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Smith SE, Livingston P, Carney E, Mardon J, Tallentire VR. Snakes and ladders: An integrative literature review of refugee doctors' workforce integration needs. MEDICAL EDUCATION 2024; 58:782-796. [PMID: 38102966 DOI: 10.1111/medu.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Healthcare systems worldwide are facing a workforce crisis; meanwhile, refugee doctors throughout the world face difficulties in accessing work. The aims of this review were to explore the integration needs of refugee doctors into host healthcare systems from the refugee perspective, synthesise the literature to construct a theory of refugee doctor integration needs and explore how these needs are met or challenged on the pathway to full integration. METHODS In this integrative literature review, 11 databases and eight grey literature sources were searched by combining terms for refugee doctor and social integration and limiting to research published in or after 2003. Data were extracted, and quality scoring was completed independently by two researchers. This study utilised template analysis to perform a qualitative synthesis of the data. The multidimensional template included a pre-defined template based on a theoretical framework and a concurrent fully inductive template. RESULTS Twenty-two papers were included, incorporating the views of 339 doctors from 30 different home countries and 10 different host countries. The resultant theory included 'foundations' (rights and responsibilities) and three pillars. The 'learning' pillar included required knowledge and skills acquisition. The 'being' pillar encompassed necessary identity work. The 'connecting' pillar comprised social connections, which impacted all other domains. The random and non-linear path to integration faced by refugee doctors was also presented as a serious game. DISCUSSION This study produced a theory exploring refugee doctors' integration needs and how these are met or challenged. Medical educators developing courses for refugee doctors should attend not only to knowledge and skills acquisition but also social connections, identity work and rights and responsibilities. The theory highlights the central importance of social connections. Medical educators can therefore have a transformative impact on refugee doctors' integration. This may also contribute to society by helping to alleviate the workforce crisis.
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Affiliation(s)
- Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- NHS Lothian, Edinburgh, UK
| | | | | | - Julie Mardon
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Emergency Medicine and Clinical Integration, NHS Forth Valley, Larbert, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- NHS Lothian, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
- NHS Education for Scotland, Edinburgh, UK
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Mokhachane M, Wyatt T, Kuper A, Green-Thompson L, George A. Graduates' Reflections on Professionalism and Identity: Intersections of Race, Gender, and Activism. TEACHING AND LEARNING IN MEDICINE 2024; 36:312-322. [PMID: 37334670 DOI: 10.1080/10401334.2023.2224306] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023]
Abstract
Phenomenon: Professionalism as a construct is weaponized to police and punish those who do not fit the norm of what a medical professional should look like or behave, more so when medical professionals in training engage in protests for social justice. In addition, professionalism silences trainees, forcing them not to question anything that looks or feels wrong in their eyes. Socialization in medicine, in both the undergraduate and postgraduate training spaces, poses challenges for contemporary medical professionals who are expected to fit the shape of the 'right kind of doctor.' Intersectionality seems to impact how medical trainees experience professionalism, be it intersections of gender, race, how they dress or adorn themselves, how they carry themselves and who they identify as. Although there is literature on the challenges pertaining to professionalism, not much has been written about the weaponization of professionalism in medical training, particularly in the South African context. There is also a paucity of data on experiences of professionalism during or after social upheaval. Approach: This is part of a study that explored the experiences of professionalism of five medical trainees during protests and after protests, extending into their postgraduate training. The main study had 13 participants, eight students and five graduates, who were all interviewed in 2020, five years after the #FeesMustFall protests. For the five postgraduate participants, we looked at how gender, race, hairstyles, adornment, and protests played out in the experiences of professionalism as medical trainees at a South African university. We employed a qualitative phenomenological approach. An intersectional analytical lens was used in analyzing the transcripts of the five graduate participants. Each transcript was translated as the story of that participant. These stories were compared, looking for commonalities and differences in terms of their experiences. Findings: The participants, four males (three Black and one white) and one Black female, were victimized or judged based on their activism for social justice, gender, and race. They were made to feel that having African hairstyles or piercings was not professional. Insights: Society and the medical profession has a narrow view of what a doctor should look like and behave - it should not be someone who wears their hair in locks, has body piercing, or is an activist, least of all if she is a woman, as professionalism is used as a weapon against all these characteristics. Inclusivity should be the norm in medical education.
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Affiliation(s)
- Mantoa Mokhachane
- Unit of Undergraduate Medical Education, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Tasha Wyatt
- Centre for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ayelet Kuper
- Department of Medicine and The Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lionel Green-Thompson
- Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa
| | - Ann George
- Centre for Health Science Education, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Kent F, Haruta J. Culture and context in Interprofessional education: Expectations in Australia and Japan. MEDICAL EDUCATION 2024. [PMID: 38728120 DOI: 10.1111/medu.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.
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Affiliation(s)
- Fiona Kent
- Education Portfolio, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Health Professions Education Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
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Cunningham IM, Gormley M, Neville P. Contemporary dental student professionalism: moving towards a macro-level perspective. Br Dent J 2024; 236:631-636. [PMID: 38671122 PMCID: PMC11052704 DOI: 10.1038/s41415-024-7297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 04/28/2024]
Abstract
Defining professionalism and developing educational interventions that foster and assess student professionalism are integral to dental education. Nevertheless, conceptual, methodological and pedagogic differences define the academic field, leaving students, educators and the profession itself struggling to make meaningful progress on how best to elicit and monitor dental student professionalism. This article proposes that more progress can be made on this important issue when a contextualised, sociological assessment of dentistry and dental professionalism is undertaken. We contend that identifying some of the socio-cultural demands in UK dental students' lives, and acknowledging how these pressures shape their interactions with the UK dental education system, provides a nuanced and contemporaneous understanding of what it means to be an oral health care professional at a time of social and health care upheaval. Dental educators can use this insight to work towards being more understanding of and responsive to dental student professional development.
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Affiliation(s)
| | - Mark Gormley
- Consultant Senior Lecturer in Oral Surgery, Bristol Dental School, University of Bristol, UK
| | - Patricia Neville
- Senior Lecturer, Bristol Dental School, University of Bristol, UK
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Kang YJ, Lin Y, Rho J, Ihm J, Kim DH. The hidden hurdles of clinical clerkship: unraveling the types and distribution of professionalism dilemmas among South Korean medical students. BMC MEDICAL EDUCATION 2024; 24:150. [PMID: 38360613 PMCID: PMC10870601 DOI: 10.1186/s12909-024-05115-9] [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: 10/04/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND To improve the medical professionalism of medical students, it is essential to understand the dilemmas they face in various situations. This study explored the types and distribution of dilemmas Korean medical students encounter during their clinical clerkships. It then compared these with previous dilemma frameworks and identified the types and distribution of "complexity dilemmas," wherein two dilemma themes emerge in a single clinical situation. METHODS The researchers organized and recorded a group discussion with 106 third-year medical students who had completed their clinical clerkships. These students participated in the discussion as part of an assignment, focusing on the dilemmas they encountered during their clerkships. For data analysis and visualization, the researchers employed the MAXQDA software program and utilized the template analysis method, a qualitative research methodology. RESULTS A total of seven dilemma themes and sixteen sub-themes were identified. The identity-related dilemma concerning student-doctors had the highest frequency. The themes "mismatch" and "Nun-chi" emerged as new additions not found in previous dilemma frameworks. The complexity dilemmas appeared in the sequence of "identity-dignity," "identity-abuse," and "identity-consent". CONCLUSIONS To navigate the unique dilemmas present within South Korea's clinical culture, several key issues need consideration: elevating the role of student-doctors, balancing the primary emphasis of educational hospitals on delivering medical services, and understanding interpersonal strategies, such as "Nun-chi".
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Affiliation(s)
- Ye Ji Kang
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea
| | - Yanyan Lin
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea
| | - Jaehee Rho
- Department of Education, College of Educational Sciences, Yonsei University, 50 Yonsei-ro Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jungjoon Ihm
- Dental Research Institute, School of Dentistry, Seoul National University, 1, Gwanak- ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Do-Hwan Kim
- Department of Medical Education, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea.
