How do postgraduate qualifications in medical education impact on health professionals?

Characteristics and motivational factors of candidates applying to the Master in Health Professions Education (MHPE) program

Objective

To determine characteristics and motivational factors of applicants applying for MHPE program at a Public-sector University, Karachi.

Methods

This cross-sectional descriptive study, conducted from September till October 2022, included all 60 applicants of MHPE program at Jinnah Sindh Medical University. The survey questionnaire was administered (google form) and comprised questions seeking demographic information, few questions with options to select and 34 statements to be responded on 5-point scale. One open-ended question asking motivational factor/s. Data was analyzed using SPSS and independent sample t-test was used to determine the differences between groups of applicants based on demographic factors.

Results

48 participants responded, mean age was 35.8 ± 7.3 years, with predominantly males (81.3%), graduates of medical and dental programs (n = 29), and employed in medical education departments (n = 36). Most of the applicants wanted to join the program to improve their teaching skills, especially psychomotor skills teaching (96%) and educational research [90%]. Majority (64.6%) learned about the program through peers, whereas 29.9% independently chose to pursue the program. Their primary motivation stemmed from their inability to secure admission elsewhere and the belief that minimal effort was needed to acquire the degree (mean score 4.58 ± 0.87 and 4.42 ± 0.94), respectively. For medical and dental graduates, comparable responses emerged, displaying a statistically significant correlation (p < 0.05). However, there was mutual disagreement regarding the program's structure and faculty as motivating factors.

Conclusion

Primary motivations to earn an MHPE degree were to improve teaching skills. Motivations to apply to this particular program was the failure to be accepted elsewhere and the perception that minimal efforts were needed to complete this program. The program goals and purpose need to be better propagated along with changes in the admission processes in order to encourage those individuals to apply who are motivated to pursue medical education as a career.

How the mapping of threshold concepts across a master's programme in health professions education could support the development of mastersness

INTRODUCTION

Global trends towards the professionalization of Health Professions Education (HPE) have catalyzed the proliferation of degree-awarding programmes in HPE. We apply the theoretical lens of threshold concepts to explore the required levels of Master's in HPE (MHPE) learning and teaching, with a view to determining how students might be supported to engage meaningfully with learning.

METHODS

Qualitative data were collected with a series of nominal group discussions. The methodology and data analysis followed a consensus building approach.

RESULTS

Four threshold concepts were identified: Being in the HPE world, the nature of HPE knowledge, the nature of HPE practice and the nature of HPE scholarship. We also mapped the threshold concepts to the World Federation for Medical Education (WFME) master's level academic skills and the Scottish Quality Assurance Agency (QAA) facets of mastersness.

CONCLUSION

It is envisaged that our findings will enhance alignment between the outcomes and assessment in an MHPE programme, form the basis of understanding feedback received from students, and inform teaching and supervisory practices. The findings also complement the WFME and QAA frameworks by clarifying the depth and complexity of academic skills expected at master's level and informing teaching and learning approaches to support the development of the identified threshold concepts.

Factors affecting the self-efficacy of medical teachers during a health crisis - a qualitative study on the example of the COVID-19 pandemic

BACKGROUND

The diversity of tasks entrusted to medical teachers with their simultaneous responsibility for the safety of patients and the effective education of future healthcare professionals requires maintaining a skillful balance between their teaching, scientific and clinical activities. Meanwhile, the COVID-19 pandemic disrupted the work of both healthcare facilities and medical universities, forcing already overworked medical teachers to establish a new balance. One's ability to perform effectively in new, ambiguous, or unpredictable situations was described by Albert Bandura as a self-efficacy concept. Consequently, this study aimed to identify factors affecting the self-efficacy of medical teachers and the influence of the COVID-19 pandemic on them.

METHODS

Twenty-five semi-structured interviews with medical teachers were conducted using a flexible thematic guide. They were transcribed and analyzed by two independent researchers (researcher triangulation) with phenomenology as the qualitative approach.

