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Phua GLG, Owyong JLJ, Leong ITY, Goh S, Somasundaram N, Poon EYL, Chowdhury AR, Ong SYK, Lim C, Murugam V, Ong EK, Mason S, Hill R, Krishna LKR. A systematic scoping review of group reflection in medical education. BMC MEDICAL EDUCATION 2024; 24:398. [PMID: 38600515 PMCID: PMC11007913 DOI: 10.1186/s12909-024-05203-w] [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: 01/20/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. METHODS A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. RESULTS 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. CONCLUSIONS Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.
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Affiliation(s)
- Gillian Li Gek Phua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, 463 Clementi Road, Singapore, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Suzanne Goh
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- KK Women's and Children Hospital, 100 Bukit Timah Rd, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Ruaridh Hill
- Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, Singapore, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
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Grainger R, Liu Q, Gladman T. Learning technology in health professions education: Realising an (un)imagined future. MEDICAL EDUCATION 2024; 58:36-46. [PMID: 37555302 DOI: 10.1111/medu.15185] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023]
Abstract
CONTEXT Technology is being introduced, used and studied in almost all areas of health professions education (HPE), often with a claim of making HPE better in one way or another. However, it remains unclear if technology has driven real change in HPE. In this article, we seek to develop an understanding of the transformative capacity of learning technology in HPE. METHODS AND OUTCOMES We first consider the wider scholarship highlighting the intersection between technology and pedagogy, articulating what is meant by transformation and the role of learning technology in driving educational transformation. We then undertake a synthesis of the current high visibility HPE-focused research. We sampled the literature in two ways-for the five highest impact factor health professional education journals over the past decade and for all PubMed indexed journals for the last 3 years-and categorised the extant research against the Substitution, Augmentation, Modification, Redefinition model. We found that the majority of research we sampled focussed on substituting or augmenting learning through technology, with relatively few studies using technology to modify or redefine what HPE is through the use of technology. Of more concern was the lack of theoretical justification for pedagogical improvement, including transformation, underpinning the majority of studies. CONCLUSIONS While all kinds of technology use in learning have their place, the next step for HPE is the robust use of technology aiming to lead transformation. This should be guided by transformational educational theory and aligned with pedagogical context. We challenge HPE practitioners and scholars to work thoughtfully and with intent to enable transformation in education for future health professionals.
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Affiliation(s)
- Rebecca Grainger
- Education Unit Te Pou Whirinaki, University of Otago Wellington, Wellington, New Zealand
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Qian Liu
- Higher Education Development Centre, University of Otago, Dunedin, New Zealand
| | - Tehmina Gladman
- Education Unit Te Pou Whirinaki, University of Otago Wellington, Wellington, New Zealand
- Otago Medical School, University of Otago, Dunedin, New Zealand
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Faisal E. Understanding the interplay of self-regulated learning strategies in medical education: A cross-sectional structural equation modeling study. Health Sci Rep 2023; 6:e1689. [PMID: 38028700 PMCID: PMC10630747 DOI: 10.1002/hsr2.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/13/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aims Although previous studies have investigated self-regulated learning strategies, a holistic study has not been conducted on note-taking, environmental structuring, self-evaluation, and self-consequence strategies among medical students. The current study focused on the relationships between these four self-regulated learning strategies in a medical context. Methods A conceptual model of the four strategies was developed, supported by the relevant literature. This cross-sectional study used an electronic structured questionnaire. The sample consisted of 557 medical undergraduates. The data were analysed using confirmatory factor analysis and structural equation modeling to investigate the hypothetical model. Results The conceptual model fits the data well. All relationships between the strategies were significantly positive, except for a regression between environmental structuring and self-evaluation, which was nonsignificant. Self-evaluation strategies represented the highest mean, whereas self-consequence strategies represented the lowest. Conclusion The findings of this study have implications for medical students, their teachers, and their universities regarding ways to enhance learners' regulated learning strategies. Future research should be conducted to develop additional statistical and comparison models for use in experimental studies and longitudinal investigations.
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Affiliation(s)
- Eman Faisal
- Department of Curriculum & InstructionKing Saud UniversityRiyadhSaudi Arabia
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Leung KCY, Peisah C. A Mixed-Methods Systematic Review of Group Reflective Practice in Medical Students. Healthcare (Basel) 2023; 11:1798. [PMID: 37372916 DOI: 10.3390/healthcare11121798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Used primarily as a pedagogical evaluation tool for didactic teaching and skill development, reflective practice (RP) for its own merits is poorly understood. This study aimed to systematically review the literature regarding the role of group RP in fostering empathy, wellbeing, and professionalism in medical students. METHODS Electronic searches of empirical studies published between 1 January 2010 and 22 March 2022 from Medline, Embase, and PsychINFO databases were conducted. Empirical studies of any design (qualitative or quantitative) which included RP (1) involving medical students; (2) with a focus on fostering empathy, or professionalism, or personal wellbeing; and (3) provided in a group setting were included. Duplicates, non-English articles, grey literature and articles using RP to examine pedagogy and specific technical skills were excluded. Both authors screened articles independently to derive a final list of included studies, with any discrepancies resolved by discussion, until consensus reached. Articles were rated for methodological quality using the Attree and Milton checklist for qualitative studies; the Oxford Centre for Evidence-Based Medicine criteria, and the Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative studies. RESULTS Of 314 articles identified, 18 were included: 9 qualitative; 4 quantitative and 5 mixed methodology. Settings included United States (6), United Kingdom (3), Australia (3), France (2), Taiwan (2), Germany (1), and Ireland (1). Themes were (i) professionalism: bridging theoretical paradigms and practice; (ii) halting empathy decline; (iii) wellbeing: shared experience. Additional themes regarding the "successful" delivery of RP groups in facilitating these outcomes also emerged. CONCLUSIONS This first systematic review of group RP in medical students shows that RP may bring theory to life in clinical dilemmas, while fostering collegiality and mitigating against isolation amongst students, despite the absence of studies directly examining wellbeing. These findings support the value of RP integration focusing on emotive and humanitarian processes into contemporary medical education for medical students. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022322496.