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Song X, Ding N, Jiang N, Zhang X, Li H, Wen D. Moral distress from professionalism dilemmas and its association with self-rated professionalism behaviors among Chinese residents. MEDICAL TEACHER 2024:1-10. [PMID: 38329725 DOI: 10.1080/0142159x.2024.2307486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Residents inevitably witness or participate in a diverse range of professionalism dilemmas. However, few studies have focused on residents' moral distress from professionalism dilemmas and its relationship with residents' professionalism. This study aimed to understand the moral distress that Chinese residents may face after exposure to professionalism dilemmas and to examine the associations between moral distress and residents' perceived fulfillment of professionalism behaviors. METHODS We conducted a cross-sectional survey of residents from four standardized residency training bases in Liaoning Province, China, using stratified cluster sampling. A checklist of professionalism dilemmas, the Moral Distress Scale, and the Behavior-based Medical Professionalism Inventory were used to assess residents' moral distress from professionalism dilemmas and their perceived fulfillment of professionalism behaviors. Descriptive statistics, non-parametric tests, multiple linear regressions, and binary logistic regressions were used to analyze the data. RESULTS A total of 647 (81.1%) residents effectively completed the survey. The proportion of residents suffering from moral distress ranged from 58.4 to 90.6% for different professionalism dilemmas. As the number of professionalism dilemmas associated with moral distress increased, residents reported lower fulfillment of professionalism behaviors (β < 0, p < 0.05). Compared with residents with no distress, residents suffering from distress reported lower fulfillment of professionalism behaviors (OR < 1, p < 0.05). Among residents suffering from distress, as the distress intensity increased, residents reported higher fulfillment of professionalism behaviors (OR > 1, p < 0.05). CONCLUSIONS Residents suffered a wide range of moral distress from professionalism dilemmas, and residents with moral distress reported lower fulfillment of professional behaviors. A responsive reporting system for residents and reflection on role modeling may help residents cope with the negative effects of moral distress and professionalism dilemmas.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Xu Zhang
- Department of Public Service, The First Hospital of China Medical University, Shenyang, P. R. China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
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Buhumaid R, Otaki F, Czabanowska K, Stanley A, Ezimokhai M, Jackson L, Ho SB. Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays. BMC MEDICAL EDUCATION 2024; 24:117. [PMID: 38321450 PMCID: PMC10848390 DOI: 10.1186/s12909-024-05103-z] [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: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.
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Affiliation(s)
- Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Health Policy Management, Faculty of Health Care, Institute of Public Health, Jagiellonian University, Kraków, Poland
| | - Adrian Stanley
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Mutairu Ezimokhai
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Lisa Jackson
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Samuel B Ho
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
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Kosendiak AA, Adamczak BB, Kuźnik Z, Makles S. Impact of Medical School on the Relationship between Nutritional Knowledge and Sleep Quality-A Longitudinal Study of Students at Wroclaw Medical University in Poland. Nutrients 2024; 16:278. [PMID: 38257170 PMCID: PMC10819250 DOI: 10.3390/nu16020278] [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: 12/20/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of this study was to investigate the impact of the first year of medical school on the relationship between nutritional knowledge and sleep. To achieve this, first-year medical students at Wroclaw Medical University were invited to participate in the study during both the initial and final months of their first academic year. The study included 570 students in the initial period and 705 in the latter. The research questionnaire comprised the KomPAN, assessing nutritional knowledge, and the Pittsburgh Sleep Quality Index (PSQI), evaluating sleep quality. The majority of students demonstrated at least sufficient nutritional knowledge, while approximately two-thirds of students experienced poor sleep in both periods. Notably, sleep quality further deteriorated in the second period (PSQI total score: 6.86 vs. 7.38, p = 0.0157). This change was influenced mainly by a decrease in sleep duration and an increase in the use of sleep medications (both p < 0.0001). The significant difference in overall sleep quality between different nutritional knowledge levels emerged only in the second semester, where students with the highest nutritional knowledge slept the best, while those with the lowest slept the worst (p = 0.0001). Crucially, in both periods, the use of sleep medications was highest among individuals with insufficient nutritional knowledge. Throughout the academic year, the usage increased for all except those with the highest nutritional knowledge, who exhibited the best sleep (p < 0.0001). The escalating use of sleep medications among medical students warrants greater attention, and leveraging the relationship between nutritional knowledge and sleep could prove beneficial, as positive habits in one domain may positively influence the other.
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Affiliation(s)
| | - Bartosz Bogusz Adamczak
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Zofia Kuźnik
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Szymon Makles
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
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Vafapour P, Wasti F, Irfan M. Letter to the editor regarding the article "understanding medical professionalism using express team-based learning; a qualitative case-based study". MEDICAL EDUCATION ONLINE 2023; 28:2279349. [PMID: 37943943 PMCID: PMC10653708 DOI: 10.1080/10872981.2023.2279349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Parmis Vafapour
- Faculty of Medicine, Barts and the London, School of Medicine and Dentistry (QMUL), London, UK
| | - Fatima Wasti
- Department of Psychiatry, Reading, Royal Berkshire NHS Trust, Berkshire, UK
| | - Mahnoor Irfan
- Faculty of Medicine, St George’s, University of London, London, UK
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Marthyman A, Nimmon L. Exploring how immigrant international medical graduates successfully manage complex sociocultural challenges. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:40-50. [PMID: 38226312 PMCID: PMC10787855 DOI: 10.36834/cmej.76244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. Methods We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. Results The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Conclusion Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.
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Affiliation(s)
- Azaria Marthyman
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Jegan R, Dierickx K. Ethics without borders: an analysis of national and international guidelines on ethics in basic medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1093-1114. [PMID: 36729197 DOI: 10.1007/s10459-022-10186-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/09/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND It has been widely recognized that ethics is central to the practice of medicine. Since physicians' identities are heavily influenced by their basic medical training, education in ethics during this period would facilitate their professional development. To enable this, some global and national organizations have published guidelines detailing the aspects of ethics that need to be taught to medical student. However, it is not known how many such guidelines exist and to what extent they concur or differ. AIM This study aims to identify and examine the content of existing national or international guidelines on the inclusion of ethics in basic medical education, in the English language. By doing so, it hopes to explore and highlight the similarities and differences regarding their pedagogical goals and their prescribed content, thereby contributing to a more holistic understanding on the state of medical ethics education. METHODS Data collection was performed through systematic searches on Google and on scientific databases. The guidelines that fulfilled the inclusion criteria were thematically analyzed using the method proposed by Braun and Clarke (2006). The resulting themes and sub-themes were grouped and characterized. RESULTS Thirteen guidelines (ten national and three international) fulfilled the inclusion criteria. Among these, two major approaches can be discerned: value-based and norm-based. Value-based guidelines tend to be more globally applicable, because they endorse more abstract and universal principles. Norm-based guidelines, on the other hand, are more context-specific and have a practical focus. Understanding this distinction could facilitate discussions on different perspectives in ethics education.
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Affiliation(s)
- Roshni Jegan
- Centre for biomedical ethics and law, Department of public health and primary care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
| | - Kris Dierickx
- Centre for biomedical ethics and law, Department of public health and primary care, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
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12
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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.
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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
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13
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Murtagh GM. A critical look at ideas, concerns and expectations in clinical communication. MEDICAL EDUCATION 2023; 57:331-336. [PMID: 36408805 DOI: 10.1111/medu.14975] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND For medical students and doctors, capturing the patient's perspective is critical if the consultation is to be meaningful for both parties. Medical students are taught the import of this in their communication skills training aided by inquiring into the patient's ideas, concerns and expectations (ICE) during the consultation. Ensuring the effectiveness of those inquiries can be a challenge for different reasons. Yet apart from a handful of papers on the subject, there is little guidance on the efficacy of ICE as a communication technique and specifically how to successfully blend questions about ICE within the interaction between doctor and patient. PROPOSAL This paper takes a closer look at this communication technique and explores some of the interactional features of inquiries into ICE. First, the background to ICE and its emergence within the field of medical education is considered. Next the argument considers some of the contextual and pedagogical issues that inquiries into ICE gives rise to. The discussion then goes on to explore some conceptual underpinnings drawing on findings from Conversation Analysis, which provide some direction in approaching questions about what the patient thinks. Finally, the implications of the argument presented are considered in relation to the teaching and assessment of medical students with a short proposal for next steps. CONCLUSION Capturing the patient's perspective through an exploration of their ideas, concerns and expectations remains a valuable approach in communication skills training in medical education. It is important, however, that ICE type inquiries are used carefully and responsively if they are to be used to improve communication with patients.