RESULTS

Identified themes demonstrate a process of the evolvement of clinical teachers' self-efficacy in response to the sudden outbreak of the COVID-19 pandemic, namely the decline of self-efficacy in the first phase of the crisis, followed by building task-specific self-efficacy and the development of general self-efficacy.

CONCLUSIONS

The study shows the significance of providing care and support for medical teachers during a health crisis. Crisis management decision-makers at educational and healthcare institutions should consider the different roles of medical teachers and the possibility of overburden associated with the cumulation of the excessive number of patient, didactic, and research duties. Moreover, faculty development initiatives and teamwork should become a vital part of the organizational culture of medical universities. A dedicated tool acknowledging the specificity and context of medical teachers' work seems necessary to quantitatively evaluate their sense of self-efficacy.

Dermatology residents as educators: a qualitative study of identity formation

BACKGROUND

One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers.

METHODS

Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach.

RESULTS

Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program.

CONCLUSIONS

Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

A decade of faculty development for health professions educators: lessons learned from the Macy Faculty Scholars Program

Faculty development (FD) programs are critical for providing the knowledge and skills necessary to drive positive change in health professions education, but they take many forms to attain the program goals. The Macy Faculty Scholars Program (MFSP), created by the Josiah Macy Jr. Foundation (JMJF) in 2010, intends to develop participants as leaders, scholars, teachers, and mentors. After a decade of implementation, an external review committee conducted a program evaluation to determine how well the program met its intended goals and defined options for ongoing improvement.The committee selected Stufflebeam's CIPP (context, input, process, products) framework to guide the program evaluation. Context and input components were derived from the MFSP description and demographic data, respectively. Process and product components were obtained through a mixed-methods approach, utilizing both quantitative and qualitative data obtained from participant survey responses, and curriculum vitae (CV).The evaluation found participants responded favorably to the program and demonstrated an overall increase in academic productivity, most pronounced during the two years of the program. Mentorship, community of practice, and protected time were cited as major strengths. Areas for improvement included: enhancing the diversity of program participants, program leaders and mentors across multiple sociodemographic domains; leveraging technology to strengthen the MFSP community of practice; and improving flexibility of the program.The program evaluation results provide evidence supporting ongoing investment in faculty educators and summarizes key strengths and areas for improvement to inform future FD efforts for both the MFSP and other FD programs.

Structure and impact of longitudinal Graduate Medical Education curricula designed to prepare future clinician-educators: A systematic scoping review: BEME Guide No. 74

BACKGROUND

Many Graduate Medical Education (GME) programs offer clinician-educator curricula. The specific instructional methods employed and current best practices for clinician-educator curricula are unknown. We aimed to characterize the structure, curriculum content, instructional methods, and outcomes of longitudinal GME clinician-educator curricula.

METHODS

We conducted a scoping review, registered with BEME, by comprehensively searching health science databases and related grey literature from January 2008 to January 2021 for studies involving longitudinal GME curricula aimed to train future clinician-educators.

RESULTS

From 9437 articles, 36 unique curricula were included in our review. Most curricula were designed for residents (n = 26) but were heterogeneous in structure, instructional methods, and content. Several curricular themes emerged, including: 1) duration ≥ 12 months, 2) application of theory-based didactics with experiential activities, 3) independent projects, 4) exposure to faculty mentorship and educator communities, 5) strengthening competencies beyond teaching and scholarship, and 6) protected time and funding. Most outcomes were positive and focused on learner satisfaction or behavior change related to scholarly output and career tracking.

CONCLUSIONS

Curricula in our review included important skills including experiential teaching, scholarly projects, and exposure to educator communities. Future curricula should build on these competencies and include more assessment of learner and program outcomes.