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Affiliation(s)
- Kelvin C Y Leung
- Research and Education Network, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Carmelle Peisah
- Research and Education Network, Westmead Hospital, Sydney, NSW 2145, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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Samarasekera DD, Lee SS, Yeo JHT, Yeo SP, Ponnamperuma G. Empathy in health professions education: What works, gaps and areas for improvement. MEDICAL EDUCATION 2023; 57:86-101. [PMID: 35790499 DOI: 10.1111/medu.14865] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/05/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Developing a physician equipped with both technical and affective skills is crucial in ensuring quality patient care. Of these skills, nurturing empathy is a key skill that has been studied in great detail, particularly among medical undergraduates. Despite numerous studies trending the changes in empathy, the results are often contradictory or confusing. Our study aims to find what interventions are effective to inculcate empathy in both undergraduate and postgraduate medical education and suggest areas for improvement. METHODS A narrative review was conducted on the interventions in nurturing empathy in undergraduate and postgraduate medical education. Original research articles and systematic reviews with clear interventions and outcomes were included in the study. RESULTS A total of 44 articles were reviewed. About 44% (n = 18) of the studies used a mixture of different approaches as their interventions. Some interventions were anchored by specific topics: Seven papers focusing on communication skills, three papers on humanities, and three on arts. A majority of the interventions (60%; n = 26) were implemented over a span of time as compared to studies which suggested a one-off intervention (30%; n = 12). Of the 26 papers in which the interventions were enforced over a period of time, 62% (n = 16) indicated an increase in student empathy whereas 16% (n = 4) indicated no changes in empathy post-intervention. On the contrary, 50% (n = 6) of the one-off interventions revealed no significant change in student empathy. Jefferson Scale of Empathy (JSE) is widely used in measuring student empathy postintervention, but approximately 41% of the studies included measuring tools other than JSE. CONCLUSIONS Pedagogical methods that invoke thought processes related to the affective domain of learning and experiential learning are more effective than the didactic methods of teaching and learning. Multimodal mixed-methods approach that combine different pedagogical interventions is more likely to bring about the desired results.
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Affiliation(s)
- Dujeepa D Samarasekera
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shuh Shing Lee
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jillian H T Yeo
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Su Ping Yeo
- Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gominda Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Kuhn AW, Hanna ES, Menon VK, Jarrett RT, Payne KL, Churchwell AL. The development of a current events and dialogue forum at a large U.S. academic medical center. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:371-375. [PMID: 33512696 PMCID: PMC9743831 DOI: 10.1007/s40037-021-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/13/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Vanderbilt Community Circle (VC2) was designed to provide all faculty, staff, and students within the entire Vanderbilt University Medical Center community a dedicated venue to discuss current events and ongoing societal issues. APPROACH During the 2017-18 academic year, four VC2 events were held on: "Race, identity, and conflict in America," "Gun violence in America," "Gender in the workplace," and "Immigration in America." Facilitators guided participants to share their views and perspectives on these matters with pre-developed open-ended questions. Attendees started discussions in small groups and then eventually combined into a large one. Pre- and post-event surveys were administered to measure the program's effectiveness. EVALUATION One-hundred and twenty-four participants were included, 75 of whom completed both the pre- and post-event surveys. Sixty-four of the 75 (85%) agreed or strongly agreed that "multiple perspectives and opinions were represented" and 73% felt that their "own perspective was broadened on the issue." Most (89%) believed that the format and setting of the event was conducive to dialogue and discussion, and almost all (91%) reported that they would attend a similar event in the future. Groningen Reflection Ability Scale scores were high before (94 [25th-75th: 88-99]) and remained high after the events (93 [25th-75th: 88-93.3], p > 0.05). REFLECTION We successfully implemented a medical center-wide, recurring current events and dialogue forum in hopes of increasing reflection, unity, and understanding across our own community.
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Affiliation(s)
- Andrew W Kuhn
- Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Eriny S Hanna
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Varun K Menon
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ryan T Jarrett
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kate L Payne
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - André L Churchwell
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Office for Diversity Affairs, Vanderbilt University Medical Center, Nashville, TN, USA
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Wang Z, Guan C, Cai S. How authentic leadership affects green creativity: the role of self-reflection and psychological capital. CHINESE MANAGEMENT STUDIES 2022. [DOI: 10.1108/cms-10-2021-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose
Based on social cognitive theory, this study aims to explore the effect of authentic leadership on employee green creativity by studying the mediating role of reflection and rumination and the moderating role of psychological capital.
Design/methodology/approach
This study used experience sampling methodology to test hypothesis. Specifically, this study applied two-level path analysis to analyze 1,290 observations from 129 employees.
Findings
The results show that authentic leadership positively influences reflection but negatively influences rumination, which in turn impact employees’ green creativity. Psychological capital positively moderates the effects of authentic leadership on reflection and negatively moderates the effects of authentic leadership on rumination. Furthermore, psychological capital moderates the linkages between authentic leadership, self-reflection and employee green creativity.
Practical implications
Organizations should make efforts in promoting authentic leadership and recruiting employees who possess high psychological capital. Moreover, managers can make effective efforts to stimulate employees’ reflection and mitigate rumination, thereby facilitating organizational sustainable development.
Originality/value
In investigating green issues related to employees’ daily cognitive processes, this study focuses on within-personal reaction mechanism to authentic leadership, concerning the moderating effect of individual psychological capital.
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Boyd T, Besche H, Goldhammer R, Alblooshi A, Coleman BI. First-year medical students' perceptions of a self-regulated learning-informed intervention: an exploratory study. BMC MEDICAL EDUCATION 2022; 22:821. [PMID: 36447223 PMCID: PMC9710124 DOI: 10.1186/s12909-022-03908-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Students with developed self-regulated learning (SRL) skills demonstrate an ability to set individualized educational goals, select optimal learning strategies for reaching these goals, and reflect on overall progress. The primary aims of this study were to investigate first-year medical students' perceived utility of a self-regulated learning-informed intervention and to assess the impact of its implementation on students' intended use of SRL throughout medical school. METHODS A two-part educational intervention focused on SRL skill development was carried out at Harvard Medical School during the start of the 2021 academic year. For the first component of the intervention, 169 first-year medical students engaged in an interactive class session structured around SRL concept videos, a brief lecture, small group discussions and individual reflection. Students completed pre- and post-intervention surveys which inquired about learners' current and anticipated application of SRL skills. During the second component of the intervention, 15 first-year medical students participated in a set of one-on-one academic SRL coaching sessions. All coaching participants completed follow-up semi-structured interviews. RESULTS A statistically significant increase was observed between students' use of skills in all domains of self-regulated learning prior to the intervention and their anticipated use of these skills following the intervention. Prior to the intervention, 60.1% (n = 92) of students reported utilizing evidence-based learning strategies, compared to 92.8% (n = 142) of students (p < 0.001) who anticipated applying this SRL skills at the completion of the classroom session. Six core themes emerged from qualitative analysis of the post-intervention survey including learning plan development, accountability and progress tracking, goals for growth, engagement through active learning, routine reflection, and adapting to the curriculum. CONCLUSIONS Both classroom-based learning sessions and one-on-one academic coaching programs are feasible approaches for encouraging the use of self-regulated learning techniques in the preclinical setting.
