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Bashir A, McTaggart IJ, Tufail S, Mustafa N, Rauf A. Negative faculty role modelling - is it a reflection of deteriorating societal values? MEDICAL TEACHER 2024:1-7. [PMID: 38306677 DOI: 10.1080/0142159x.2024.2306844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan. METHODS This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category. RESULTS Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels. CONCLUSIONS In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.
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Affiliation(s)
- Adeela Bashir
- Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan
| | | | - Shazia Tufail
- Department of Obstetrics & Gynaecology, CMH Lahore Medical College, National University of Medical Sciences, Lahore, Pakistan
| | - Nilofar Mustafa
- Department of Obstetrics & Gynaecology, CMH Lahore Medical College, National University of Medical Sciences, Lahore, Pakistan
| | - Ayesha Rauf
- Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan
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Laird-Gion JN, Garabedian LF, Conrad R, Shaffer AC, Witkowski ML, Mateo CM, Jones DS, Hundert E, Kasper J. "The Water in Which We Swim:" A Unique, Post-Clerkship Multidisciplinary Course. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241232184. [PMID: 38390256 PMCID: PMC10883117 DOI: 10.1177/23821205241232184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To improve patient outcomes and promote health equity, medical students must be taught not only biomedicine, but also the social sciences to understand the larger contexts in which patients live and health care operates. Yet, most undergraduate medical education does not explicitly cover these topics in a required, longitudinal curriculum. METHODS In January 2015 at Harvard Medical School, we created a two-part sequence (pre- and post-clerkship) of required, 4-week multidisciplinary courses-"Essentials of the Profession I and II"-to fill this gap. "Essentials of the Profession II (EOP2)" is an advanced social sciences course anchored in patient narratives and the lived experiences of students and includes clinical epidemiology and population health, healthcare delivery and leadership, health policy, medical ethics and professionalism, and social medicine that engages students to conduct structural analyses to be effective healers, advocates, and leaders. RESULTS Per student course evaluations, the overall course rating was 1.7 (SD 0.9, 1 = excellent and 5 = poor); its overall rating has improved over time; and it has scored well even when run virtually. It was rated highly in application of critical thinking, integration of the disciplines, and relevance for clinical work. Qualitative analyses of student responses revealed the following key course strengths: breadth of topics, teaching faculty and guest speakers, and small group discussions. The weaknesses included workload, lack of diversity of opinions, repetition, and time spent in lectures. CONCLUSIONS We argue that EOP2 is "essential" for post-clerkship medical education. It offers an opportunity to re-ignite and enhance humanism and activism; remind students why they chose the medical profession; equip them with frameworks and toolkits to help them to overcome challenges; and devise solutions to improve health care and patient outcomes that are applicable to their future training and ongoing practice of medicine.
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Affiliation(s)
- Jessica N Laird-Gion
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura F Garabedian
- Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Rachel Conrad
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam C Shaffer
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary L Witkowski
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, MA, USA
| | - Camila M Mateo
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - David S Jones
- Harvard Medical School, Boston, MA, USA
- Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
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McWalter P, AlKhenizan A, Ahmad M. An Evaluation of Mentorship for Hospital Residents in Saudi Arabia: A Qualitative study using Semi-structured Interviews. MEDEDPUBLISH 2023; 13:8. [PMID: 38379756 PMCID: PMC10877095 DOI: 10.12688/mep.19364.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 02/22/2024] Open
Abstract
Background In this study, we explore how doctors in training perceive mentorship and leadership and whether they believed that mentoring influences the development of leadership skills. The study also addressed whether certain leadership styles lend themselves better to mentoring. Methods A qualitative research method was employed in this study and ethical approval was granted by the Research Ethics Committee (REC) at King Faisal Specialist Hospital and Research Centre (KFSH&RC), after which twelve hospital residents were recruited using purposive sampling. Semi-structured interviews were conducted by the authors and thematic data analysis was performed. Results Three themes emerged and were later refined, using Braun and Clarke's 2006 thematic analysis method:1. Purpose of mentorship, with sub themes: a. Expectations, b. Perception of mentorship as supervision, and c. The role of mentorship, including informal mentoring in leadership development2. Role of mentorship in leadership development.3. Perceptions of a leader, with sub-themes: a. The leader as a manager, b. The leader as a role model, and c. The merits of different leadership styles. Discussion Most of the residents (doctors in training) viewed mentorship in a positive way. However, when the mentor was perceived more as a supervisor, the usefulness of mentoring was less clear. However, they found that informal mentoring would contribute to leadership skills and would inspire them to become leaders themselves. They were likely to be influenced positively when they saw the leader as a role model, rather than a manager.