I am an Educator: Investigating Professional Identity Formation using Social Cognitive Career Theory

PhenomenonClinician-educators (CE) are physicians who fill a unique role within academic medicine, as they are responsible both for patient care and for training future physicians via teaching, curricular design, and creation of educational scholarship. Development of a strong professional identity as an educator leads to greater career satisfaction and a higher likelihood of staying in academic medicine. However, little is known about how this identity develops, especially in the training environment where there are competing pressures to develop as a clinician and researcher. This study aimed to explore professional identity formation in residents and fellows interested in becoming educators. Approach: We used a longitudinal, qualitative approach to investigate professional identity formation in residents and fellows participating in the Clinician-Educator Training Pathway. The longitudinal nature allowed us to temporally explore which aspects of the program and experiences acted as barriers or facilitators of professional identity formation as a CE. Our study used the social cognitive career theory (SCCT) Career Choice Model, which considers contextual influences in addition to the three variables of self-efficacy beliefs, outcome expectations, and goals. Findings: We found that participants shared a common goal of building self-efficacy as an educator. Participants took actions to engage more deliberately in formal and informal teaching and acting as an educator by giving learner feedback, developing curricula, and consuming and conducting educational research, all of which increased self-efficacy as educators. At the beginning of the program, participants were unclear of the roles and trajectories followed to become CEs. Engaging with a community of CEs clarified pathways and presented role models that could be seen as possible selves. This study also elucidated contextual influences relating to personal factors, career opportunities, and potential for advancement that mediated the goals and actions taken by participants to become educators. Insights: This study demonstrates that the SCCT Career Choice Model provides an excellent framework for understanding professional identity formation in future educators. Our participants built self-efficacy, formed outcome expectations, and set goals and took specific actions toward the goal of becoming an educator. Participants tested the various role model attributes as possible selves to see how those would be effective in their own career. Reflection on expectations, career goals, and self-efficacy as a clinician and an educator can assist in identity formation as a CE and can assist those designing CE training programs to better support identity formation in their participants.

Restructuring education activities for full online learning: findings from a qualitative study with Malaysian nursing students during Covid-19 pandemic

The COVID-19 pandemic and Movement Control Order have restricted learning activities from traditional face-to-face classrooms attendance shifted to full online learning in the student's environment. The present study is aimed to explore pertaining issues on full online learning among nursing students and offer a contingency solution. Nursing students from one Malaysian public institution were recruited. The sessions were conducted online via teleconference and were recorded. The data were analysed using thematic analysis with the assistance of QDA Miner Lite software. Twenty-one students participated, resulting in four focus group discussions and three in-depth interviews. Three themes with a total of ten sub-themes were generated: (i) Full online learning has ramifications on life (it is about life; blurred division on education life and personal life; non-conducive environment for learning; health and well-being; human is an adaptable being while the transition takes time), (ii) full online learning is a medium of teaching and learning delivery but with several concerns (the boon and bane of fully online learning; challenges associated with full online learning; coping strategy in handling full online learning), and (iii) Foundation in teaching and learning is the key (role of the educator; teaching and learning approaches; motivation and regulation). A model of practice for full online learning was developed, consisting of some modifications to create a conducive and healthy learning environment. This study embarks on a more structured and standard online learning practice for making the Internet of Things and Industrial Revolution 4.0 concept a contemporary and mainstream education practice.

Becoming Agents of Change: Contextual Influences on Medical Educator Professionalization and Practice in a LMIC Context

