of this multi-language-capable SQA assessment and teaching instrument into their undergraduate medical curriculum.
Collapse
Affiliation(s)
- Gerald H Stein
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hironobu Tokunaga
- Department of Emergency Medicine, University of Fukui, Faculty of Medical Sciences, Fukui, Japan
| | - Hirotaka Ando
- Department of Emergency Medicine, University of Fukui, Faculty of Medical Sciences, Fukui, Japan
| | - Mikako Obika
- Centers for Graduate Medical Education, Okayama, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tomoko Miyoshi
- Department of Medical Education and Primary Care, Okayama University School of Medicine, Okayama, Japan
| | - Yasuharu Tokuda
- Mito Medical Center, University of Tsukuba Hospital, Institute of Clinical Medic ine, University of Tsukuba, Ibaraki, Japan
| | - Miho Bautista
- Department of Aging and Geriatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hitomi Kataoka
- Department of Medical Education and Primary Care, Okayama University School of Medicine, Okayama, Japan
| | - Hidekazu Terasawa
- Department of Emergency Medicine, University of Fukui, Faculty of Medical Sciences, Fukui, Japan
| |
Collapse
|
4
|
Takata Y, Stein GH, Endo K, Arai A, Kohsaka S, Kitano Y, Honda H, Kitazono H, Tokunaga H, Tokuda Y, Obika M, Miyoshi T, Kataoka H, Terasawa H. Content analysis of medical students' seminars: a unique method of analyzing clinical thinking. BMC MEDICAL EDUCATION 2013; 13:156. [PMID: 24289320 PMCID: PMC4220556 DOI: 10.1186/1472-6920-13-156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 11/25/2013] [Indexed: 05/31/2023]
Abstract
BACKGROUND The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar). METHODS The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students' verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking. RESULTS The most basic level of verbal simple responses accounted for a majority (85%) of the total students' verbal comments. Only 15% of the students' comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students' verbal response time for the four sessions with the male instructor was 6.9%; total mean students' verbal response time for the four sessions with the female instructor was 19% (p < 0.05). CONCLUSIONS This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.
Collapse
Affiliation(s)
- Yukari Takata
- University of Florida College of Journalism and Communications, Gainesville, Florida, USA
| | - Gerald H Stein
- Department of Medicine and Veterans Affairs Medical Center, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Akiko Arai
- University of Florida College of Health and Human Performance, Gainesville, Florida, USA
| | - Shun Kohsaka
- Keio University School of Medicine, Tokyo, Japan
| | - Yuka Kitano
- St Marianna University School of Medicine, Kanazawa, Japan
| | | | | | - Hironobu Tokunaga
- Department of Emergency Medicine, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Yasuharu Tokuda
- Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba School of Medicine, Mito, Ibaraki, Japan
| | - Mikako Obika
- Center for Graduate Medical Education, Okayama University Medical School, Okayama, Japan
| | - Tomoko Miyoshi
- Department of Medical Education and Primary Care, Okayama University Medical School, Okayama, Japan
| | - Hitomi Kataoka
- Department of Medical Education and Primary Care, Okayama University Medical School, Okayama, Japan
| | - Hidekazu Terasawa
- Department of Emergency Medicine, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| |
Collapse
|