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Affiliation(s)
- Patricia McWalter
- Keele University, Keele, Newcastle, ST5 5BG, UK
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hopital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Abdullah AlKhenizan
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hopital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Marium Ahmad
- Department of Family Medicine and Polyclinics, King Faisal Specialist Hopital and Research Center, Riyadh, 11211, Saudi Arabia
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Cottrell E, Alberti H. Cultural Attitudes towards General Practice within Medical Schools: Experiences of GP Curriculum Leaders. EDUCATION FOR PRIMARY CARE 2023; 34:287-294. [PMID: 37437257 DOI: 10.1080/14739879.2023.2225477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION UK undergraduate medical curricula are under pressure to become more community-focused and generalist in approach to equip all future doctors with generalist skills and increase recruitment to generalist specialities like general practice. However, the amount of general practice teaching in UK undergraduate curricula is static or falling. Undervaluing, in the form of general practice denigration and undermining, is increasingly recognised from a student perspective. However, little is known about the perspectives of academics working within medical schools. AIM To explore the cultural attitudes towards general practice within medical schools as experienced by general practice curriculum leaders. METHODS A qualitative study using semi-structured interviews of eight general practice curriculum leaders in UK medical schools. Purposive sampling for diversity was used. Interviews were analysed using reflexive thematic analysis. FINDINGS Seven themes were identified covering 'a kaleidoscope of attitudes towards general practice', 'overt everyday denigration of general practice', 'a hidden curriculum of undervaluing general practice', 'valuing general practice: representation, recognition and respect', 'relating to others, relating to oneself', 'power, empowerment and vulnerability', and 'the pandemic as an opportunity'. CONCLUSIONS Cultural attitudes towards general practice were diverse: a spectrum varying from valuing general practice to overt denigration, with a 'hidden curriculum' of subtle undervaluing of general practice. Hierarchical, tense relationships between general practice and hospital were a recurring theme. Leadership was identified as important in setting the tone for cultural attitudes, as well as indicating general practice is valued when general practitioners are included within leadership. Recommendations include a shift in narrative from denigration to mutual speciality respect between all doctors.
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Affiliation(s)
- Emily Cottrell
- School of Medicine, Cookson Building, Newcastle University Medical School, Newcastle Upon Tyne, England
| | - Hugh Alberti
- School of Medicine, Cookson Building, Newcastle University Medical School, Newcastle Upon Tyne, England
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Mokhachane M, George A, Wyatt T, Kuper A, Green-Thompson L. Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:427-452. [PMID: 36301374 PMCID: PMC10169886 DOI: 10.1007/s10459-022-10164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/15/2022] [Indexed: 05/11/2023]
Abstract
The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.
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Affiliation(s)
| | - Ann George
- University of Witwatersrand, Johannesburg, South Africa
| | - Tasha Wyatt
- Uniformed University of the Health Sciences, Bethesda, USA
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Koh EYH, Koh KK, Renganathan Y, Krishna L. Role modelling in professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:194. [PMID: 36991373 PMCID: PMC10052869 DOI: 10.1186/s12909-023-04144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). METHODS A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. RESULTS 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. CONCLUSION Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.
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Affiliation(s)
- Eugene Yong Hian Koh
- Singapore Armed Forces, 303 Gombak Drive, Singapore, 669645, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Kai Kee Koh
- 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 Dr, Singapore, 169610, Singapore
| | - Yaazhini Renganathan
- 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 Dr, Singapore, 169610, Singapore
| | - Lalit 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 Dr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- The Palliative Care Centre for Excellence in Research and Education, PalC, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Salesky M, Kaur G, Weiser L, Thompson A, Kim EH, Campbell AR, Sosa JA, Gosnell J, Alseidi A, Lin MYC, Roman SA. Surgical support team: Lessons learned after piloting a near peer support program for medical students during their core surgery clerkship. Am J Surg 2023; 225:429-431. [PMID: 36243561 DOI: 10.1016/j.amjsurg.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/22/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Madeleine Salesky
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Gurbani Kaur
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Lucas Weiser
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Avery Thompson
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Edward H Kim
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Andre R Campbell
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Julie Ann Sosa
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Jessica Gosnell
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Adnan Alseidi
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Matthew Y C Lin
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA
| | - Sanziana A Roman
- University of California San Francisco (UCSF) Department of Surgery, San Francisco, CA, USA.