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Affiliation(s)
- Ged M Murtagh
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
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Goddard VCT, Brockbank S. Re-opening Pandora's box: Who owns professionalism and is it time for a 21st century definition? MEDICAL EDUCATION 2023; 57:66-75. [PMID: 35761477 PMCID: PMC10083973 DOI: 10.1111/medu.14862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND The concept of professionalism is dominant within health care education and the lives of practising clinicians globally, and yet there is no single agreed definition nor framework applied universally across the health care professions. This article questions how much attention is paid to where definitions of the concept of professionalism came from and whether the accepted norms within the dominant discourses are still truly applicable to a 21st century workforce. METHOD Taking a critical look at the existing body of literature on professionalism using a locus of medical education, this article reviews who the dominant voices have been in the creation of current understandings of professionalism. Using a pragmatic and targeted approach, regulatory body definitions of professionalism from across the world are compared to demonstrate the complexities of finding a universally accepted definition of the concept. RESULTS The article suggests that the extant definitions are grounded but also stuck in a background of Western, White, heteronormative view of society and the professions of the past and argues that we need to better understand the expectations of professionalism from the perspectives of those who now work in health care and health care education, as well as reviewing the views of the "public" within this debate. CONCLUSIONS By reopening the "Pandora's box" of professionalism, this article argues that we can improve the quality of definitions-and thus application-of professionalism for health care professionals and patients.
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Rashid MA. Hyperglobalist, sceptical, and transformationalist perspectives on globalization in medical education. MEDICAL TEACHER 2022; 44:1023-1031. [PMID: 35465822 DOI: 10.1080/0142159x.2022.2058384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Globalisation has been hotly debated in recent decades and has seemingly had a profound impact on medical education. This review synthesises the medical education literature using key perspectives from globalisation theory by Holton (Making globalisation). METHODS Holton (Making globalisation) recognised three key perspectives in globalisation theory-hyperglobalist, sceptical, and transformationalist. This article critically reviews the literature on globalisation in the field of medical education using this theoretical framework. RESULTS Hyperglobalist and sceptical perspectives dominated early periods of medical education literature on globalisation, projecting it either as a mainly positive or mainly negative force, respectively. Most forecasts grounded in these perspectives have not materialised in medical education policy and practice. Since 2010, the volume of scholarship about globalisation has increased and has been predominantly transformationalist in perspective, recognising a reality that has both positive and negative consequences. CONCLUSIONS The medical education literature has mirrored the broader social science literature, in moving over time from hyperglobalist and sceptical positions, towards a 'third wave' of globalisation thinking that is transformationalist. Medical education practitioners and policymakers should be mindful of these perspectives and trends as they navigate the opportunities and challenges presented by globalisation.
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Neve H, Hanks S. Tangrams: a simple visual tool for communicating the complexities of professionalism. MEDEDPUBLISH 2022; 12:2. [PMID: 36168529 PMCID: PMC9370087 DOI: 10.12688/mep.17558.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
Professionalism is vital for high quality healthcare and fundamental to health profession education. It is however complex, hard to define and can be challenging to teach, learn about and assess. We describe the development and use of an innovative visual tool, using a tangram analogy, to introduce and explore core professionalism concepts, which are often troublesome for both learners and educators. These include the hidden curriculum, capability, professional identity and the difference between unprofessionalism and high professional standards. Understanding these concepts can help individuals to see professionalism differently, encourage faculty to design professionalism programmes which focus on professional excellence, support assessors to feel more confident in identifying and addressing underperformance and facilitate learners to appreciate the complexity and uncertainty inherent in professionalism and to become more alert to the hidden curriculum and its potential impact. We have used the tangram model to educate for professionalism in multiple contexts with learners and educators. Participants regularly report that it leads to a deeper understanding and important new insights around professionalism and helps them identify ways of changing their practice. We believe this approach has relevance across the health professions and suggest ways it could be further developed to explore wider professionalism issues such as reflective practice, resilience and teamworking.
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Affiliation(s)
- Hilary Neve
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Sally Hanks
- Peninsula Dental School, University of Plymouth, Plymouth, UK
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17
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Neve H, Hanks S. Tangrams: a simple visual tool for communicating the complexities of professionalism. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.17558.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Professionalism is vital for high quality healthcare and fundamental to health profession education. It is however complex, hard to define and can be challenging to teach, learn about and assess. We describe the development and use of an innovative visual tool, using a tangram analogy, to introduce and explore core professionalism concepts, which are often troublesome for both learners and educators. These include the hidden curriculum, capability, professional identity and the difference between unprofessionalism and high professional standards. Understanding these concepts can help individuals to see professionalism differently, encourage faculty to design professionalism programmes which focus on professional excellence, support assessors to feel more confident in identifying and addressing underperformance and facilitate learners to appreciate the complexity and uncertainty inherent in professionalism and to become more alert to the hidden curriculum and its potential impact. We have used the tangram model to educate for professionalism in multiple contexts with learners and educators. Participants regularly report that it leads to a deeper understanding and important new insights around professionalism and helps them identify ways of changing their practice. We believe this approach has relevance across the health professions and suggest ways it could be further developed to explore wider professionalism issues such as reflective practice, resilience and teamworking.
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Parthiban N, Boland F, Fadil Azim DH, Pawlikowska T, O’Shea MT, Jaafar MH, Morgan K. Asian medical students' attitudes towards professionalism. MEDICAL EDUCATION ONLINE 2021; 26:1927466. [PMID: 33999787 PMCID: PMC8143598 DOI: 10.1080/10872981.2021.1927466] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between pre-clinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, IrelandMethods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used.Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students.Conclusion: Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.
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Affiliation(s)
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Mohamad Hasif Jaafar
- Perdana University - Royal College of Surgeons in Ireland, Perdana University, Malaysia
| | - Karen Morgan
- Perdana University - Royal College of Surgeons in Ireland, Perdana University, Malaysia
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Habib SR, Sattar K, Ahmad T, Barakah RM, Alshehri AM, Andejani AF, Almansour AA. An insightful evaluation of professionalism among dentistry students. Saudi Dent J 2021; 33:753-760. [PMID: 34803330 PMCID: PMC8589603 DOI: 10.1016/j.sdentj.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose The objective of this study was to explore the ambience of professionalism related to academic integrity among undergraduate dental students. Methodology “Dundee Polyprofessionalism Inventory I: Academic Integrity” was used to collect responses from first-year to fifth-year dental students of the College of Dentistry, King Saud University (Response rate = 78%). The participants’ responses (for 34 professionalism lapses) were recorded by using the Dundee Polyprofessionalism Inventory. Statistical analysis included descriptive statistics, Chi-square, and T-tests (P < 0.05). Results The “Ignore” sanction was not opted for any of the 34 professionalism behaviors, and there was unanimous agreement between the participants in considering all 34 behavior statements to be “wrong”. Male and female participants were found to opt for a similar sanction as the median for 16 statements (47%), whereas, for 18 statements (53%), their responses differed with a range of levels 0.5 to 1.5. Preclinical- and clinical-year student responses also showed similarities in their 11 statements (32.3%), and they did differ for 20 statements (58.8%). Interestingly, clinical year respondents were overall on the stricter side of recommending sanctions. Conclusions For the majority of the dental students tested, there was a good understanding of the significance of some lapses of professionalism associated with academic integrity. Some of the disclosures in this study were substantially appreciable because none of the students selected “ignore” sanction for any of the survey statements. We found that using the Dundee Polyprofessionalism Inventory for learning and understanding academic professionalism among dental students is useful.
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Affiliation(s)
- Syed Rashid Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Kamran Sattar
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Saudi Arabia
| | - Rana M Barakah
- Intern, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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20
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Asghari F, Shahvari Z, Ebadi A, Alipour F, Samadi S, Bahreini M, Amini H. Developing and validating an instrument to measure: the medical professionalism climate in clinical settings. J Med Ethics Hist Med 2021; 14:11. [PMID: 35035799 PMCID: PMC8696557 DOI: 10.18502/jmehm.v14i11.7666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/01/2021] [Indexed: 11/24/2022] Open
Abstract
This study was conducted to develop and validate an instrument to measure the medical professionalism climate in clinical settings. The item pool was developed based on the Tehran University of Medical Sciences Guideline for Professional Conduct. The items were distributed between two questionnaires, one for health-care providers and the other for patients. To assess the construct validity of the questionnaires, 350 health-care providers and 88 patients were enrolled in the study. The reliability of the questionnaires was evaluated by calculating Cronbach's alpha and ICC. At first a 74-item pool was generated. After assessing and confirming face and content validity, 41 items remained in the final version of the scale. Exploratory factor analysis revealed the three factors of "personal behavior", "collegiality" and "respect for patient autonomy" in a 25-item questionnaire for service providers and a single factor of "professional behavior" in a 6-item questionnaire for patients. The three factors explained 51.775% of the variance for service providers' questionnaire and the single factor explained 63.9% of the variance for patients' questionnaire. The findings demonstrated that from the viewpoints of patients and service providers, this instrument could be applied to assess the medical professionalism climate in hospital clinical settings.
