1
|
Chan GWH, Chua MT, Lee SK, Krishna LKR. Willingness of physicians to teach ethics at the bedside: a qualitative study from an Asian perspective. Singapore Med J 2024:00077293-990000000-00075. [PMID: 38189481 DOI: 10.4103/singaporemedj.smj-2022-025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/11/2022] [Indexed: 01/09/2024]
Affiliation(s)
- Gene Wai Han Chan
- Emergency Medicine Department, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sock Koon Lee
- Emergency Medicine Department, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre of Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
| |
Collapse
|
2
|
Lönn A, Weurlander M, Seeberger A, Hult H, Thornberg R, Wernerson A. The impact of emotionally challenging situations on medical students' professional identity formation. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1557-1578. [PMID: 37184676 PMCID: PMC10184105 DOI: 10.1007/s10459-023-10229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students' experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students' professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students' reflective essays at the end of their education (tenth term). The analysis showed that students' main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students' development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.
Collapse
Affiliation(s)
- Annalena Lönn
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden.
| | - Maria Weurlander
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Astrid Seeberger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| | - Håkan Hult
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| | - Robert Thornberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| |
Collapse
|
3
|
Ho JY, Tuang V, Teo DB, Ponnamperuma G. Development and validation of a new self-assessment tool to measure professionalism among medical students. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:457-466. [PMID: 38920192 DOI: 10.47102/annals-acadmedsg.2022457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Professionalism is a key quality that medical students should possess, but it is difficult to define and assess. Current assess-ment tools have room for improvement. This study aimed to design and validate a self-assessment tool to assess professionalism among medical students. Method A questionnaire was created based on 10 tenets of professionalism from the Charter on Medical Professionalism jointly published by the American Board of Internal Medicine Foundation, American College of Physicians Foundation and European Federation of Internal Medicine, along with input from Singapore guides. The self-administered questionnaire was administered to Year 2 to 5 students from Yong Loo Lin School of Medicine, National University of Singapore in a voluntary, anonymised manner in the academic year of 2019/2020. Construct validity and internal reliability were evaluated using Principal Component Analysis (PCA) and Cronbach's alpha, respectively. Results There was a total of 541 respondents. After removing incomplete responses, 504 responses were included. Following PCA, a 17-item questionnaire titled "Medical Professionalism: A Self-assessment Tool" (MPAST) with a 5-component solution was obtained. The 5 components were commit-ment to: (1) patient's best interest, (2) honesty and integrity, (3) professional competency, (4) patient safety and care, and (5) educational responsibilities. Their Cronbach's alpha value ranged from 0.540 to 0.714, with an overall Cronbach's alpha value of 0.777. Conclusion MPAST is valid, reliable, practical, and is the first validated self-assessment tool to assess professional attributes and behaviours among medical students, to our knowledge.
Collapse
Affiliation(s)
- Jin Yang Ho
- Internal Medicine, National University Health System, Singapore
| | | | - Desmond B Teo
- Fast and Chronic Programmes, Alexandra Hospital, Singapore
| | - Gominda Ponnamperuma
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
4
|
Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity. PLoS One 2020; 15:e0228450. [PMID: 32032394 PMCID: PMC7006897 DOI: 10.1371/journal.pone.0228450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/15/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment. Methods Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs. Results Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions. Conclusions These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.
Collapse
|
5
|
Guraya SY, Guraya SS, Mahabbat NA, Fallatah KY, Al-Ahmadi BA, Alalawi HH. The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine. J Clin Diagn Res 2016; 10:JE01-5. [PMID: 27437247 DOI: 10.7860/jcdr/2016/19917.7832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
Abstract
Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms "professionalism" AND "duty" AND "assessment" OR "professionalism behavioural" AND "professionalism-cognitive" were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.