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Liu J, Li S. An ethnographic investigation of medical students' cultural competence development in clinical placements. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10179-7. [PMID: 36371573 DOI: 10.1007/s10459-022-10179-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
As a result of an increased understanding of culture's impact on health and healthcare, cultural competence and diversity curricula have been incorporated into many medical programs. However, little is known about how students develop their cultural competence during their training. This ethnographic case study combined participant observation with interviews and focus group to understand students' views and experiences in developing their cultural competence during clinical placements. The results show that students' development of cultural competence is an individually varied process via four distinctive yet interrelated learning avenues. Immersion in a diverse healthcare environment contributes to students' development of cultural awareness and knowledge. Observation of culturally appropriate or inappropriate practices allows students to enhance their practical skills and critical reflection. Interaction with other clinical professionals, patients, and their family members, enables students' engagement within the busy clinical practice. Reflection helps students to actively think about culture's impact on health and internalize the importance of cultural competence. Students' learning via each avenue is interrelated and constantly interacting with their learning environment, which collectively contributes to their development. Integrating the results allowed the authors to generate a theoretical model that conceptualizes medical students' cultural competence development in clinical placements, which unearths students' cultural learning within the informal and hidden curriculum. This study provides a rare view of students' development of cultural competence in clinical placements, which may inform the pedagogic development of cultural competence and diversity education in medicine and healthcare.
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Affiliation(s)
- Jia Liu
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shuangyu Li
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- King's Cultural Competency Unit, Faculty of Arts and Humanities, King's College London, London, UK.
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Gillissen A, Kochanek T, Zupanic M, Ehlers J. Bad things can happen: are medical students aware of patient centered care and safety? Diagnosis (Berl) 2022; 10:110-120. [PMID: 36351267 DOI: 10.1515/dx-2022-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Objectives
Quality and safety in healthcare are of the utmost importance, but little is known about whether undergraduate students are aware of patient safety concepts. The objectives of our study were to assess the perception of medical students of challenges in patient safety, and collect their perceptions of error management and prevention.
Methods
This study used an exploratory mixed method strategy. The first study phase collected data from semi-structured interviews of 28 students. Based on this, an online survey was constructed and sent to about 80,000 medical students in Germany. 1053 replies were received and analyzed for responses based on gender, curriculum type (problem based [PBC] vs. science based curriculum [SBC]) and years of training.
Results
Most students understand the importance of patient safety, error avoidance, and the challenges of patient safety interventions. Four themes were identified: (a) the culture of patient safety (what is a good doctor? Doctors’ responsibility), (b) the working environment (the inevitability of mistakes, high work load, hierarchy, competition, teamwork), (c) the challenges of risk reduction (error avoidance, management, skills), and (d) materialistic issue (income vs. humanistic values). Female students were more risk aware than male students. Sixteen percent of students expect negative effects (e.g. punishment) when medical errors were disclosed in a team. Regardless, >70% regard teamwork as an effective error avoidance measure. Error disclosure willingness was high (89.7%).
Conclusions
Although not formally part of the curriculum, students had a positive perspective concerning patient safety. The opportunities and challenges for incorporating patient safety content into the training curriculum were identified and presented.
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Affiliation(s)
- Adrian Gillissen
- Department of Medicine, Faculty of Health , Institute for Didactics and Educational Research in Health Care, Witten/Herdecke University , Witten , Germany
| | - Tonja Kochanek
- Department of Medicine, Faculty of Health , Institute for Didactics and Educational Research in Health Care, Witten/Herdecke University , Witten , Germany
| | - Michaela Zupanic
- Department of Medicine, Faculty of Health, Interprofessional and Collaborative Didactics in Medicine-and Health Professions , Witten/Herdecke University , Witten , Germany
| | - Jan Ehlers
- Department of Medicine, Faculty of Health , Institute for Didactics and Educational Research in Health Care, Witten/Herdecke University , Witten , Germany
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Aslam F, Mahboob U, Zahra Q, Zohra S, Malik R, Khan RA. The Drudgery of a Doctor's Disciple: Exploring the effects of Negative Role Modelling on medical students' professional development. MEDICAL TEACHER 2022; 45:1-7. [PMID: 36272400 DOI: 10.1080/0142159x.2022.2133690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Role modelling is considered an essential component of teaching in various educational settings and impact students' professional development. Most studies found in the literature have explored the influence of positive role models and limited data is available about the negative role modelling. This study explores the effects of negative role modelling of teachers on the professional development of future doctors. METHODS A qualitative exploratory study was done in three medical colleges of Lahore, Pakistan. Fifteen, telephonic, semi-structured interviews were done with fifth-year MBBS students. A thematic analysis was done through manual coding of transcribed interviews. RESULTS A total of 374 codes were generated in the first cycle of coding, that was merged to 42 in the second cycle. These codes led to 4 subthemes that finally emerged as two themes. The first theme was "Students & patients: In the same boat" highlighting the damaging effects of negative role modelling. The second theme was "Taking the bad with the good" focusing on the ambivalent response of students towards the unprofessional behaviours of their role models. CONCLUSION Negative role modelling exponentially affects the attitude and behaviour of medical students especially in informal settings and have detrimental effects on patient care. Students lose some degree of humanism while unconsciously observing the unethical behaviours, to become a part of hospital culture whereas some students show determination to channelize their resentment to reforms.