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Affiliation(s)
- Fariba Asghari
- Professor,Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shahvari
- AssistantProfessor,School of Nursing and Midwifery, Islamic Azad University of Ghachsaran, Ghachsaran, Iran.
| | - Abbas Ebadi
- Professor, Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Fateme Alipour
- Associate Professor, Eye Research Center, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shahram Samadi
- Associate Professor, Department of Anesthesia and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Bahreini
- Associate Professor, Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Homayoun Amini
- Professor, Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Cullen MJ, Zhang C, Mustapha T, Tiryaki E, Benson B, Konia M, Sackett PR, Culican SM. Development of a taxonomy of unprofessional behavior in clinical learning environments using learner-generated critical incidents. MEDICAL TEACHER 2021; 43:1161-1169. [PMID: 33974489 DOI: 10.1080/0142159x.2021.1918331] [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: 06/12/2023]
Abstract
PURPOSE Few studies have examined medical residents' and fellows' (trainees) direct experience of unprofessional behavior in clinical learning environments (CLE). The purpose of this study was to create a taxonomy of unprofessional behavior in CLEs using critical incidents gathered from trainees. METHOD In step 1 (data collection), the authors collected 382 critical incidents from trainees at more than a dozen CLEs over a six-year period (2013-2019). In step 2 (model generation), nine subject matter experts (SMEs) sorted the incidents into homogenous clusters and this structure was tested with principal components analysis (PCA). In step 3 (model evaluation), two new groups of SMEs each re-sorted half of the incidents into the PCA-derived categories. RESULTS A 13-component solution accounted for 62.46% of the variance in the critical incidents collected. The SMEs who re-sorted the critical incidents demonstrated good agreement with each other and with the 13-component PCA solution. The resulting taxonomy included 13 dimensions, with 48.7% of behaviors focused on displays of aggression or discriminatory conduct. CONCLUSIONS Critical incident methodology can provide unique insights into the dimensionality of unprofessional behavior in the CLE. Future research should leverage the taxonomy created to inform professionalism assessment development in the CLE.
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Affiliation(s)
- Michael J Cullen
- Graduate Medical Education, University of Minnesota, Minneapolis, MN, USA
| | - Charlene Zhang
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Taj Mustapha
- Departments of Internal Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Ezgi Tiryaki
- Minneapolis VA HealthCare System, Minneapolis, MN, USA
| | | | - Mojca Konia
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Paul R Sackett
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Susan M Culican
- Graduate Medical Education, University of Minnesota, Minneapolis, MN, USA
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22
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Gordon SJG, Gardner DH, Weston JF, Bolwell C, Benschop J, Parkinson TJ. Using the critical incident technique to determine veterinary professional competencies important for enhancing the veterinarian-client interaction. Vet Rec 2021; 190:e943. [PMID: 34558089 DOI: 10.1002/vetr.943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 07/08/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND While previous research has examined components of professionalism that veterinary employers and clients expect in veterinarians, little attention has been paid to practising clinical veterinarians' opinions on important professional competencies that help to enhance the veterinarian-client relationship. This study used a phenomenological approach and critical incident technique to gather the narratives of practising veterinarians in New Zealand about positive and negative veterinarian-client interactions. The intention was to identify the underlying principles of professionalism that resulted in the positive/negative outcomes of those interactions. METHODS Twenty-two practising veterinarians were interviewed, and each respondent was asked to recollect and narrate a significant positive and a significant negative critical incident in their career that involved a veterinarian-client interaction within a clinical setting. The professional competencies that the veterinarian believed contributed to a successful or an unsuccessful outcome were elucidated using thematic analysis. RESULTS Thematic analysis of the critical incident narratives revealed four major themes under the overarching theme of 'building a relationship between the veterinarian and the client': 'accountability and integrity', 'effective communication skills', 'personal wellbeing' and 'quality of care'. CONCLUSION The description of the important professional competencies that helped to enhance the veterinarian-client relationship provides a reference for the practising profession to help improve the likelihood of veterinarians enjoying satisfied and successful careers.
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Affiliation(s)
- Stuart J G Gordon
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Dianne H Gardner
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Jenny F Weston
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Charlotte Bolwell
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Jackie Benschop
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Tim J Parkinson
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Dar UF, Khan YS. Self-Reported Academic Misconduct among Medical Students: Perception and Prevalence. ScientificWorldJournal 2021; 2021:5580797. [PMID: 34475809 PMCID: PMC8407971 DOI: 10.1155/2021/5580797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/11/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Academic integrity is the basis of an education system and must be taught as an ethical behavior during academic training. Students who reflect honesty and truthfulness during the academic years are more likely to follow this path, develop professional integrity, and thus become responsible and dependable professionals. Here, we determine the prevalence of academic lapses among medical students by a cross-sectional descriptive survey based on a self-assessment questionnaire. Students' perception of 37 behaviors comprising five domains, plagiarism, indolence, cheating, disruptive behavior, and falsifying data, were explored. A high percentage of students (83%) indicated that all 37 behaviors constitute misconduct. Approximately 65% of students thought that their fellow students were involved in dishonest behaviors, and 34% answered that they were indulged in some form of misconduct. Content analysis identified some prevalent behaviors such as doing work for another student (82.5%), getting information from the students who already took the exam (82.5%), copying the answer from neighbors (79%), and marking attendance for absent friends (74.5%). Multiple regression analysis points out that future indulgence in a behavior is significantly (p ≤ 0.5) correlated with understanding a behavior as wrong, perceiving that others do it and whether one has already indulged in it. This study can serve as a diagnostic tool to analyze the prevalence of misconduct and a foothold to develop the medical school system's ethical guidelines.
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Affiliation(s)
- Umar F. Dar
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka 72388, Al-Jouf, Saudi Arabia
| | - Yusuf S. Khan
- Department of Basic Medical Sciences, College of Medicine, Vision (Alfarabi) Colleges, Riyadh 13226, Saudi Arabia
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Mossenson AI, Bailey JG, Whynot S, Livingston P. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings. Anesth Analg 2021; 133:215-225. [PMID: 34127590 DOI: 10.1213/ane.0000000000005584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development. METHODS This qualitative study used in-depth interviews to explore VAST facilitators' perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature. RESULTS Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice. CONCLUSIONS The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.
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Affiliation(s)
- Adam I Mossenson
- From the Department of Anaesthesia, SJOG Midland Public and Private Hospitals, Dalhousie University, Curtin University, Perth, Western Australia
| | - Jonathan G Bailey
- Department of Anesthesia, Pain Management, and Perioperative Medicine
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Bashir A, McTaggart IJ. Importance of faculty role modelling for teaching professionalism to medical students: Individual versus institutional responsibility. J Taibah Univ Med Sci 2021; 17:112-119. [PMID: 35140573 PMCID: PMC8802861 DOI: 10.1016/j.jtumed.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Adeela Bashir
- Department of Health Professions Education, National University of Medical Sciences, Pakistan
- Corresponding address: Department of Health Professions Education, National University of Medical Sciences, The Mall, Abid Majeed Road, Rawalpindi, Punjab, 46000, Pakistan.
| | - Irene J. McTaggart
- Centre of Medical Education, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
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Chang YW, Hirsh DA, Fang WH, Li H, Tzeng WC, Kao S. Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study. BMC MEDICAL EDUCATION 2021; 21:153. [PMID: 33691688 PMCID: PMC7944602 DOI: 10.1186/s12909-021-02553-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context. METHODS We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students. RESULTS Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood. CONCLUSION In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.
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Affiliation(s)
- Yaw-Wen Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China
- Graduate Institute of Medical Science, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist.,, Taipei City, 11490, Taiwan, Republic of China
| | - David A Hirsh
- Harvard Medical School Academy, Tosteson Medical Education Center, Room 384, 260 Longwood Ave, Boston, MA, 02115, USA
- HMS-Cambridge Integrated Clerkship, Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, USA
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China
| | - Honghe Li
- Institute of International Healthcare Professionals Education and Research, China Medical University, No.77, Puhe Rd., Shenyang North New Area, Shenyang, Liaoning, P.R. China
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China
| | - Senyeong Kao
- Graduate Institute of Life Science, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan, Republic of China.