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Affiliation(s)
- Taylor Boyd
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Henrike Besche
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | | | - Afaf Alblooshi
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Doron R, Eichler R, Rajhans V. Effectiveness of online learning in improving optometry student's reflective abilities. JOURNAL OF OPTOMETRY 2022:S1888-4296(22)00066-8. [PMID: 36400680 PMCID: PMC9666351 DOI: 10.1016/j.optom.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Optometry education strives to develop competencies required for reflective practice in its pupils. The forced changes in academia during COVID-19 pandemic, rapid switching to online methods imposed serious challenges on the training of reflective skills. We hypothesize that the synchronous online sessions of case-based reflections are effective in imparting training for reflective practice in optometry students. METHODS A prospective study was done with planned, synchronous, online, small group workshops for case-based reflections through the second year of optometry program during 'introduction to patient care' course. The reflective competencies were measured with a modified Groningen Reflection Ability Scale (GRAS) at the beginning and towards conclusion. Data was analysed with Mann-Whitney one tail test and qualitative thematic methods. RESULTS Total of 104 students participated in the study. The aggregate score showed significant improvement (p<0.05) in students' reflective ability. A rising trend was seen in each component namely self-reflection, empathetic and communication reflections. DISCUSSIONS The results demonstrate that the reflective skills can be developed using virtual patient experiences, case-based reflective practices conducted in synchronous small group workshops in online mode. Students perceived it as useful activity in developing themselves as healthcare professionals.
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Affiliation(s)
- Ravid Doron
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Rachel Eichler
- Department of Optometry, Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Vidyut Rajhans
- Laxmi College of Optometry, Laxmi Eye Institute, Panvel, Maharashtra, India.
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Sagi D, Rudolf MCJ, Spitzer S. A social ecological approach to promote learning health disparities in the clinical years: impact of a home-visiting educational program for medical students. BMC MEDICAL EDUCATION 2022; 22:698. [PMID: 36180860 PMCID: PMC9524119 DOI: 10.1186/s12909-022-03755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clinical years or as voluntary courses. ETGAR a required health disparities course, based on the social ecological model, was initiated to answer the NAM call. This study aimed to ascertain the course impact on students learning of SDOH and health disparities. METHODS Students during their first clinical year cared for four patients in their transition from hospital back home, one patient in each internal medicine, surgery, pediatrics and obstetrics/gynecology rotation. The students home-visited their patients after meeting them in hospital and preparing a plain language discharge letter. Training session prior to the course, a tutorial in each rotation, and structured feedback gave the educational envelope. Mixed methodology was employed to evaluate the course impact. Quantitative data collected by students during the home-visit: patients' characteristics and quality and safety of the transition back home using the Medication Discrepancy Tool and Care Transition Measure questionnaire. Stakeholders' views were collected via interviews and focus groups with students representing all affiliated hospitals, and interviews with heads of departments most involved in the course. RESULTS Three hundred six students in three academic years, between October 2016-July 2019, completed home visits for 485 disadvantaged patients with improvement in patients' knowledge of their treatment (3.2 (0.96) vs 3.8 (0.57), Z = -7.12, p < .0001) and identification of medication discrepancies in 42% of visits. Four themes emerged from the qualitative analysis: contribution to learning, experience-based learning, professional identity formation, and course implementation. CONCLUSIONS ETGAR was perceived to complement hospital-based learning, making students witness the interaction between patients' circumstances and health and exposing them to four patients' environment levels. It provided a didactic framework for promoting awareness to SDOH and tools and behaviors required to ameliorate their impact on health and health disparities. The course combined communication and community learning into traditionally bio-medical clinical years and serves as a model for how social-ecology approaches can be integrated into the curriculum.
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Affiliation(s)
- Doron Sagi
- Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel.
- MSR- The Israel Center for Medical Simulation, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | - Sivan Spitzer
- Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel
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Van Winkle LJ, Thornock BO, Schwartz BD, Horst A, Fisher JA, Michels N. Critical reflection on required service to the community propels prospective medical students toward higher empathy, compassion, and bias mitigation but are these gains sustainable? Front Med (Lausanne) 2022; 9:976863. [PMID: 36160142 PMCID: PMC9500161 DOI: 10.3389/fmed.2022.976863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We observed increased cognitive empathy and reflective capacity scores when prospective medical students wrote critical reflections on mandatory team service-learning in a Medical Humanities course, but these findings did not include a control group. Here we compare these survey results in similar courses with and without required service-learning. Methods Forty-three prospective medical students completed a Medical Humanities course requiring critical reflection on team service-learning. In comparison, 32 students finished a similar course in which service to the community was not mandatory. Before starting the courses, students completed reliable surveys of their cognitive empathy and reflective capacity, and more than 93% of the students completed the same surveys after finishing the courses. Results Students' cognitive empathy and reflective capacity scores increased significantly when service-learning was required, but the scores did not increase significantly when service to the community was not required. The effect size for the empathy increase was of crucial practical importance (r = 0.50), whereas it was of moderate practical importance for the increase in reflective capacity (r = 0.34). Conclusions These and prior findings strongly support the conclusion that students' critical reflection on mandatory team service-learning fosters development of their cognitive empathy and reflective capacity. We present a model program to incorporate critical reflection on service to the community throughout the curricula of all healthcare professions trainees.
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Affiliation(s)
- Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
- Department of Biochemistry, Midwestern University, Downers Grove, IL, United States
- *Correspondence: Lon J. Van Winkle
| | - Bradley O. Thornock
- Department of Medical Humanities, Rocky Vista University, Ivins, UT, United States
| | - Brian D. Schwartz
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Alexis Horst
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Jensen A. Fisher
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
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Gajria C, Gunning E, Horsburgh J, Kumar S. Using vlogging to facilitate medical student reflection. EDUCATION FOR PRIMARY CARE 2022; 33:244-247. [PMID: 35638935 DOI: 10.1080/14739879.2022.2070868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reflection is a critical skill for medical professionals, however medical students often find it difficult to grasp and engage with. During a special choice module on yoga and mindfulness, students practised mindfulness at home and posted their reflections on the activities in text and vlogs in a closed WhatsApp group. Semi-structured focus groups investigated student perspectives on the acceptability and impact of v-logging on their reflective practice. We thematically analysed transcripts of the WhatsApp conversations and two focus groups.Students felt v-logging was more engaging and convenient than written reflections. V-logging was found to enhance emotional content that is commonly lacking in written reflection, which is has importance as emotional recognition promotes a higher quality of reflection. Although some students were concerned about their appearance in videos, they appeared to overcome this, finding v-logging facilitated deeper reflection compared with traditional written reflections due to accessibility and ease of expression. Furthermore, there was additional learning through watching other students' emotive vlogs which fits with the phenomenon of reflective vicarious learning.Sharing vlogs within a WhatsApp group appeared to be an accessible way for facilitating greater engagement with affective and expressive aspects of reflection.