Medical educators are particularly needed in Low- and Middle-Income Countries (LMIC), where medical schools have grown rapidly in size, number, and global outlook in response to persistent health workforce shortages and increased expectations of quality care. Educator development is thus the focus of many LMIC programs initiated by universities and governments of high income countries. While signs of medical educator professionalization such as postgraduate qualifications, specialized units, and professional associations have emerged in LMIC, whether these relate to programs originating from outside LMIC contexts is unknown. This study investigated the contextual influences on the long-term impact of an international faculty development program a decade after its delivery in a LMIC context - Vietnam. Ten years after an international aid program to develop clinical skills teaching expertise in Vietnam, we conducted in-depth qualitative interviews with eight medical educators from all eight participating medical schools. Selected for their leadership potential, each participant had completed the Maastricht Masters in Health Professions Education during the program. Interview transcripts underwent thematic analysis, using the Theory of Practice Architectures as a conceptual lens to highlight the contextual influences on professional practice. Four themes were identified: Careers and Practices before, during, and after the program, Unrecognized and Unseen practice, Structural Restraints on individual advancement and collective activity, and the Cultivation of Connections through social traditions. Participants reported being in well-established teaching delivery roles. However, the absence of professionalizing discourses and material resources meant that practice was restricted and determined by institutional leadership and individuals' adaptations. Informed by the theory of practice architectures, we found that change in medical education practice will falter in contexts that lack supporting discursive, material-economic, and socio-political arrangements. While there were emerging signs of individual agency, the momentum of change was not sustained and perhaps unapparent to Western framings of educational leadership. Practice architectures offers a framework for identifying the contextual features which influence practice, from which to design and deliver sustainable and impactful interventions, and to advance context-relevant evaluation and research. Our findings suggest that faculty development delivered across diverse contexts, such as in distributed or transnational medical programs, may have more effect if informed by a practice architectures analysis of each context.

Planned or emergent? An evaluation of a Master's in Health Professions Education programme

BACKGROUND

Programme developers have the responsibility of ongoing programme renewal and evaluation to ensure that curricula remain responsive to rapidly changing educational and healthcare contexts. In reporting on programmes, significant emphasis is often placed on content and outcomes of Master's in Health Professions Education (MHPE) programmes. However, less emphasis has been placed on meaningful evaluation of all aspects of these programmes, particularly from a student perspective including what worked and what needs to be enhanced, as well as any emergent or unplanned factors. As the number of established MHPE programmes increases, so does the need for evaluation models that consider programme complexity. In this article we consider a MHPE programme against a model that provided scope for going beyond 'did it work?' Our intention was to determine whether the renewed MPhil in HPE programme was implemented as planned, and to which extent it achieved the planned outcomes.

METHODS

This programme evaluation was conducted in an interpretive paradigm. We collected qualitative data at two points. Firstly, at the start of students' first-year with voluntary participation in focus groups and secondly, a year later with voluntary participation in individual interviews. Two members of the research team performed the initial thematic analysis of both the focus group interviews and the individual interviews. Thereafter, the full author team worked collaboratively discussing the themes until we reached consensus, looking specifically to identify any "emergent" factors.

RESULTS

We identified three themes in the student data related to the process of implementing the new programme and the outcomes from it, including those aspects that could be regarded as emergent or unplanned: balancing work, personal lives and studies; managing the hybrid learning approach; and the scholarly journey.

CONCLUSIONS

While many of the outcomes of the renewed programme were met, not all manifested as had been planned. The experience of the programme differed from one student to the next such that at the end of the two years they were at different points in their scholarly journeys. We realised that although we sought to be pedagogically sound in the process of curriculum renewal, we did not take into account the complex matrix of influences that sit outside the formal curriculum. Future renewal activities should intentionally and sensitively consider those factors, both planned and emergent, that influence a student's journey towards becoming a scholarly teacher and teaching scholar.

The association between the practice environment and selected nurse educator outcomes in public nursing education institutions: A cross-sectional study

AIM

The purpose of this study is to describe the association between the practice environment and nurse educator outcomes (burnout, engagement, incivility, job satisfaction and intention to leave) in public nursing education institutions in the Gauteng province of South Africa.

BACKGROUND

The practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse workforce; however, the association between the practice environment and nurse educator outcomes has been relatively unexplored.

DESIGN

Cross-sectional design.