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Affiliation(s)
- Fatima Aslam
- Department of Psychiatry & Behavioural Sciences, Avicenna Medical College & Hospital, Lahore, Pakistan
| | - Usman Mahboob
- Institute of Health Professions Education (IHPE&R), Khyber Medical University, Peshawar, Pakistan
| | - Qundeel Zahra
- Department of Ophthalmology, Azra Naheed Medical College & Hospital, Lahore, Pakistan
| | | | - Rabia Malik
- Department of Medical Education, Muhammad Islam Medical & Dental College, Gujranwala, Pakistan
| | - Rehan Ahmed Khan
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
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Yang MM, Golden BP, Cameron KA, Gard L, Bierman JA, Evans DB, Henschen BL. Learning through Teaching: Peer Teaching and Mentoring Experiences among Third-Year Medical Students. TEACHING AND LEARNING IN MEDICINE 2022; 34:360-367. [PMID: 33934679 DOI: 10.1080/10401334.2021.1899930] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PHENOMENON Classroom studies of peer-led teaching and mentoring report benefits for students both as teachers and learners. Such benefits include both improved content mastery and personal and professional development. While benefits of peer-led teaching in the clinical setting have been well characterized among other health professions, less is known within undergraduate medical education. In this study, we explored medical students' perceptions and experiences relevant to peer teaching and mentoring in outpatient clinical clerkships. APPROACH Third-year medical students enrolled in two different longitudinal primary care clerkships, Education Centered Medical Home (ECMH) or Individual Preceptorship (IP), participated in semi-structured interviews in 2018. Students were asked to describe their peer teaching experiences during the clerkship and to reflect on their experiences serving as role models or mentors. We analyzed transcripts utilizing a two-cycle team-based inductive approach. FINDINGS Thirty-three students completed interviews. We derived three main themes: (1) diversity of peer teaching and mentoring opportunities, (2) transitioning one's role from learner to teacher, and (3) personal and professional development. While participants from both clerkships participated in peer teaching and mentoring experiences, ECMH students described more opportunities to interact with students across all years of medical school training, noting that "getting that guidance and in turn being able to teach is a valuable experience." ECMH students further perceived the responsibility of creating a comfortable learning environment for others. Students from both clerkships reflected on 'learning through teaching,' that teaching served as a reaffirmation of the knowledge they gained, and that teaching experience contributed to their personal and professional growth. INSIGHTS Students perceived their participation in peer teaching and mentoring experiences in the clinical setting as contributing positively to personal and professional development. Students from both clerkships reflected on their teaching and mentoring opportunities as a facilitator of growth in their own teaching skills; ECMH students further described a heightened sense of self-confidence and fulfillment. These findings highlight the importance of creating learning environments that foster peer teaching and mentoring, as such opportunities may lead to further growth as a learner and as a physician.
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Affiliation(s)
- Monica M Yang
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Blair P Golden
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Gard
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jennifer A Bierman
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel B Evans
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bruce L Henschen
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Neve H, Hanks S. Tangrams: a simple visual tool for communicating the complexities of professionalism. MEDEDPUBLISH 2022; 12:2. [PMID: 36168529 PMCID: PMC9370087 DOI: 10.12688/mep.17558.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
Professionalism is vital for high quality healthcare and fundamental to health profession education. It is however complex, hard to define and can be challenging to teach, learn about and assess. We describe the development and use of an innovative visual tool, using a tangram analogy, to introduce and explore core professionalism concepts, which are often troublesome for both learners and educators. These include the hidden curriculum, capability, professional identity and the difference between unprofessionalism and high professional standards. Understanding these concepts can help individuals to see professionalism differently, encourage faculty to design professionalism programmes which focus on professional excellence, support assessors to feel more confident in identifying and addressing underperformance and facilitate learners to appreciate the complexity and uncertainty inherent in professionalism and to become more alert to the hidden curriculum and its potential impact. We have used the tangram model to educate for professionalism in multiple contexts with learners and educators. Participants regularly report that it leads to a deeper understanding and important new insights around professionalism and helps them identify ways of changing their practice. We believe this approach has relevance across the health professions and suggest ways it could be further developed to explore wider professionalism issues such as reflective practice, resilience and teamworking.