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Affiliation(s)
- Camille Gajria
- Department of Public Health and Primary Care, Medical Education Innovation and Research Centre, London, UK
| | - Elinor Gunning
- Department of Public Health and Primary Care, Medical Education Innovation and Research Centre, London, UK
| | - Jo Horsburgh
- Department of Public Health and Primary Care, Medical Education Innovation and Research Centre, London, UK
| | - Sonia Kumar
- Department of Public Health and Primary Care, Medical Education Innovation and Research Centre, London, UK
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Flickinger TE, Kon RH, Jacobsen B, Schorling J, May N, Harrison M, Plews-Ogan M. "Flourish in the Clerkship Year": a Curriculum to Promote Wellbeing in Medical Students. MEDICAL SCIENCE EDUCATOR 2022; 32:315-320. [PMID: 35528301 PMCID: PMC9054975 DOI: 10.1007/s40670-022-01522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED The stresses of medical training can lead to burnout and other adverse outcomes. The Flourish curriculum was designed to mitigate negative effects of stress among clerkship students through debriefing and skills-building activities that foster practical wisdom: mindfulness, appreciative practice, story-telling/listening, and reflection. Students rated the curriculum highly, felt it addressed common concerns about clerkships, and were able to apply techniques from the curriculum to their clinical work. This framework can help students process their experiences and benefit from peer support, mentorship, and reflection. Fostering medical students' wisdom capacities for reflection and compassion may be protective against burnout during their training. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01522-z.
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Affiliation(s)
- Tabor E. Flickinger
- Division of General, Geriatric, Palliative & Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, P.O. Box 800744, VA 22908 Charlottesville, USA
| | - Rachel H. Kon
- Division of General, Geriatric, Palliative & Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, P.O. Box 800744, VA 22908 Charlottesville, USA
| | - Beck Jacobsen
- University of Virginia School of Medicine, Charlottesville, VA USA
| | - John Schorling
- Division of General, Geriatric, Palliative & Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, P.O. Box 800744, VA 22908 Charlottesville, USA
| | - Natalie May
- University of Virginia School of Nursing, Charlottesville, VA USA
| | - Madaline Harrison
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Margaret Plews-Ogan
- Division of General, Geriatric, Palliative & Hospital Medicine, Department of Medicine, University of Virginia School of Medicine, P.O. Box 800744, VA 22908 Charlottesville, USA
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Pieris D, Jafine H, Neilson S, Amster E, Zazulak J, Lam C, Grierson L. Understanding moral empathy: A verbatim-theatre supported phenomenological exploration of the empathy imperative. MEDICAL EDUCATION 2022; 56:186-194. [PMID: 34612521 DOI: 10.1111/medu.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/05/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Several studies have measured a decline in empathy during medical training, speculating that factors within the formal, informal and hidden curricula are responsible for this phenomenon. Although the medical education literature describes the moral domain of empathy as most fundamental to the empathic response, most research into the decline has examined the cognitive, affective and behavioural domains. This study distinguishes itself by focusing on how moral empathy is affected through training. METHODS Ten medical residents from core education specialties at McMaster University participated in lightly structured interviews concerning their training experiences. Interview transcripts were analysed by way of a descriptive phenomenological approach. Analyses afforded descriptions of the way medical training influences moral empathy. These descriptions were then used to generate a verbatim theatre play that was performed for an audience of residents, educators, learners, researchers and scholars. Following the play, audience participants completed a survey to member-check the descriptions and to glean other reflective experiences in resident training that impact moral empathy. The survey results informed revisions to the codebook that was subsequently used to re-analyse the interview transcripts. This resulted in a final, refined version of the influence of training on learner moral empathy. RESULTS The findings suggest that a resident's sense of moral empathy relies upon the notion of an innate capacity for empathy, and is influenced by their clinical and classroom education, and specific experiences with patients during training. Importantly, these factors are rarely experienced as having a direct deleterious impact on residents' moral empathy but rather are experienced as challenges to their ability to act on their moral empathy. CONCLUSIONS The study promotes reflection of what it means to experience empathy in the moral domain. The description offers a new perspective from which to view empathic declines that have been previously reported, while also highlighting a moral-behavioural tension that has implications for competency-based assessment and the way empathy is conceptualised in medical education.
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Affiliation(s)
- Dilshan Pieris
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hartley Jafine
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Shane Neilson
- Department of English and Cultural Studies, Faculty of Humanities, McMaster University, Hamilton, Canada
| | - Ellen Amster
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Joyce Zazulak
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
| | - Connie Lam
- Bachelor of Health Sciences Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- Health Sciences Education Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Family Medicine, Faculty of Health Sciences, Department of Religious Studies, McMaster University, Hamilton, Canada
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Chen A, Harnett J, Kothari P, Ernst M. A Review of Mentorship in Urology: Are We Satisfied? Curr Urol Rep 2022; 23:383-392. [PMID: 36459377 PMCID: PMC9716155 DOI: 10.1007/s11934-022-01122-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE OF REVIEW To evaluate the state of mentorship in the field of urology. RECENT FINDINGS Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured. Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.
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Affiliation(s)
- Annie Chen
- Department of Urology, Stony Brook University, 101 Nicholls Rd, Stony Brook, New York, NY, 11795, USA
| | - Joseph Harnett
- Department of Urology, Stony Brook University, 101 Nicholls Rd, Stony Brook, New York, NY, 11795, USA
| | - Pankti Kothari
- Department of Urology, Stony Brook University, 101 Nicholls Rd, Stony Brook, New York, NY, 11795, USA
| | - Michael Ernst
- Department of Urology, Stony Brook University, 101 Nicholls Rd, Stony Brook, New York, NY, 11795, USA.