METHODS

The Gauteng province was purposively selected, as it has the highest number of public nursing education institutions in South Africa. All-inclusive sampling was applied to public nursing educations institutions in Gauteng province (N = 6) and then to Heads of Department (N = 30; n = 17) and nurse educators (senior lecturers [N = 162; n = 45] and lecturers [N = 257; n = 80]). Data were collected during March to November 2018. The data were collected using the Practice Environment Scale of the Nursing Work Index; Maslach Burnout Inventory - Educators Survey; Utrecht Work Engagement Scale (UWES); Incivility in Nursing Education-Revised (INE-R); job satisfaction and Propensity to Leave Scale.

RESULTS

The results show that nurse educators are an aging population, with limited numbers having master's and doctoral qualifications. The most job dissatisfaction is regarding wages (M=2.0; SD 1.07); appreciation, recognition and rewards for good work (M=2.1; SD 1.01); and opportunities for advancement (M=2.2; SD 1.01). The nurse educators do not experience their public nursing education institutions as having a positive practice environment. Nurse educators experienced high levels of work engagement, moderate levels of burnout and low levels of incivility, that were highly correlated with the subscale of foundations of quality outcomes. They experienced moderate levels of job satisfaction but did not intend to leave their places of employment, which was highly correlated with the subscale of manager's ability, leadership and support.

CONCLUSIONS

A positive practice environment improves nurse educator outcomes. The subscale of foundations of quality outcomes and manager's ability, leadership and support had the most impact on nurse educator outcomes, thus quality teaching practices should be cultivated and recognised; and managers must have the necessary skill and knowledge to lead effectively, while also including nurse educators in decisions that impact them and involving them in the affairs of the nursing education institution. There is a shortage of qualified nurse educators globally and in South Africa and urgent attention must be given to factors that influence the recruitment and retention of nurse educators.

TWITTER ABSTRACT

The practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse educator workforce, especially regarding foundations of quality outcomes and manager's ability, leadership and support.

Setting Agenda for Medical Education Research in Pakistan

OBJECTIVE

To justify the allocation of human and financial resources, this study aims to identify multiple stakeholders' views of medical education research priorities in Pakistan for the next five years.

METHODS

This two-stage exploratory mixed-method study was conducted from Jan 2018 to Jun 2019. A purposively selected sample of 250 faculty members, research supervisors, postgraduate students, undergraduate students and policymakers actively involved in improving Medical Education were included. In Stage-I: An exploratory open-ended questionnaire asking about Medical Education Research (MER) priorities in Pakistan for the next five years was emailed. Data were thematically analyzed to identify MER areas. In Stage-II: Another questionnaire was developed based on MER areas. The participants were asked to rate their importance on a scale of one to five. Descriptive statistics were calculated using SPSS.v.24.

RESULTS

In Stage-I, 140 participants and in Stage-II, 130 participants from different stakeholder groups responded. We identified 20 research priorities grouped under eight themes: curriculum organization, content, delivery, assessment, workplace, students, faculty and educational management. Top three research priorities were identifying needs and developing effective provisions for continuous professional development of the faculty, improving assessment and communication skills.

CONCLUSION

The study identified top MER priority areas as continuous professional development, assessment and communication skills. Some areas unique to the current study include admissions, fostering critical thinking, Islamic values in professionalism and ethics. The study provides evidence-base for decision-making about allocating time and funds for MER in Pakistan.

An Evaluation of Faculty Development Programs for Clinician-Educators: A Scoping Review

PURPOSE

Faculty development (FD) has become increasingly important for clinician-educators. An array of FD programs has been developed, but the impact of these programs on clinician-educators and their learners and workplace is less known. The authors conducted a scoping review to explore the status of program evaluation in FD for clinician-educators to inform future planning and research.

METHOD

Five databases were searched for articles published from January 1998 to August 2018 using Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Studies that described evaluation methods and outcomes of FD programs for clinician-educators were included. Data were collected and organized according to program domain (teaching, research/scholarship, leadership, or a combination of skills). A modified version of the Kirkpatrick model was used to compare results among studies.