Collapse
Affiliation(s)
- Salman Y Guraya
- Professor, Department of Surgery and Consultant Colorectal Surgeon, College of Medicine Taibah University Almadinah Almunawwarah, Saudi Arabia
| | - Shaista S Guraya
- Assistant Professor, Department of Radiology, College of Medicine Taibah University Almadinah Almunawwarah, Saudi Arabia
| | - Nehal Anam Mahabbat
- Resident, Department of Plastic Surgery, National Guards Hospital , Riyadh, Saudi Arabia
| | - Khulood Yahya Fallatah
- Resident, Department of Dermatology, Maternity and Children Hospital , Riyadh, Saudi Arabia
| | - Bashaer Ahmad Al-Ahmadi
- Resident, Department of Pediatrics, Prince Sultan Military Medical City , Riyadh, Saudi Arabia
| | - Hadeel Hadi Alalawi
- Resident, Department of Surgery Orthopeadic, Prince Sultan Armed Forces Hospital , Almadinah Almunawwarah, Saudi Arabia
| |
Collapse
|
6
|
Langendyk V, Mason G, Wang S. How do medical educators design a curriculum that facilitates student learning about professionalism? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:32-43. [PMID: 26845777 PMCID: PMC4744412 DOI: 10.5116/ijme.5683.c2e0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/30/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study analyses the ways in which curriculum reform facilitated student learning about professionalism. METHODS Design-based research provided the structure for an iterative approach to curriculum change which we undertook over a 3 year period. The learning environment of the Personal and Professional Development Theme (PPD) was analysed through the sociocultural lens of Activity Theory. Lave and Wenger's and Mezirow's learning theories informed curriculum reform to support student development of a patient-centred and critically reflective professional identity. The renewed pedagogical outcomes were aligned with curriculum content, learning and teaching processes and assessment, and intense staff education was undertaken. We analysed qualitative data from tutor interviews and free-response student surveys to evaluate the impact of curriculum reform. RESULTS Students' and tutors' reflections on learning in PPD converged on two principle themes--'Developing a philosophy of medicine' and 'Becoming an ethical doctor'--which corresponded to the overarching PPD theme aims of communicative learning. Students and tutors emphasised the importance of the unique learning environment of PPD tutorials for nurturing personal development and the positive impact of the renewed assessment programme on learning. CONCLUSIONS A theory-led approach to curriculum reform resulted in student engagement in the PPD curriculum and facilitated a change in student perspective about the epistemological foundation of medicine.
Collapse
Affiliation(s)
- Vicki Langendyk
- Medical Education Unit, School of Medicine, Western Sydney University, Australia
| | - Glenn Mason
- Medical Education Unit, School of Medicine, Western Sydney University, Australia
| | - Shaoyu Wang
- School of Community Health, Charles Sturt University, Australia
| |
Collapse
|
7
|
Yu E, Wright SM. "Beginning with the end in mind": imagining personal retirement speeches to promote professionalism. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:790-793. [PMID: 25785681 DOI: 10.1097/acm.0000000000000690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PROBLEM The goal of teaching professionalism in medicine is to transform a theoretical concept into an internalized and actualized identity. Many trainees struggle with professionalism in the abstract, particularly when instruction methods are didactic and disconnected from personal experience. APPROACH The authors aim to demonstrate the feasibility of having interns frame a personal definition of professionalism based on a reflective technique called "beginning with the end in mind." Interns composed remarks that might be used to introduce them at their own retirement ceremony following a career in medicine. This "career eulogies" exercise was introduced to groups of six interns during the first third of the internship year as part of a two-week curriculum focused on professional development. Two investigators independently coded the written introductions, identifying emergent themes through content analysis. OUTCOMES Of the 19 interns in an internal medicine residency program (2012-13), 17 participated in the exercise. Six themes emerged from the data: aligning behaviors with core values, achieving excellence in medicine, changing the world and giving back, valuing teamwork and relationships, realizing work-life balance, and appreciating a career in medicine. These themes correlate with accepted published definitions of professionalism. NEXT STEPS The personal reflections produced through this exercise allow physicians to begin to formulate their professional self-conception. Extensions of this work might include linking such forms of critical reflection to individualized learning plans and updating the speeches over time. Further research on "reflecting forward" may determine its impact as a complement to traditional narrative reflection.
Collapse
Affiliation(s)
- Eunice Yu
- E. Yu is a resident in internal medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland. S.M. Wright is professor, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
8
|
Abstract
This article considers the role of the clinical leader as a team member and leader and explores how an understanding of the purpose and functions of teams can help doctors work more effectively in the various teams with which they are involved.