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Menezes P, Guraya SY, Guraya SS. A Systematic Review of Educational Interventions and Their Impact on Empathy and Compassion of Undergraduate Medical Students. Front Med (Lausanne) 2021; 8:758377. [PMID: 34820397 PMCID: PMC8606887 DOI: 10.3389/fmed.2021.758377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction: A compassionate and patient-centered care leads to improved clinical outcomes. Promoting empathy and compassion of medical students is a forerunner of their well-being, emotional stability, and a patient-centered care. However, there is slender evidence about best educational interventions that can inculcate empathy and compassion skills. Our objective was to conduct a systematic review of research evaluating the associations between spectrum, effectiveness, frequency of teaching modalities and their outcomes on compassion and empathy to highlight best practices. Methods: We searched the Web of Science, PubMed, Scopus, and EBSCO Host on 22nd July 2020. We adapted our search strategy from a previously published systematic review on education for compassion and empathy. Selected studies were required to have used unique educational interventions for promoting empathy and compassion of medical students. The research questions were based on Participants (medical students), Intervention (empathy and/or compassion related teaching), Comparison, and Outcome. Results: We analyzed 24 articles from the initial yield of 2,861. Twenty-two were quantitative studies with a mean of 12.8 on MERSQI. Twelve were randomized controlled trials while 5 measured outcomes with single group pre- and post-tests. There was no association found between duration, frequency and complexity of an educational intervention and its effectiveness. Twenty used multimodality curricula, and of those 18 reported statistically significant positive improvement in empathy, while 3 of 4 single modality were effective. Only three studies looked for long-term effects of educational interventions. Fourteen studies evaluated Kirkpatrick's level one (self-reported knowledge), 2 level three (behavior), and 6 level four (patient outcomes). We identified six major educational constructs of teaching empathy and compassion; communication, mindfulness, early clinical exposure, technology-enhanced learning, comics and arts and culture. Discussion: Our review couldn't identify a standard teaching construct in place and highlighted that different teaching tools carry similar impact in promoting compassion and empathy and a sustainable program rather than a single training activity is essential.
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Affiliation(s)
- Prianna Menezes
- Royal College of Surgeons Ireland, Bahrain RCSI-Medical University of Bahrain (MUB), Busaiteen, Bahrain
| | | | - Shaista Salman Guraya
- Royal College of Surgeons Ireland, Bahrain RCSI-Medical University of Bahrain (MUB), Busaiteen, Bahrain
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Guckian J, Utukuri M, Asif A, Burton O, Adeyoju J, Oumeziane A, Chu T, Rees EL. Social media in undergraduate medical education: A systematic review. MEDICAL EDUCATION 2021; 55:1227-1241. [PMID: 33988867 DOI: 10.1111/medu.14567] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high-quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. METHODS Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. RESULTS 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self-reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. CONCLUSIONS Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher-quality study is required to identify longer-term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms.
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Affiliation(s)
- Jonathan Guckian
- Dermatology Department, Leeds Teaching Hospitals NHS Trust, Yorkshire, UK
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aqua Asif
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Oliver Burton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joshua Adeyoju
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam Oumeziane
- School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Timothy Chu
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Eliot L Rees
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
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The effect of abusive supervision on safety behaviour of Chinese underground miners: a multi-level moderated mediation analysis. CHINESE MANAGEMENT STUDIES 2021. [DOI: 10.1108/cms-08-2020-0342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Prior research has suggested that abusive supervision has negative impacts on various work outcomes. However, little attention has been paid to the relationship between abusive supervision and employees’ safety behaviour. The purpose of this study is, therefore, to address these limitations by developing and testing a theoretically based conceptual model that explicitly considers the underlying mechanism and boundary condition of the relationship between abusive supervision and safety behaviour of underground coal miners in China.
Design/methodology/approach
At Time 1, the authors conducted a survey of 630 employees to assess their supervisors’ abusive leadership behaviours, their own power distance beliefs and their self-reflection. At Time 2, the authros sent questionnaires to the leaders and invited them to evaluate employees’ safety behaviour in the workplace. After cleaning the survey data, the authors tested our model using a multi-level analysis on a sample (n = 458) of underground miners across 96 coal mining sites in China.
Findings
The authors propose that abusive supervision decreases employees’ safety compliance/participation by reducing reflection but strengthening rumination. The authors further find that the linkage from abusive supervision to reflection/rumination to safety compliance/participation is affected by power distance.
Originality/value
To the best of the authors’ knowledge, This is one of the first empirical studies to investigate the mediating effects of a deep cognitive processing variable – namely, self-reflection – and the moderating effects of power distance on the relationship between abusive supervision and safety behaviour.
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Zhou YC, Tan SR, Tan CGH, Ng MSP, Lim KH, Tan LHE, Ong YT, Cheong CWS, Chin AMC, Chiam M, Chia EWY, Lim C, Wijaya L, Chowdhury AR, Kwek JW, Fong W, Somasundaram N, Ong EK, Mason S, Krishna LKR. A systematic scoping review of approaches to teaching and assessing empathy in medicine. BMC MEDICAL EDUCATION 2021; 21:292. [PMID: 34020647 PMCID: PMC8140468 DOI: 10.1186/s12909-021-02697-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/21/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Empathy is pivotal to effective clinical care. Yet, the art of nurturing and assessing empathy in medical schools is rarely consistent and poorly studied. To inform future design of programs aimed at nurturing empathy in medical students and doctors, a review is proposed. METHODS This systematic scoping review (SSR) employs a novel approach called the Systematic Evidence Based Approach (SEBA) to enhance the reproducibility and transparency of the process. This 6-stage SSR in SEBA involved three teams of independent researchers who reviewed eight bibliographic and grey literature databases and performed concurrent thematic and content analysis to evaluate the data. RESULTS In total, 24429 abstracts were identified, 1188 reviewed, and 136 included for analysis. Thematic and content analysis revealed five similar themes/categories. These comprised the 1) definition of empathy, 2) approaches to nurturing empathy, 3) methods to assessing empathy, 4) outcome measures, and 5) enablers/barriers to a successful curriculum. CONCLUSIONS Nurturing empathy in medicine occurs in stages, thus underlining the need for it to be integrated into a formal program built around a spiralled curriculum. We forward a framework built upon these stages and focus attention on effective assessments at each stage of the program. Tellingly, there is also a clear need to consider the link between nurturing empathy and one's professional identity formation. This foregrounds the need for more effective tools to assess empathy and to better understand their role in longitudinal and portfolio based learning programs.