RESULTS

From a total of 2,091 articles, 1,095 were eligible for full review, and 31 met the inclusion criteria. Seven programs targeted only teaching skills, 3 research/scholarship skills, 7 leadership skills, and 14 a combination of skills. Eighteen programs required the completion of a project; fewer offered fellowships, master's degrees, or certificates. Participant surveys were the most common evaluation method across all domains. Often used metrics included participant satisfaction and self-reported knowledge, skills, behavior changes, scholarly output, and leadership positions. Less common evaluation methods included learner and peer evaluations, interviews, and focus groups. Change at the institutional level was evaluated in 11 programs.

CONCLUSIONS

Program evaluation remains an underdeveloped area in FD for clinician-educators. Developers expend significant effort on program design and implementation but approach evaluation less purposefully. Rigorous metrics that align with program goals and are used longitudinally are needed to accurately assess the impact of FD programs on participants and their learners, workplace, and institutions at large.

Curriculum integration: From Ladder to Ludo

This Personal View is based on our experiences with the levels of integration. We are concerned about the (mis) interpretation of 'integration ladder' in our context and propose directions for rethinking curriculum integration. We share the famous board game 'Ludo' as a metaphor to understand the concept of integration. Mughal emperors (educators) played (lead) Ludo (curriculum/teaching reforms) in which tokens (disciplines) move from their silos (departments) towards others (integrate) according to rolls of a dice (resources) and not stepwise (1-2-3…11) like in a ladder. There are safe spaces (timetable/minimum hours), double pieces (combination of different integration levels) and tokens (disciplines) can also be pushed back to their silos by opponents (challenges). The game (change management) involves skill (competence in medical education), strategy (planning), emotion (emotional intelligence) and luck. We found Ludo relevant to understanding integration and discuss three different systems with implications on the curriculum, assessment, organisational structure and timetable/schedules. We believe that a clear description of integration as three different systems will counter the issues with the integration ladder and make it easier for institutions and educationists to understand, opt for and implement curriculum integration.

World Federation for Medical Education: Appropriateness of Basic Medical Education standards in Pakistan

Objective:

To explore the appropriateness of WFME Basic Medical Education (BME) standards to Pakistani context.

Methods:

A descriptive cross-sectional survey of faculty, graduates and students of five Masters’ in Health Professions Education programmes was carried out from Jul-Dec 2017. Participants were asked to rate the appropriateness of WFME-BME basic standards to Pakistani context on a fourpoint Likert scale (Strongly Disagree through to Strongly Agree). They were also asked for additional comments, if any. Descriptive statistics were carried out for quantitative data, while content analysis for qualitative data.

Results:

A total of 127/200 participants responded (63.5%). For all major areas (106 standards), 97.7% responses (n=13,149) were positive while only 2.3% (n=313) were negative. Ninety-six standards got more than 95% positive response while only 10 standards in three major areas got more than five percent negative response. These include five standards from major area Mission and Outcomes, one from Educational Programme and four from Students.

Conclusions:

This is the first study exploring the appropriateness of WFME-BME standards for accreditation in Pakistan. We found that all the areas, sub-areas and standards are largely appropriate. We recommend further deliberation on 10 standards with more than five percent negative responses, regarding their contextualization to Pakistan and the development of guidelines and possible reconsiderations in WFME future revisions.

Using Bourdieu to explore graduate attributes in two online Master's programmes

Within the expansion of postgraduate educational qualifications for health professionals, graduate attributes have become important markers of outcomes and value. However, it is not clear how or when graduate attributes develop, or how they are applied in professional practice after graduation. We interviewed 17 graduates from two online Master's programmes to explore their perceptions of how postgraduate study had influenced their practice and professional identity. Our thematic analysis produced three main themes (academic voice, infectious curiosity, and expanding worldview) which reflected changes in the participants' confidence, attitude, perspective, and agency across professional and academic settings. We then conducted a secondary phase of analysis using Bourdieu's concepts of 'field', 'capital', and 'habitus'. While graduate attributes have been conceptualised as the context-independent acquisition of traits that can be employed by individuals, Bourdieu's framework highlights their relational qualities: they are caught up in the cultural history and context of the student/professional, the reputation of the awarding institution, and the graduate's location within a network of professional peers.

Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development

The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. "Axes of difference" are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients-clinicians, trainees-trainers, classrooms-clinics, uniprofessional-interprofessional, local-global, and teachers-clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.

Individual and institutional influencing factors on completion rates in a medical education master's program in Germany

Background: The increasing significance of didactic aspects in medical education has also led to the development of special postgraduate programs. Completion rates represent an important outcome criterion for these programs of study. Up to today, detailed studies on what factors influence these completion rates have been lacking. Methods: Within the framework of outcomes research, a semi-structured online survey of students was conducted in the Master of Medical Education Germany program. Of the 90 items, 21 referred to the master's thesis that is required for graduation. Results: 157 out of 246 (63.8%) of students from classes 1-10 of the program (study period 2004-2014) participated in the survey. 109 participants had submitted a master's thesis, whereas 45 participants had not completed their studies by submitting a master's thesis. Influencing factors of successful completion were, among other things, little difficulty in choosing the topic, retention of the originally chosen topic, general support by the program administration in the modules and ensuring timely feedback from the advisor, and the provision of temporal, staff and financial resources by the home faculty. The failure to turn in the project report and a lengthy interruption of master thesi's work could be identified as critical parameters. Conclusion: Taking into account these results can contribute to increasing completion rates in medical education graduate programs. Systematic outcomes research leads, moreover, to quality assurance. Such studies should be conducted in a standardized manner in the future, in order to facilitate comparisons between medical education programs.

Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study

BACKGROUND

Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM).

METHODS

A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method.

RESULTS

Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement.

DISCUSSION

The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.

The influence of postgraduate qualifications on educational identity formation of healthcare professionals

Demand for postgraduate qualifications in medical education can be judged by the increase in providers worldwide over the last two decades. However, research into the impact of such courses on identity formation of healthcare professionals is limited. This study investigates the influence of such programmes on graduates' educational identities, practices and career progression. Informed by constructivist grounded theory (CGT), semi-structured interviews were conducted with 27 graduates (2008-2012) from one postgraduate programme, who were at different stages in their careers worldwide. The audio data were transcribed and analysed using a CGT approach. Participants enrolled in award-bearing medical education courses for various intrinsic and extrinsic reasons. The findings from this study highlight their development as educators, and educational researchers, leaders and learners, as their self-efficacy in educational practices and engagement in scholarly activities increased. Graduates attributed career progression to the qualification, with many being promoted into senior positions. They also described substantial performance attainments in the workplace. The findings contribute to understanding the complexity and nuances of educational identity formation of healthcare professionals. A qualification in medical education encouraged transformational changes and epistemological development as an educator. Awareness of these findings will inform both those considering enrolment and those supporting them of potential benefits of these programmes.

Developing and rewarding teachers as educators and scholars: remarkable progress and daunting challenges

CONTEXT

This article describes the scholarly work that has addressed the fifth recommendation of the 1988 World Conference on Medical Education: 'Train teachers as educators, not content experts alone, and reward excellence in this field as fully as excellence in biomedical research or clinical practice'.

PROGRESS

Over the past 30 years, scholars have defined the preparation needed for teaching and other educator roles, and created faculty development delivery systems to train teachers as educators. To reward the excellence of educators, scholars have expanded definitions of scholarship, defined educator roles and criteria for judging excellence, and developed educator portfolios to make achievements visible for peer review. Despite these efforts, the scholarship of discovery continues to be more highly prized and rewarded than the scholarship of teaching. These values are deeply embedded in university culture and policies.

CHALLENGES

To remedy the structural inequalities between researchers and educators, a holistic approach to rewarding the broad range of educational roles and educational scholarship is needed. This requires strong advocacy to create changes in academic rewards and support policies, provide a clear career trajectory for educators using learning analytics, expand programmes for faculty development, support health professions education scholarship units and academies of medical educators, and create mechanisms to ensure high standards for all educators.