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Ibrahim H, Nair S, Abdel-Razig S. Acceptability of the American Board of Internal Medicine medical professionalism framework in the United Arab Emirates. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2021; 12:31-33. [PMID: 33645528 PMCID: PMC8411340 DOI: 10.5116/ijme.6023.b4ea] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/10/2021] [Indexed: 05/21/2023]
Affiliation(s)
- Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Satish Nair
- Department of Academic Affairs, Tawam Hospital Johns Hopkins Medicine Affiliate, Al Ain, UAE
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Archibald D, Eyre A, Szczepanik D, Burns JK, Laroche L. Capturing the impact of cultural differences in residency. BMC MEDICAL EDUCATION 2021; 21:115. [PMID: 33602186 PMCID: PMC7890890 DOI: 10.1186/s12909-021-02548-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/28/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Postgraduate training is a period in which residents develop both their medical competency and their professional identity in an environment of apprenticeship. As situated learning suggests, a critical dimension of such apprenticeship is the mode through which trainees can legitimately participate in the practice before they become experts, in this case physicians. One source of barriers to participation is cultural difference between learner and the clinical environment. OBJECTIVE To assess the extent cultural differences create barriers for residents, particularly but not exclusively for international medical graduates (IMGs). METHODS In 2014-15 a questionnaire was developed with subscales assessing areas such as sense of hierarchy, individuality versus teamwork, and risk tolerance. We refined the instrument by subjecting it to a review panel of experts in postgraduate education followed by "think aloud" sessions with residents. RESULTS Piloting this instrument yielded a Cronbach's alpha of 0.675. When administered to a larger group of residents and faculty representing many specialties, the Impact of Cultural Differences on Residency Experiences (ICDRE) questionnaire revealed a few items for which the Canadian Medical Graduates and International Medical Graduates differed in their mean opinion. The groups were not substantially different overall, but we did observe an interesting diversity of cultural beliefs within each group. CONCLUSIONS We suggest that the ICDRE may be useful in identifying beliefs which may present challenges to an individual resident or in capturing trends in a resident population so that a specialty program can address the trends proactively. The instrument also provides language with which to anchor preceptors' evaluations of residents' professionalism and may serve as an interventional coaching tool.
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Affiliation(s)
- Douglas Archibald
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
- Bruyère Research Institute, Ottawa, Ontario, Canada.
| | - Alison Eyre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorota Szczepanik
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lionel Laroche
- MultiCultural Business Solutions Inc., Markham, Ontario, Canada
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Fong W, Kwan YH, Yoon S, Phang JK, Thumboo J, Leung YY, Ng SC. Assessment of medical professionalism using the Professionalism Mini Evaluation Exercise (P-MEX) in a multi-ethnic society: a Delphi study. BMC MEDICAL EDUCATION 2020; 20:225. [PMID: 32664983 PMCID: PMC7362541 DOI: 10.1186/s12909-020-02147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The importance of medical professionalism and its assessment has been well documented in the literature. However, there is currently no culturally-adapted tool to assess medical professionalism in Singapore. This study sets out to find consensus on relevance of the items from the Professionalism Mini Evaluation Exercise (P-MEX) for assessing medical professionalism in Singapore. METHODS A two-round Delphi survey was completed by an expert panel consisting of program directors, associate designated institutional officials, and designated institutional official (n = 15) from residency programs in Singapore. Round 1 comprised of 23 items from the P-MEX rated on a 5-point scale (1 = Definitely include, 2 = Possibly include, 3 = Neutral, 4 = Possibly exclude, 5 = Definitely exclude). In round 2, the experts received feedback from the previous round, and were asked to re-rate the items which did not achieve consensus in the previous round. The threshold for consensus in the study was defined as 70% or greater agreement among experts. RESULTS Completed questionnaires for both rounds were received from all 15 experts. In round 1, 18 items (78%) achieved consensus to be included. In round 2, 1 (4%) item achieved consensus to be included. However, none of the remaining items achieved consensus to be removed, and they exhibited stability in responses. A list of 19 items covering four domains of medical professionalism (Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills) was obtained during the two-rounds of Delphi survey. CONCLUSIONS Nineteen items in the P-MEX had garnered consensus and is suitable for assessing medical professionalism in Singapore. The findings of this study can provide guidance for faculty and institutions who want to assess medical professionalism of their medical trainees.
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Affiliation(s)
- Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Swee Cheng Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Giuliani M, Frambach J, Broadhurst M, Papadakos J, Fazelad R, Driessen E, Martimianakis MAT. A critical review of representation in the development of global oncology curricula and the influence of neocolonialism. BMC MEDICAL EDUCATION 2020; 20:93. [PMID: 32228538 PMCID: PMC7106787 DOI: 10.1186/s12909-020-1989-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/28/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND Global curricular homogenization is purported to have a multitude of benefits. However, homogenization, as typically practiced has been found to promote largely Western ideals. The purpose of this study was to explore the issue of representation in the development of global oncology curricula. METHODS This systematic review of global oncology curricula involved a comprehensive search strategy of eight databases from inception to December 2018. Where available, both controlled vocabulary terms and text words were used. Two investigators independently reviewed the publications for eligibility. Full global/core oncology curricular documents were included. Data analysis included exploration of representation across a number of axes of power including sex and geographic sector, consistent with a neocolonial approach. RESULTS 32,835 documents were identified in the search and 17 remained following application of the inclusion/exclusion criteria. Eleven of 17 papers were published from 2010 to 2018 and 13 curricula originated from Europe. The 17 curricula had 300 authors; 207 were male and most were from Europe (n = 190; 64%) or North America (n = 73; 24%). The most common curricular purposes were promoting quality patient care (n = 11), harmonization of training standards (n = 10), and facilitating physician mobility (n = 3). The methods for creation of these curricula were most commonly a committee or task force (n = 10). Over time there was an increase in the proportion of female authors and the number of countries represented in the authorship. CONCLUSION Existing global oncology curricula are heavily influenced by Western male authors and as a result may not incorporate relevant socio-cultural perspectives impacting care in diverse geographic settings.
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Affiliation(s)
- Meredith Giuliani
- Radiation Medicine Program, Princess Margret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, 610 University Ave, Toronto, ON M5G2M9 Canada
| | - Janneke Frambach
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | | | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rouhi Fazelad
- Information Sciences, Princess Margret Cancer Centre, Toronto, Canada
| | - Erik Driessen
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Giuliani M, Martimianakis MA, Broadhurst M, Papadakos J, Fazelad R, Driessen E, Frambach J. Humanism in global oncology curricula: an emerging priority. ACTA ACUST UNITED AC 2020; 27:46-51. [PMID: 32218660 DOI: 10.3747/co.27.5461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Training in humanism provides skills important for improving the quality of care received by patients, achieving shared decision-making with patients, and navigating systems-level challenges. However, because of the dominance of the biomedical model, there is potentially a lack of attention to humanistic competencies in global oncology curricula. In the present study, we aimed to explore the incorporation of humanistic competencies into global oncology curricula. Methods This analysis considered 17 global oncology curricula. A curricular item was coded as either humanistic (as defined by the iecares framework) or non-humanistic. If identified as humanistic, the item was coded using an aspect of humanism, such as Altruism, from the iecares framework. All items, humanistic and not, were coded under the canmeds framework using 1 of the 7 canmeds competency domains: Medical Expert, Communicator, Collaborator, Leader, Scholar, Professional, or Health Advocate. Results Of 7792 identified curricular items in 17 curricula, 780 (10%) aligned with the iecares humanism framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%, and the proportion increased from 3% in the oldest curricula to 11% in the most recent curricula. Of the humanistic items, 35% were coded under Respect, 31% under Compassion, 24% under Empathy, 5% under Integrity, 2% under Excellence, 1% under Altruism, and 1% under Service. Within the canmeds domains, the humanistic items aligned mostly with Professional (35%), Medical Expert (31%), or Communicator (25%). Conclusions The proportion of humanistic competencies has been increasing in global oncology curricula over time, but the overall proportion remains low and represents a largely Western perspective on what constitutes humanism in health care. The representation of humanism focuses primarily on the iecares attributes of Respect, Compassion, and Empathy.