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Affiliation(s)
- Yi Cheng Zhou
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Shien Ru Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Chester Guan Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Matthew Song Peng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Kia Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Lorraine Hui En Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore Blk MD6, Centre for Translational Medicine, 14 Medical Dr, #05-01, Singapore, 117599, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Elisha Wan Ying Chia
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Infectious Diseases, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore, 169854, Singapore
| | - Anupama Roy Chowdhury
- Department of General Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore, 544886, Singapore
| | - Jin Wei Kwek
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Warren Fong
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Centre of Biomedical Ethics, National University of Singapore, Blk MD 11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Tseng TC, Chen TY, Chu SY, Wang HC, Chang CY. Survey of the triple-mentoring program for students at a religious medical school. BMC MEDICAL EDUCATION 2021; 21:159. [PMID: 33726739 PMCID: PMC7970779 DOI: 10.1186/s12909-021-02593-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Tzu Chi University in Taiwan offers a unique mentoring program. This program differs from others as it comprises triple mentorship, namely, faculty mentors, Tzu Cheng/Yi De (TC/YD; senior volunteers), and school counselors. This study aimed to survey the role functions of the mentors from the perspective of medical students. METHODS The Role Functions of the Mentoring Program Scale (RFMPS) was developed on the basis of literature reviews and focus groups and it underwent exploratory factor analysis for internal consistency and reliability. RFMPS comprises four role functions, namely, mental, educational, career, and humanistic/moral guidance counseling. The survey was distributed to 171 medical students via an online network with two-month intervals and was analyzed using multivariate analysis of variance. RESULTS The overall response rate was 64% (116/171). The mean scores of the four role functions in descending order belonged to faculty mentors, TC/YD, and school counselors. For humanistic/moral guidance, students had an equal preference for the faculty mentors and TC/YD over school counselors. As for educational, career, and mental guidance counseling, students preferred faculty mentors over TC/YD and school counselors. Faculty mentors provided students with the required guidance counseling for all the four role functions, especially educational guidance; TC/YD in particular offered prominent humanistic/moral guidance and career counseling; school counselors were less preferred but guided students in need. CONCLUSIONS Medical students value different role functions provided by faculty mentors, TC/YD, and school counselors. A diversified focus could be provided by the faculty mentors, particularly in educational, career, mental, and humanistic/moral counseling; TC/YD specialized in humanistic/moral guidance; and the school counselors carried out their role function only when needed. Humanistic/moral guidance is equally preferred to other types of guidance, which can be equally valuable in future mentoring programs.
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Affiliation(s)
| | - Tsung-Ying Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Anesthesiology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shao-Yin Chu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung-Che Wang
- Department of Education and Human Potentials Development, National Dong Hwa University, Hualien, Taiwan
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Gilligan C, Powell M, Lynagh MC, Ward BM, Lonsdale C, Harvey P, James EL, Rich D, Dewi SP, Nepal S, Croft HA, Silverman J. Interventions for improving medical students' interpersonal communication in medical consultations. Cochrane Database Syst Rev 2021; 2:CD012418. [PMID: 33559127 PMCID: PMC8094582 DOI: 10.1002/14651858.cd012418.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence). Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported. AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Martine Powell
- Centre for Investigative Interviewing, Griffith Criminology Institute, Griffith University, Brisbane, Australia
| | - Marita C Lynagh
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | | | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, Australia
| | - Pam Harvey
- School of Rural Health, Monash University, Bendigo, Australia
| | - Erica L James
- School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, Callaghan, Australia
| | - Dominique Rich
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sari P Dewi
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Smriti Nepal
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Darlington, Australia
| | - Hayley A Croft
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
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Skjevik EP, Boudreau JD, Ringberg U, Schei E, Stenfors T, Kvernenes M, Ofstad EH. Group mentorship for undergraduate medical students-a systematic review. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:272-280. [PMID: 32820416 PMCID: PMC7550430 DOI: 10.1007/s40037-020-00610-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Mentoring has become a prevalent educational strategy in medical education, with various aims. Published reviews of mentoring report very little on group-based mentorship programs. The aim of this systematic review was to identify group-based mentorship programs for undergraduate medical students and describe their aims, structures, contents and program evaluations. Based on the findings of this review, the authors provide recommendations for the organization and assessment of such programs. METHODS A systematic review was conducted, according to PRISMA guidelines, and using the databases Ovid MEDLINE, EMBASE, PsycINFO and ERIC up to July 2019. Eight hundred abstracts were retrieved and 20 studies included. Quality assessment of the quantitative studies was done using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS The 20 included studies describe 17 different group mentorship programs for undergraduate medical students in seven countries. The programs were differently structured and used a variety of methods to achieve aims related to professional development and evaluation approaches. Most of the studies used a single-group cross-sectional design conducted at a single institution. Despite the modest quality, the evaluation data are remarkably supportive of mentoring medical students in groups. DISCUSSION Group mentoring holds great potential for undergraduate medical education. However, the scientific literature on this genre is sparse. The findings indicate that group mentorship programs benefit from being longitudinal and mandatory. Ideally, they should provide opportunities throughout undergraduate medical education for regular meetings where discussions and personal reflection occur in a supportive environment.
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Affiliation(s)
| | - J Donald Boudreau
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Canada
| | | | - Edvin Schei
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Monika Kvernenes
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik H Ofstad
- Institute of Social Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Williams JC, Ireland T, Warman S, Cake MA, Dymock D, Fowler E, Baillie S. Instruments to measure the ability to self-reflect: A systematic review of evidence from workplace and educational settings including health care. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:389-404. [PMID: 31108006 DOI: 10.1111/eje.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/16/2019] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Self-reflection has become recognised as a core skill in dental education, although the ability to self-reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self-reflective ability of adults studying or working within any setting, not just health care. MATERIALS AND METHODS A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost. RESULTS A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self-reported scales and observed behaviour. CONCLUSIONS Three types of instrument were identified to assess the ability to self-reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self-reflect, and how this should be managed.