A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency

Both Germany and the United States of America have a long tradition of science and medical excellence reaching back as far as the nineteenth century. The same tribute must be paid to the medical educational system in both countries. Despite significant initial similarities and cross-inspiration, the paths from enrolling in a medical university to graduating as a medical doctor in Germany and the US seem to have become much different. To fill a void in literature, the authors’ objective therefore is to delineate both structures of medical education in an up-to-date review and examine their current differences and similarities. Recent medical publications, legal guidelines of governmental or official organizations, articles in media, as well as the authors’ personal experiences are used as sources of this report.

Tuition loans of over $200,000 are not uncommon for students in the US after graduating from medical schools, which are often private institutions. In Germany, however, the vast majority of medical universities are tax-funded and, for this reason, free of tuition. Significant differences and surprisingly multiple similarities exist between these two systems, despite one depending on government and the other on private organizations. Germany currently employs an integrated medical curriculum that typically begins right after high school and consists of a 2-year long pre-clinical segment teaching basic sciences and a 4-year clinical segment leading medical students to the practical aspects of medicine. On the other hand, the US education is a two-stage process. After successful completion of a Bachelor’s degree in college, an American student goes through a 4-year medical program encompassing 2 years of basic science and 2 years of clinical training. In this review, we will address some of these similarities and major differences.

Excellence in PhD dissertations in health professions education: Toward standards and expectations

The authors of this perspective contribution have served two terms (2014 and 2016) in the Jury of the biennial Best PhD Dissertation Award committee of the Netherlands Association for Medical Education. During this period, the committee reviewed 32 dissertations. Based on discussions among the jury regarding elements of an award winning dissertation and existing literature, we propose seven criteria to evaluate PhD dissertations: size, breadth of research skills exhibited, coherence of studies, relevance to field, validity, style, communicative power and ethics, and impact of the work. We anticipate these may not only assist similar committees but also provide criteria of excellence for future doctoral work in health professions education.

Exploring the tensions of being and becoming a medical educator

BACKGROUND

Previous studies have identified tensions medical faculty encounter in their roles but not specifically those with a qualification in medical education. It is likely that those with postgraduate qualifications may face additional tensions (i.e., internal or external conflicts or concerns) from differentiation by others, greater responsibilities and translational work against the status quo. This study explores the complex and multi-faceted tensions of educators with qualifications in medical education at various stages in their career.

METHODS

The data described were collected in 2013-14 as part of a larger, three-phase mixed-methods research study employing a constructivist grounded theory analytic approach to understand identity formation among medical educators. The over-arching theoretical framework for the study was Communities of Practice. Thirty-six educators who had undertaken or were undertaking a postgraduate qualification in medical education took part in semi-structured interviews.

RESULTS

Participants expressed multiple tensions associated with both becoming and being a healthcare educator. Educational roles had to be juggled with clinical work, challenging their work-life balance. Medical education was regarded as having lower prestige, and therefore pay, than other healthcare career tracks. Medical education is a vast speciality, making it difficult as a generalist to keep up-to-date in all its areas. Interestingly, the graduates with extensive experience in education reported no fears, rather asserting that the qualification gave them job variety.

CONCLUSION

This is the first detailed study exploring the tensions of educators with postgraduate qualifications in medical education. It complements and extends the findings of the previous studies by identifying tensions common as well as specific to active students and graduates. These tensions may lead to detachment, cynicism and a weak sense of identity among healthcare educators. Postgraduate programmes in medical education can help their students identify these tensions in becoming and develop coping strategies. Separate career routes, specific job descriptions and academic workload models for medical educators are recommended to further the professionalisation of medical education. (Tensions, Fears, Healthcare Educators, Medical Education, Postgraduate Programmes, Identity, Career Choice, Faculty Development, Communities of Practice).