Collapse
Affiliation(s)
- Helen O'Sullivan
- Professor of Medical Education, School of Medicine, University of Liverpool, Liverpool L69 3BX
| | - Michael J Moneypenny
- Director of Scottish Clinical Simulation Centre, Forth Valley Royal Hospital, Larbert
| | - Judy McKimm
- Director of Strategic Educational Development, College of Medicine, Swansea University, Swansea
| |
Collapse
|
9
|
Penciner R, Woods RA, McEwen J, Lee R, Langhan T. Core competencies for emergency medicine clerkships: results of a Canadian consensus initiative. CAN J EMERG MED 2015. [DOI: 10.2310/8000.2012.120686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTObjectives:There is no consensus on what constitutes the core competencies for emergency medicine (EM) clerkship rotations in Canada. Existing EM curricula have been developed through informal consensus and often focus on EM content to be known at the end of training rather than what is an appropriate focus for a time-limited rotation in EM. We sought to define the core competencies for EM clerkship in Canada through consensus among an expert panel of Canadian EM educators.Methods:We used a modified Delphi method and the CanMEDS 2005 Physician Competency Framework to develop a consensus among expert EM educators from across Canada.Results:Thirty experts from nine different medical schools across Canada participated on the panel. The initial list consisted of 152 competencies organized in the seven domains of the CanMEDS 2005 Physician Competency Framework. After the second round of the Delphi process, the list of competencies was reduced to 62 (59% reduction). A complete list of competencies is provided.Conclusion:This study established a national consensus defining the core competencies for EM clerkship in Canada.
Collapse
|
10
|
Jha V, Mclean M, Gibbs TJ, Sandars J. Medical professionalism across cultures: a challenge for medicine and medical education. MEDICAL TEACHER 2015; 37:74-80. [PMID: 25073712 DOI: 10.3109/0142159x.2014.920492] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND The recognition of medical professionalism as a complex social construct makes context, geographical location and culture important considerations in any discussion of professional behaviour. Medical students, medical educators and practitioners are now much more on the move globally, exposing them to cultural and social attitudes, values and beliefs that may differ from their own traditional perceptions of professionalism. AIMS AND METHODS This paper uses the model of the intercultural development continuum and the concept of "cultural fit" to discuss what might transpire when a student, teacher or doctor is faced with a new cultural environment. Using our own experiences as medical educators working abroad and supported by evidence in the literature, we have developed four anecdotal scenarios to highlight some of the challenges that different cultural contexts bring to our current (Western) understanding of professionalism. RESULTS AND CONCLUSIONS The scenarios highlight some of the potentially different regional and/or cultural perspectives and nuances of professional behaviours, attitudes or values that many of us either take for granted or find difficult, depending on our training and socio-cultural upbringing. With this paper, we hope to start a long overdue conversation about global professionalism amongst medical educators, identify potential areas for research and highlight a need for medical schools to embrace a "global" approach to how professionalism is embedded in their curricula.
Collapse
|
11
|
“Addiction Pharmacy” and the Professionalization Process: Technology-Enhanced Assessment of Reflective Practice and Teamwork. PHARMACY 2014. [DOI: 10.3390/pharmacy2020175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
12
|
Hodgson JL, Pelzer JM, Inzana KD. Beyond NAVMEC: competency-based veterinary education and assessment of the professional competencies. JOURNAL OF VETERINARY MEDICAL EDUCATION 2013; 40:102-118. [PMID: 23709107 DOI: 10.3138/jvme.1012-092r] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The implementation of competency-based curricula within the health sciences has been an important paradigm shift over the past 30 years. As a result, one of the five strategic goals recommended by the North American Veterinary Medical Education Consortium (NAVMEC) report was to graduate career-ready veterinarians who are proficient in, and have the confidence to use, an agreed-upon set of core competencies. Of the nine competencies identified as essential for veterinary graduates, seven could be classified as professional or non-technical competencies: communication; collaboration; management (self, team, system); lifelong learning, scholarship, value of research; leadership; diversity and multicultural awareness; and adaptation to changing environments. Traditionally, the professional competencies have received less attention in veterinary curricula and their assessment is often sporadic or inconsistent. In contrast, the same or similar competencies are being increasingly recognized in other health professions as essential skills and abilities, and their assessment is being undertaken with enhanced scrutiny and critical appraisal. Several challenges have been associated with the assessment of professional competencies, including agreement as to their definition and therefore their evaluation, the fact that they are frequently complex and require multiple integrative assessments, and the ability and/or desire of faculty to teach and assess these competencies. To provide an improved context for assessment of the seven professional competencies identified in the NAVMEC report, this article describes a broad framework for their evaluation as well as specific examples of how these or similar competencies are currently being measured in medical and veterinary curricula.
Collapse
Affiliation(s)
- Jennifer L Hodgson
- Virginia Maryland Regional College of Veterinary Medicine, Virginia Polytechnic & State University, Blackburg, VA 24061, USA.
| | | | | |
Collapse
|