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Affiliation(s)
- Julie C Williams
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Tony Ireland
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Sheena Warman
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Martin A Cake
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia, Australia
| | - David Dymock
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Ellayne Fowler
- Centre for Medical Education, University of Bristol, Bristol, UK
| | - Sarah Baillie
- Bristol Veterinary School, Faculty of Health Sciences, University of Bristol, Bristol, UK
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Curricula for empathy and compassion training in medical education: A systematic review. PLoS One 2019; 14:e0221412. [PMID: 31437225 PMCID: PMC6705835 DOI: 10.1371/journal.pone.0221412] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022] Open
Abstract
Background Empathy and compassion are vital components of health care quality; however, physicians frequently miss opportunities for empathy and compassion in patient care. Despite evidence that empathy and compassion training can be effective, the specific behaviors that should be taught remain unclear. We synthesized the biomedical literature on empathy and compassion training in medical education to find the specific curricula components (skills and behaviors) demonstrated to be effective. Methods We searched CENTRAL, MEDLINE, EMBASE, and CINAHL using a previously published comprehensive search strategy. We screened reference lists of the articles meeting inclusion criteria to identify additional studies for potential inclusion. Study inclusion criteria were: (1) intervention arm in which subjects underwent an educational curriculum aimed at enhancing empathy and/or compassion; (2) clearly defined control arm in which subjects did not receive the curriculum; (3) curriculum was tested on physicians (or physicians-in-training); and (4) outcome measure assessing the effect of the curriculum on physician empathy and/or compassion. We performed a qualitative analysis to collate and tabulate effects of tested curricula according to recommended methodology from the Cochrane Handbook. We used the Cochrane Collaboration’s tool for assessing risk of bias. Results Fifty-two studies (total n = 5,316) met inclusion criteria. Most (75%) studies found that the tested curricula improved physician empathy and/or compassion on at least one outcome measure. We identified the following key behaviors to be effective: (1) sitting (versus standing) during the interview; (2) detecting patients’ non-verbal cues of emotion; (3) recognizing and responding to opportunities for compassion; (4) non-verbal communication of caring (e.g. eye contact); and (5) verbal statements of acknowledgement, validation, and support. These behaviors were found to improve patient perception of physician empathy and/or compassion. Conclusion Evidence suggests that training can enhance physician empathy and compassion. Training curricula should incorporate the specific behaviors identified in this report.
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Rogers SL, Priddis LE, Michels N, Tieman M, Van Winkle LJ. Applications of the reflective practice questionnaire in medical education. BMC MEDICAL EDUCATION 2019; 19:47. [PMID: 30732611 PMCID: PMC6367754 DOI: 10.1186/s12909-019-1481-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 01/30/2019] [Indexed: 05/17/2023]
Abstract
BACKGROUND We sought to determine whether the Reflective Practice Questionnaire (RPQ) is a reliable measure of reflective capacity and related characteristics in medical students. We also planned to learn how the RPQ could be used in medical education. METHODS The RPQ is a 40 item self-report questionnaire that includes a multi-faceted approach to measuring reflective capacity. It also includes sub-scales on several other theoretically relevant constructs such as desire for improvement, confidence, stress, and job satisfaction. The reliabilities of reflective capacity and other sub-scales were determined by calculating their Cronbach alpha reliability values. In the present study, the RPQ was answered by 98 graduating fourth-year medical students from an American University, and these RPQ scores were compared with general public and mental health practitioner samples from a prior study using ANOVA and Bonferroni adjusted comparisons. RESULTS Medical students reported a higher reflective capacity than the general public sample, but students were statistically indistinguishable from the mental health practitioner sample. For medical students, reflective capacity was associated with features of confidence, stress, and desire for improvement. Job satisfaction was positively associated with confidence in communication with patients, and negatively associated with stress when interacting with patients. A cluster analysis revealed that around 19% of the medical students exhibited a relatively high level of anxiety interacting with patients, 23% were less engaged, 5% were dissatisfied, and 7% expressed a level of over-confidence in their knowledge and skills that was concerning. CONCLUSIONS The RPQ is a reliable measure of reflective capacity (Chronbach's alpha value = 0.84) and related characteristics (Cronbach's alpha values from 0.75 to 0.83) in medical students. The RPQ can be used as part of pre-post evaluations of medical education initiatives, to complement student self-reflection activities in the curriculum, and to identify students who might benefit from targeted intervention.
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Affiliation(s)
| | | | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134 USA
| | - Michael Tieman
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134 USA
| | - Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134 USA
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Uygur J, Stuart E, De Paor M, Wallace E, Duffy S, O'Shea M, Smith S, Pawlikowska T. A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51. MEDICAL TEACHER 2019; 41:3-16. [PMID: 30634872 DOI: 10.1080/0142159x.2018.1505037] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical education. The aim of this review was to determine: (i) which educational interventions are being used to develop reflection, (ii) how is reflection being assessed, and (iii) what are the most effective interventions. METHODS Inclusion criteria comprised: (i) undergraduate medical students, (ii) a teaching intervention to develop reflection, and (iii) assessment of the intervention. A review protocol was developed and nine databases were searched. Screening, data extraction, and analysis procedures were performed in duplicate. Due to the heterogeneity of studies, a narrative synthesis approach was performed for the study analysis. RESULTS Twenty-eight studies met the inclusion criteria. The interventions in these studies had at least of two of the following components related to reflection: (i) introduction, (ii) trigger, (iii) writing, (iv) guidelines, (v) small group discussion, (vi) tutor and (vii) feedback. Three validated rubrics were used to assess reflective writing in these studies. CONCLUSIONS The strongest evidence from studies in this review indicates that guidelines for, and feedback on, reflective writing improve student reflection.
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Affiliation(s)
- Jane Uygur
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Ellen Stuart
- a Department of General Practice , RCSI , Dublin , Ireland
| | | | - Emma Wallace
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Seamus Duffy
- a Department of General Practice , RCSI , Dublin , Ireland
| | - Marie O'Shea
- b Health Professions Education Centre, RCSI , Dublin , Ireland
| | - Susan Smith
- a Department of General Practice , RCSI , Dublin , Ireland
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Pealing L, Tempest HV, Howick J, Dambha-Miller H. Technology: a help or hindrance to empathic healthcare? J R Soc Med 2018; 111:390-393. [PMID: 30175938 DOI: 10.1177/0141076818790669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Pealing
- 1 Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX2 6GG, UK
| | - H V Tempest
- 2 Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - J Howick
- 1 Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX2 6GG, UK
| | - H Dambha-Miller
- 1 Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX2 6GG, UK
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Van Winkle LJ, Schwartz BD, Michels N. A Model to Promote Public Health by Adding Evidence-Based, Empathy-Enhancing Programs to All Undergraduate Health-care Curricula. Front Public Health 2017; 5:339. [PMID: 29322041 PMCID: PMC5732135 DOI: 10.3389/fpubh.2017.00339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/28/2017] [Indexed: 12/30/2022] Open
Abstract
Fostering empathy in future health-care providers through service-learning is emerging as central to public health promotion. Patients fare better when their caregivers have higher relationship-centered characteristics such as the ones measured by the Jefferson Scale of Empathy. Unfortunately, these characteristics often deteriorate during health-care professional training. Nevertheless, growing literature documents how we can promote empathy, and other patient-centered characteristics, throughout health-care professional students’ undergraduate education. As for proven treatment plans, we believe we should also use evidence-based guidelines to foster relationship-centered characteristics in our students when training them to practice as part of an interdisciplinary health-care team.