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Affiliation(s)
- M Giuliani
- Radiation Medicine Program, Princess Margret Cancer Centre, and Department of Radiation Oncology, University of Toronto
| | | | - M Broadhurst
- Cancer Education, Princess Margret Cancer Centre
| | - J Papadakos
- Cancer Education, Princess Margret Cancer Centre
| | - R Fazelad
- Information Sciences, Princess Margret Cancer Centre, Toronto, ON
| | - E Driessen
- Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences
| | - J Frambach
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
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McGurgan P, Calvert KL, Narula K, Celenza A, Nathan EA, Jorm C. Medical students' opinions on professional behaviours: The Professionalism of Medical Students' (PoMS) study. MEDICAL TEACHER 2020; 42:340-350. [PMID: 31738619 DOI: 10.1080/0142159x.2019.1687862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: The Professionalism of Medical Students (PoMS) study aimed to develop a comprehensive understanding of Australian and New Zealand (Aus/NZ) medical students' opinions and experience with professionalism dilemmas.Methods: A confidential, online survey for medical students was developed and distributed to all Aus/NZ medical schools. Students submitted de-identified demographic information, gave opinions on the acceptability of a range of student behaviours for professionally challenging situations, and whether they had encountered similar situations.Results: 3171 medical students participated from all 21 Aus/NZ medical schools (16% of the total student population). Medical students reported encountering many of the professionally challenging situations and had varying opinions on what was acceptable behaviour for the scenarios. In general, students' opinions were not influenced by the seniority, gender or the type of health professional involved in the scenario. Participant demographic factors appeared to have significant effects on professional opinions - particularly male gender and being a student in the latter stages of the course.Discussion: Medical students' professional opinions are a complex area. The PoMS data provides a reference point for students, their educators and other health professionals in identifying current student professional behaviour norms, determining the effects of demographic factors on their decision making, and where important gaps exist in medical students' approaches to professionalism.
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Affiliation(s)
- P McGurgan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - K L Calvert
- Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Australia
| | - K Narula
- Fiona Stanley Hospital, Perth, Australia
| | - A Celenza
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - E A Nathan
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - C Jorm
- School of Medicine and Public Health, Newcastle University, Australia
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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.
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Sánchez X, Landázuri A, Londo P, Manzano A, Moreno Roca A, Jimbo R. Knowledge, Attitudes and Practices in Antibiotic Use in Family Medicine Students. J Prim Care Community Health 2020; 11:2150132720984758. [PMID: 33371782 PMCID: PMC7783681 DOI: 10.1177/2150132720984758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Inappropriate prescriptions of antibiotics lead to ineffective and unsafe
treatments and worsening of diseases. Medical students may have deficiencies
in their prescription skills and they may need further training in the use
of antibiotics for their practice. Medical skills in prescribing antibiotics
can be improved through continuous medical education. The aim of this study
was to assess the current levels of knowledge, attitudes, and practices
(KAP) in antibiotic prescription in upper respiratory tract infections
(URTI) among postgraduate family medicine students in Ecuador. Methods A cross-sectional study with an on-line survey, based on micro-curricular
contents, to evaluate KAPs regarding antibiotic prescription in URTI among
postgraduate family medicine students in 5 provinces of Ecuador. Results Two hundred and seventy-three physicians responded (94.1%). Most physicians
treated between 1 and 5 URTI cases per day. The odds for inadequate
knowledge and inappropriate practices in URTI among postgraduate family
medicine students were 8.74 (95%CI, 4.94-15.46,
P < .001) and 5.99, (IC95%, 2.66-13.50,
P < .001) in physicians who were students of the
first half of the study program. Conclusion The knowledge in URTI was limited among physicians. Nonetheless, they
expressed a positive attitude toward not using antibiotics in URTI. A
postgraduate program can significantly improve the knowledge and practices
related to antibiotic prescriptions in URTI.
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Affiliation(s)
- Xavier Sánchez
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
- Universidad de Alcalá de Henares, Madrid, España
| | - Andrea Landázuri
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
| | - Paulina Londo
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
| | - Andrea Manzano
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
| | - Andrés Moreno Roca
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
| | - Ruth Jimbo
- Pontificia Universidad Católica del Ecuador, Facultad de Medicina, Postgrado de Medicina Familiar y Comunitaria, Quito, Ecuador
- Universidad de Alcalá de Henares, Madrid, España
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Bazrafkan L, Hayat AA, Tabei SZ, Amirsalari L. Clinical teachers as positive and negative role models: an explanatory sequential mixed method design. J Med Ethics Hist Med 2019; 12:11. [PMID: 32328224 PMCID: PMC7166239 DOI: 10.18502/jmehm.v12i11.1448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/07/2019] [Indexed: 11/24/2022] Open
Abstract
Today, role modeling is an essential component of medical education that facilitates the students' learning and affects their attitudes and behaviors. Hence, this study aimed to examine the characteristics of positive and negative role models using a mixed method approach. In the quantitative part, data were collected using a questionnaire with 24 items. The research population included medical students who were in their clinical period between May 2017 and December 2018 at Shiraz University of Medical Sciences (n = 750). A total of 282 questionnaires were completed by these students, and in the qualitative part, 26 semi-structured interviews were conducted with them. The most important components of role modeling for students included: individual characteristics, clinical skills and competence, teaching skills and professionalism, in that order. The qualitative analysis confirmed the results of the quantitative analysis. The findings showed that the characteristics of a negative role model can also be classified in four main components. The results demonstrated that 46.8% of the students identified one or more medical teachers as negative models. Students paid attention to not only the positive characteristics of their teachers, but also their negative features, stating that they had been influenced by both. Therefore, it can be concluded that clinical teachers should improve their performance as positive role models through reducing these negative effects and reinforcing positive characteristics.
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Affiliation(s)
- Leila Bazrafkan
- Assistant Professor, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Asghar Hayat
- Assistant Professor, Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ziaaddin Tabei
- Professor, Department of Medical Ethics and Philosophy in Health Care, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Amirsalari
- Researcher, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Gordon SJG, Gardner DH, Weston JF, Bolwell CF, Benschop J, Parkinson TJ. Quantitative and thematic analysis of complaints by clients against clinical veterinary practitioners in New Zealand. N Z Vet J 2019; 67:117-125. [DOI: 10.1080/00480169.2019.1585300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- SJG Gordon
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - DH Gardner
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - JF Weston
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - CF Bolwell
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - J Benschop
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - TJ Parkinson
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
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Matsui T, Sato M, Kato Y, Nishigori H. Professional identity formation of female doctors in Japan - gap between the married and unmarried. BMC MEDICAL EDUCATION 2019; 19:55. [PMID: 30755206 PMCID: PMC6373051 DOI: 10.1186/s12909-019-1479-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/29/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND During professional identity formation (PIF), medical students and young doctors enter the process of socialization in medicine with their preexisting personal identities. Here, the authors focused on how gender influences both the professional and personal identities of doctors. The authors' particular research question was how the professional and personal identities of female doctors are formed in Japan, a patriarchal and highly masculinized country, especially before and after marriage and childbirth. METHODS Narrative inquiry was used as the research methodology. The authors purposively sampled 10 unmarried and 15 married Japanese female physicians with varying lengths of full-time work experience and conducted individual semi-structured face-to-face interviews between July 2013 and February 2015. The authors recorded, transcribed and anonymized the narrative data and extracted themes and representative narratives related to the formation of professional and personal identities. Based on these, the authors developed the master narrative for the whole study. RESULTS The PIF process by which female physicians integrate personal and professional identities was profoundly affected by gender stereotypes. Further, participant narratives revealed the existence of conflict between married and unmarried female doctors, which created a considerable gap between them. CONCLUSIONS Female physicians lived with conflicting emotions in a chain of gender stereotype reinforcement. To overcome these issues, we propose that it is necessary to depart from a culture that determines merit based on a fixed sense of values, and instead develop a cultural system and work environment which allows the cultivation of a professional vision that accepts a wide variety of professional and personal identities, and a similarly wide variety of methods by which the two can be integrated.
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Affiliation(s)
- Tomoko Matsui
- Department of General Medicine/Family and Community Medicine, Nagoya University Graduate School of Medicine, 65-banchi, Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Motoki Sato
- Department of General Medicine Nagoya University, Nagoya University Hospital, Nagoya, Japan
| | - Yoko Kato
- Department of Psychology, Sugiyama Jogakuen University, City, Nisshin, Japan
| | - Hiroshi Nishigori
- Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sim JH, Ngan OMY, Ng HK. Bioethics Education in the Medical Programme among Malaysian Medical Schools: Where Are We Now? JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519883887. [PMID: 31832540 PMCID: PMC6887801 DOI: 10.1177/2382120519883887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/27/2019] [Indexed: 06/08/2023]
Abstract
INTRODUCTION A global trend in medical education is the inclusion of bioethics teaching in medical programme. The objective of this article is to describe the current state of bioethics education in the medical programme among Malaysian medical schools. METHOD A national survey was conducted among Malaysian medical schools between January and March 2019. One representative from each medical school was invited to respond to the survey. Respondents were faculty members involved in teaching and assessment of bioethics in their medical schools, or/and in developing and coordinating bioethics curriculum. Descriptive statistics were reported. FINDINGS Out of 30 medical schools, 11 completed and returned the survey (overall response rate = 36.7%). Of these 11 schools, 6/10 (60%) were from public institutions while 5/20 (25%) were from private institutions. All except 1 school implemented a formal bioethics curriculum. A wide range of bioethics topics are currently taught in the medical programme. The majority involved in teaching bioethics were health care professionals (mainly clinicians), followed by lawyers. Lecture and attendance, respectively, are the most common teaching and assessment method. Major barriers to the implementation of bioethics education included limited qualified teaching staff (6/11 = 54.5%), no established curriculum to follow (5/11 = 45.5%), limited financial resources to hire qualified staff (4/11 = 36.4%), and no consensus among faculty members (4/11 = 36.4%). CONCLUSION Bioethics education in Malaysia is relatively new and mostly limited by a shortage of scholars in bioethics. National support and institutional collaboration in providing bioethics training is the key to enhance the quality of bioethics education.
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Affiliation(s)
- Joong Hiong Sim
- Medical Education & Research Development Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Olivia Miu Yung Ngan
- Office of Medical Education, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- CUHK Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Keung Ng
- Office of Medical Education, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Brodmann Maeder M, Saghir R, Pun M, Stawinoga AE, Turner R, Strapazzon G, Exadaktylos AK, Brugger H. Intercultural Competence of Western Teachers for Nepalese Rescuers. High Alt Med Biol 2018; 20:22-27. [PMID: 30526053 PMCID: PMC6459269 DOI: 10.1089/ham.2018.0102] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction: Educational projects in mountain rescue in Nepal have a long tradition. They are usually led by Western experts who train their Nepalese colleagues using teams of people with diverse cultural background. To better understand the challenges of these encounters, we conducted a prospective cohort study during the first mountain rescue instructor course in Nepal. Methods: Western instructors (WIs) and Nepalese instructor candidates (NICs) were asked to self-assess their intercultural competence with the help of questionnaires. The responses were compared and analyzed for differences between WIs and NICs and differences in a pre–post assessment of the WIs. In addition, semistructured interviews were conducted with randomly selected NICs. Results: We found significant differences in communication styles between NICs and WIs: NICs showed a preference to establish relationships before discussing business and not to speak openly in conflict situations. WIs were much more direct and preferred dispassionate exchanges. In an assessment after the course, WIs had changed their attitude toward the host culture. Conclusions: We found differences in communication styles between WIs and NICs that are relevant to globalized medical education. Faculty members should be prepared before implementing medical training abroad and should have time to experience the host culture.
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Affiliation(s)
- Monika Brodmann Maeder
- 1 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy .,2 Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
| | - Raphael Saghir
- 3 University of Bern , Faculty of Medicine, Bern, Switzerland
| | - Matiram Pun
- 1 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | | | - Rachel Turner
- 1 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Giacomo Strapazzon
- 1 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
| | - Aristomenis K Exadaktylos
- 2 Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
| | - Hermann Brugger
- 1 Institute of Mountain Emergency Medicine , EURAC Research, Bolzano, Italy
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Shaw MK, Rees CE, Andersen NB, Black LF, Monrouxe LV. Professionalism lapses and hierarchies: A qualitative analysis of medical students' narrated acts of resistance. Soc Sci Med 2018; 219:45-53. [DOI: 10.1016/j.socscimed.2018.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/26/2022]
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Wild D, Nawaz H, Ullah S, Via C, Vance W, Petraro P. Teaching residents to put patients first: creation and evaluation of a comprehensive curriculum in patient-centered communication. BMC MEDICAL EDUCATION 2018; 18:266. [PMID: 30453937 PMCID: PMC6245928 DOI: 10.1186/s12909-018-1371-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/31/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patient-centered communication is essential for successful patient encounters and positive patient outcomes. Therefore, training residents how to communicate well is one of the key responsibilities of residency programs. However, many residents, especially international medical graduates, continue to struggle with communication barriers. METHODS All residents and faculty from a small community teaching hospital participated in a three-year, multidimensional patient-centered communication curriculum including communication training with lectures, experiential learning, communication skills practice, and reflection in the areas of linguistics, physician-patient communication, cultural & linguistically appropriate care, and professionalism. We evaluated the program through a multipronged outcomes assessment, including self-assessment, scores on the Calgary-Cambridge Scale during Objective Structured Clinical Examination (OSCE), a survey to measure the hidden curriculum, English Communication Assessment Profile (E-CAP),, the Maslach Burnout-Inventory (MBI), and residents' evaluation of faculty communication. RESULTS Sixty-two residents and ten faculty members completed the three-year curriculum. We saw no significant changes in the MBI or hidden curriculum survey. Communication skills as measured by Calgary Cambridge Score, E-CAP, and resident communication improved significantly (average Calgary-Cambridge Scale scores from 70% at baseline to 78% at follow-up (p-value < 0.001), paired t-test score from 68% at baseline to 81% at follow-up (p-value < 0.004), average E-CAP score from 73 to 77% (p-value < 0.001)). Faculty communication and teaching as rated by residents also showed significant improvement in four out of six domains (learning climate (p < 0.001), patient-centered care (p = 0.01), evaluation (p = 0.03), and self-directed learning (p = 0.03)). CONCLUSION Implementing a multidimensional curriculum in patient-centered communication led to modest improvements in patient-centered communication, improved language skills, and improved communication skills among residents and faculty.
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Affiliation(s)
- Dorothea Wild
- Preventive Medicine Residency Program, Griffin Hospital, Derby, USA
| | - Haq Nawaz
- Combined Internal Medicine/Preventive Medicine Residency Program, Griffin Hospital, Derby, United States
| | - Saif Ullah
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
| | - Christina Via
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
| | | | - Paul Petraro
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
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Karume M. Medical Family Therapy: Advanced Applications. J Child Adolesc Ment Health 2018; 30:1-3. [PMID: 30404571 DOI: 10.2989/17280583.2018.1540147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michelle Karume
- a Psychology Department , United States International University Africa , Nairobi , Kenya
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The Influence of Culture on Teamwork and Communication in a Simulation-Based Resuscitation Training at a Community Hospital in Honduras. ACTA ACUST UNITED AC 2018; 13:363-370. [DOI: 10.1097/sih.0000000000000323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Batra M, Pitt MB, St Clair NE, Butteris SM. Global Health and Pediatric Education: Opportunities and Challenges. Adv Pediatr 2018; 65:71-87. [PMID: 30053931 DOI: 10.1016/j.yapd.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Maneesh Batra
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, 4800 Sand Point Way Northeast, Mailstop OC.7.830, Seattle, WA 98105, USA.
| | - Michael B Pitt
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Minnesota, 2450 Riverside Avenue, M657, Minneapolis, MN 55414, USA
| | - Nicole E St Clair
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Wisconsin School of Medicine and Public Health, H4/470 CSC, Box 4108, 600 Highland Avenue, Madison, WI 53792-4108, USA
| | - Sabrina M Butteris
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Wisconsin School of Medicine and Public Health, H4/470 CSC, Box 4108, 600 Highland Avenue, Madison, WI 53792-4108, USA
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Rees CA, Keating EM, Lukolyo H, Swamy P, Turner TL, Marton S, Sanders J, Mohapi EQ, Kazembe PN, Schutze GE. Host clinical preceptors' perceptions of professionalism among learners completing global health electives. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:206-212. [PMID: 30055101 PMCID: PMC6129158 DOI: 10.5116/ijme.5b40.6e4b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/07/2018] [Indexed: 05/04/2023]
Abstract
OBJECTIVES This study aims to gain an understanding of the perceptions of host clinical preceptors in Malawi and Lesotho of the professionalism exhibited by short-term learners from the United States and Canada during short-term global health electives. METHODS Focus group discussions were conducted with 11 host clinical preceptors at two outpatient pediatric HIV clinics in sub-Saharan Africa (Malawi and Lesotho). These clinics host approximately 50 short-term global health learners from the United States and Canada each year. Focus group moderators used open-ended discussion guides to explore host clinical preceptors' perceptions of the professionalism of short-term global health learners. Thematic analysis with an inductive approach was used to identify salient themes from these focus group discussions. RESULTS Eleven of the 18 possible respondents participated in two focus group discussions. Adaptability, eagerness to learn, active listening, gratitude, initiative, and punctuality was cited as professional behaviors among short-term global health learners. Cited unprofessional behaviors included disregard of local clinicians' expertise and unresponsiveness to feedback. Host clinical preceptors described difficulty providing feedback to short-term global health learners and discrepancies between what may be considered professional in their home setting versus in the study settings. Respondents requested pre-departure orientation for learners and their own orientation before hosting learners. CONCLUSIONS Both host clinical preceptors and short-term global health learners should be aware that behaviors that may be considered best practice in one clinical setting may be perceived as unprofessional in another. Future studies to develop a common definition of professionalism during short-term global health electives are merited.