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Datta SS, Agrawal S. Can e-learning help you to connect compassionately? Commentary on a palliative care e-learning resource for India. Ecancermedicalscience 2017; 11:ed72. [PMID: 29104615 PMCID: PMC5659824 DOI: 10.3332/ecancer.2017.ed72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/23/2022] Open
Abstract
e-learning resources need to be customised to the audience and learners to make them culturally relevant. The ‘Palliative care e-learning resource for health care professionals in India’ has been developed by the Karunashraya Hospice, Bengaluru in collaboration with the Cardiff Palliative Care Education Team, Wales to address the training needs of professionals in India. The resource, comprising over 20 modules, integrates psychological, social and medical care for patients requiring palliative care for cancer and other diseases. With increased internet usage, it would help in training a large number of professionals and volunteers in India who want to work in the field of palliative care.
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Affiliation(s)
- Soumitra Shankar Datta
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, West Bengal, India 700160.,UCL EGA Institute for Women's Health (IfWH), UCL School of Life and Medical Sciences, University College London, UK
| | - Sanjit Agrawal
- Department of Breast Surgery, Tata Medical Centre, Kolkata, West Bengal, India 700160
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Chou CL, Teherani A. A Foundation for Vital Academic and Social Support in Clerkships: Learning Through Peer Continuity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:951-955. [PMID: 28353506 DOI: 10.1097/acm.0000000000001661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Most medical students on clerkships currently experience lack of continuity of patient care, disjointed learning, and frequent changes in supervisors. Clerkship programs with continuity of care, curriculum, and supervisors appear to benefit student learning and patient-centeredness. A fourth form of continuity is proposed: continuity of peers, in which a stable cohort of students frequently meets to process their experiences on clerkships. This structure builds on benefits previously seen in peer-assisted learning, including enhanced knowledge, technical skills, and collegial peer relationships. Additional advantages of peer continuity in clerkships include facilitated integration into the workplace, social support, and enhanced clinical and professional learning. Practical components required for a successful peer continuity structure include intentional formation of peer cohorts; regular meetings that cover didactic or clinical skills learning; frequent opportunities for reflection on patient care, professional development, and well-being; and skilled facilitators without evaluative roles. Theoretical support for peer continuity comes from social cognitive theory, communities of clinical practice, and social comparison theory. Therefore, in conjunction with empirical programs that have shown benefits of developing these structures, peer continuity should become a formalized educational structure in clerkships.
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Affiliation(s)
- Calvin L Chou
- C.L. Chou is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. A. Teherani is professor, Department of Medicine, and education researcher, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
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Abstract
BACKGROUND Using the frameworks of transformational learning and situated learning theory, we developed a technology-enhanced professionalism curricular model to build a learning community aimed at promoting residents' self-reflection and self-awareness. The RAPR model had 4 components: (1) Recognize: elicit awareness; (2) Appreciate: question assumptions and take multiple perspectives; (3) Practice: try new/changed perspectives; and (4) Reflect: articulate implications of transformed views on future actions. OBJECTIVE The authors explored the acceptability and practicality of the RAPR model in teaching professionalism in a residency setting, including how residents and faculty perceive the model, how well residents carry out the curricular activities, and whether these activities support transformational learning. METHODS A convenience sample of 52 postgraduate years 1 through 3 internal medicine residents participated in the 10-hour curriculum over 4 weeks. A constructivist approach guided the thematic analysis of residents' written reflections, which were a required curricular task. RESULTS A total of 94% (49 of 52) of residents participated in 2 implementation periods (January and March 2015). Findings suggested that RAPR has the potential to foster professionalism transformation in 3 domains: (1) attitudinal, with participants reporting they viewed professionalism in a more positive light and felt more empathetic toward patients; (2) behavioral, with residents indicating their ability to listen to patients increased; and (3) cognitive, with residents indicating the discussions improved their ability to reflect, and this helped them create meaning from experiences. CONCLUSIONS Our findings suggest that RAPR offers an acceptable and practical strategy to teach professionalism to residents.
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De Gagne JC, Yamane SS, Conklin JL. Evidence-based strategies to create a culture of cybercivility in health professions education. NURSE EDUCATION TODAY 2016; 45:138-41. [PMID: 27472429 DOI: 10.1016/j.nedt.2016.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/17/2016] [Accepted: 07/07/2016] [Indexed: 05/23/2023]
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Hur Y, Cho AR, Kim S. Measuring medical students' empathy using direct verbal expressions. KOREAN JOURNAL OF MEDICAL EDUCATION 2016; 28:305-313. [PMID: 27363499 PMCID: PMC5016265 DOI: 10.3946/kjme.2016.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Empathy is an important trait in physicians and a key element in the physician-patient relationship. Accordingly, one of the goals in medical education is developing empathy in students. We attempted to practically assess medical students' empathy through their direct verbal expressions. METHODS The medical students' empathy was measured using the modified Pencil-and-Paper Empathy Rating Test by Winefield and Chur-Hansen (2001). The students took 15 minutes or so to complete the scale, and it was then scored by one of two trained evaluators (0 to 4 points for each item, for a total score of 40). The subjects were 605 medical students, and the data were analyzed using descriptive analysis, independent t-test, and one-way analysis of variance in SPSS version 21.0. RESULTS The students' empathy scores were low (mean, 12.13; standard deviation, 2.55); their most common responses (78.6%) registered as non-empathetic. Differences in empathy were observed by gender (female students>male students; t=-5.068, p<0.001), school system (medical school>medical college; t=-1.935, p=0.053), and academic level (pre-medical 1 year < other years; t=-4.050, p<0.001). CONCLUSION Our findings lead us to the significant conclusion that there is the need for empathy enhancement training programs with practical content.
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Affiliation(s)
- Yera Hur
- Department of Medical Education, Konyang University College of Medicine, Daejeon, Korea
| | - A Ra Cho
- Department of Medical Education, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun Kim
- Department of Medical Education, The Catholic University of Korea College of Medicine, Seoul, Korea
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Terry C, Cain J. The Emerging Issue of Digital Empathy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2016; 80:58. [PMID: 27293225 PMCID: PMC4891856 DOI: 10.5688/ajpe80458] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/06/2015] [Indexed: 05/07/2023]
Abstract
Empathy can have strong positive effects on patient outcomes, increase patient satisfaction, and reduce malpractice litigation. With modern advances in technology, however, the appropriate expression of empathy in today's age is being threatened, largely as a result of psychological processes that form online disinhibition. The digitization of health care and the corresponding decrease in the expression of empathy may be cause for concern. Because empathy is strongly correlated to positive health outcomes and is an important part of health professions in general, the construct of digital empathy should be considered for integration into health professions curricula.
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Affiliation(s)
| | - Jeff Cain
- University of Kentucky College of Pharmacy, Lexington, Kentucky
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