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Affiliation(s)
- Chris A. Rees
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, USA
| | - Elizabeth M. Keating
- University of Utah, Department of Pediatric Emergency Medicine, Salt Lake City, UT, USA
| | - Heather Lukolyo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Padma Swamy
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Teri L. Turner
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie Marton
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jill Sanders
- Baylor College of Medicine Children's Foundation Lesotho, Maseru, Lesotho
| | - Edith Q. Mohapi
- Baylor College of Medicine Children's Foundation Lesotho, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Findyartini A, Sudarsono NC. Remediating lapses in professionalism among undergraduate pre-clinical medical students in an Asian Institution: a multimodal approach. BMC MEDICAL EDUCATION 2018; 18:88. [PMID: 29716581 PMCID: PMC5930750 DOI: 10.1186/s12909-018-1206-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 04/20/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Fostering personal identity formation and professional development among undergraduate medical students is challenging. Based on situated learning, experiential learning and role-modelling frameworks, a six-week course was developed to remediate lapses in professionalism among undergraduate medical students. This study aims to explore the students' perceptions of their personal identity formation and professional development following completion of the course. METHODS This qualitative study, adopting a phenomenological design, uses the participants' reflective diaries as primary data sources. In the pilot course, field work, role-model shadowing and discussions with resource personnel were conducted. A total of 14 students were asked to provide written self-reflections. Consistent, multi-source feedback was provided throughout the course. A thematic analysis was conducted to identify the key processes of personal and professional development among the students during remediation. RESULTS Three main themes were revealed. First, students highlighted the strength of small group activities in helping them 'internalise the essential concepts'. Second, the role-model shadowing supported their understanding of 'what kind of medical doctors they would become'. Third, the field work allowed them to identify 'what the "noble values" are and how to implement them in daily practice'. CONCLUSION By implementing multimodal activities, the course has high potential in supporting personal identity formation and professional development among undergraduate pre-clinical medical students, as well as remediating their lapses in professionalism. However, there are challenges in implementing the model among a larger student population and in documenting the long-term impact of the course.
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Affiliation(s)
- Ardi Findyartini
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nani Cahyani Sudarsono
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Kaslow NJ, Grus CL, Allbaugh LJ, Shen-Miller D, Bodner KE, Veilleux J, Van Sickle K. Trainees with Competence Problems in the Professionalism Domain. ETHICS & BEHAVIOR 2018. [DOI: 10.1080/10508422.2018.1438897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Lucy J. Allbaugh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Kimberly E. Bodner
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri
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Kim DH, Lee JH, Park J, Shin JS. Process-oriented evaluation of an international faculty development program for Asian developing countries: a qualitative study. BMC MEDICAL EDUCATION 2017; 17:260. [PMID: 29268749 PMCID: PMC5740877 DOI: 10.1186/s12909-017-1101-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/12/2017] [Indexed: 05/12/2023]
Abstract
BACKGROUND Non-English-speaking developing countries in Southeast Asia have been provided only limited opportunities for faculty development in the education of health professions. Although there exist a few programs that have been shown to be effective, they are frequently presented with few explanations on how and why the programs work due to their outcome-oriented nature. This study explores the process of the Lee Jong-Wook Fellowship for Health Professional Education, an international faculty development program designed for capacity building of educators of health professions in Southeast Asian developing countries. METHODS Fellows were from Cambodia, Myanmar, and Laos. Qualitative data were collected from two types of semi-structured interviews - group and individual. Thematic analysis was conducted to explore the factors related to the effectiveness of the program, framed by four components of faculty development, which included context, facilitators, program, and participants. RESULTS From the thematic analysis, the authors identified a total of 12 themes in the four components of faculty development. In the context domain, the resource-poor setting, a culture that puts emphasis on hierarchy and seniority, and educational environment depending on individual commitment rather than broad consensus emerged as key factors. In the facilitators domain, their teaching methods and materials, mutual understanding between teacher and learner, and collaboration between facilitators mainly influenced the learning during the fellowship. In the program domain, the key advantages of the fellowship program were its applicability to the workplace of the fellows and enough allowed time for practice and reflection. Finally, in the participants domain, Fellows valued their heterogeneity of composition and recognized cognitive as well as non-cognitive attributes of the participants as essential. CONCLUSIONS This process-oriented evaluation reveals the diverse factors that contributed to achieving the intended outcomes of the fellowship. Although much evidence from best practices in faculty development are still valid, the findings suggest that the selection strategies, learning environment, and English communication should be given more consideration when organizing a program targeting these people and cultures. A comprehensive understanding of the process would contribute to developing tailored strategies for educators of health professions in developing countries in similar settings.
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Affiliation(s)
- Do-Hwan Kim
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- Department of Medical Education, Eulji University School of Medicine, 77 Gyeryong-ro 771 beon-gil, Jung-gu, Daejeon, 34824 Republic of Korea
| | - Jong-Hyuk Lee
- WHO Collaborating Centre for Educational Development, Seoul National University College of Medicine, 71, Ihwajang-gil, Jongno-gu, Seoul, 03087 Republic of Korea
| | - Jean Park
- WHO Collaborating Centre for Educational Development, Seoul National University College of Medicine, 71, Ihwajang-gil, Jongno-gu, Seoul, 03087 Republic of Korea
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
- WHO Collaborating Centre for Educational Development, Seoul National University College of Medicine, 71, Ihwajang-gil, Jongno-gu, Seoul, 03087 Republic of Korea
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De Leng WE, Stegers-Jager KM, Husbands A, Dowell JS, Born MP, Themmen APN. Scoring method of a Situational Judgment Test: influence on internal consistency reliability, adverse impact and correlation with personality? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:243-265. [PMID: 27757558 DOI: 10.1007/s10459-016-9720-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/06/2016] [Indexed: 05/16/2023]
Abstract
Situational Judgment Tests (SJTs) are increasingly used for medical school selection. Scoring an SJT is more complicated than scoring a knowledge test, because there are no objectively correct answers. The scoring method of an SJT may influence the construct and concurrent validity and the adverse impact with respect to non-traditional students. Previous research has compared only a small number of scoring methods and has not studied the effect of scoring method on internal consistency reliability. This study compared 28 different scoring methods for a rating SJT on internal consistency reliability, adverse impact and correlation with personality. The scoring methods varied on four aspects: the way of controlling for systematic error, and the type of reference group, distance and central tendency statistic. All scoring methods were applied to a previously validated integrity-based SJT, administered to 931 medical school applicants. Internal consistency reliability varied between .33 and .73, which is likely explained by the dependence of coefficient alpha on the total score variance. All scoring methods led to significantly higher scores for the ethnic majority than for the non-Western minorities, with effect sizes ranging from 0.48 to 0.66. Eighteen scoring methods showed a significant small positive correlation with agreeableness. Four scoring methods showed a significant small positive correlation with conscientiousness. The way of controlling for systematic error was the most influential scoring method aspect. These results suggest that the increased use of SJTs for selection into medical school must be accompanied by a thorough examination of the scoring method to be used.
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Affiliation(s)
- W E De Leng
- Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, Room AE-239, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - K M Stegers-Jager
- Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, Room AE-239, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A Husbands
- Medical School, University of Buckingham, Buckingham, UK
| | - J S Dowell
- School of Medicine, University of Dundee, Dundee, UK
| | - M Ph Born
- Department of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - A P N Themmen
- Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC, Room AE-239, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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Cullen MJ, Konia MR, Borman-Shoap EC, Braman JP, Tiryaki E, Marcus-Blank B, Andrews JS. Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors. MEDICAL TEACHER 2017; 39:85-91. [PMID: 27670731 DOI: 10.1080/0142159x.2016.1231917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians. METHOD In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a "brief" and "extended" professionalism checklist for monitoring physician misconduct. RESULTS This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly. DISCUSSION Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.
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Affiliation(s)
- Michael J Cullen
- a Graduate Medical Education , University of Minnesota , Minneapolis , MN , USA
| | - Mojca R Konia
- b Department of Anesthesiology , University of Minnesota , Minneapolis , MN , USA
| | | | - Jonathan P Braman
- d Department of Orthopaedic Surgery , University of Minnesota , Minneapolis , MN , USA
| | - Ezgi Tiryaki
- e Minneapolis VA Health Care System , Minneapolis , MN , USA
- f Department of Neurology, University of Minnesota , Minneapolis , MN , USA
| | | | - John S Andrews
- a Graduate Medical Education , University of Minnesota , Minneapolis , MN , USA
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