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Affiliation(s)
- Hilary Neve
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Sally Hanks
- Peninsula Dental School, University of Plymouth, Plymouth, UK
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An analysis of student essays on medical leadership and its educational implications in South Korea. Sci Rep 2022; 12:5788. [PMID: 35388040 PMCID: PMC8987100 DOI: 10.1038/s41598-022-09617-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Abstract
To examine medical students’ perceptions of leadership and explore their implications for medical leadership education. We conducted a qualitative analysis of the essays submitted by students in the medical leadership course from 2015 to 2019. We categorised the essays by the characteristics of the selected model leaders (N = 563) and types of leadership (N = 605). A statistically significant proportion of students selected leaders who were of the same gender as themselves (P < 0.001), graduate track students chose leaders in science (P = 0.005), while; military track students chose leaders in the military (P < 0.001). Although the highest proportion of students chose politicians as their model leaders (22.7%), this number decreased over time (P < 0.001), and a wider range of occupational groups were represented between 2015 and 2019. Charismatic leadership was the most frequently selected (31.9%), and over time there was a statistically significant (P = 0.004) increase in the selection of transformational leadership. Students tended to choose individuals whose acts of leadership could be seen and applied. Medical leadership education should account for students’ changing perceptions and present a feasible leadership model, introducing specific examples to illustrate these leadership skills.
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Neve H, Hanks S. Tangrams: a simple visual tool for communicating the complexities of professionalism. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.17558.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Professionalism is vital for high quality healthcare and fundamental to health profession education. It is however complex, hard to define and can be challenging to teach, learn about and assess. We describe the development and use of an innovative visual tool, using a tangram analogy, to introduce and explore core professionalism concepts, which are often troublesome for both learners and educators. These include the hidden curriculum, capability, professional identity and the difference between unprofessionalism and high professional standards. Understanding these concepts can help individuals to see professionalism differently, encourage faculty to design professionalism programmes which focus on professional excellence, support assessors to feel more confident in identifying and addressing underperformance and facilitate learners to appreciate the complexity and uncertainty inherent in professionalism and to become more alert to the hidden curriculum and its potential impact. We have used the tangram model to educate for professionalism in multiple contexts with learners and educators. Participants regularly report that it leads to a deeper understanding and important new insights around professionalism and helps them identify ways of changing their practice. We believe this approach has relevance across the health professions and suggest ways it could be further developed to explore wider professionalism issues such as reflective practice, resilience and teamworking.
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/fqax8042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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Paige JT, Bonanno LS, Garbee DD, Yu Q, Kiselov VJ, Badeaux JA, Martin JB, Kalil DM, Devlin RJ. Team Training for Interprofessional Insight, Networking and Guidance (T 2IPING) points: a study protocol. Simul Healthc 2022. [DOI: 10.54531/ijohs/ijaa015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3).The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.
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Affiliation(s)
- John T Paige
- 1Department of Surgery, Louisiana State University (LSU) Health New Orleans School of Medicine, New Orleans, LA, USA
| | - Laura S Bonanno
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Deborah D Garbee
- 3Office of the Dean, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Qingzhao Yu
- 4Department of Biostatistics, LSU Health New Orleans School of Public Health, New Orleans, LA
| | | | - Jennifer A Badeaux
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Jennifer B Martin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - David M Kalil
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
| | - Raymond J Devlin
- 2Nurse Anesthesia Program, LSU Health New Orleans School of Nursing, New Orleans, LA
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Butler J, Kassel L, Miesner AR, Grady S, Wall GC. Incidence of a negative hidden curriculum, cynicism, and burnout within pharmacy resident education: A nationwide survey. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:922-927. [PMID: 34294255 DOI: 10.1016/j.cptl.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/29/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The term "hidden curriculum" (HC) is a set of ethical, moral, and value-based teachings communicated in a non-explicit manner. Recent literature has described increasing awareness of the prevalence of the HC and potential negative impact on medical learners; however, this information is lacking in pharmacy resident education. Consequently, we conducted a survey study of United States pharmacy residents to learn their perceptions concerning the HC in pharmacy residency training. METHODS A nationwide survey of pharmacy residents was conducted in June 2019. The survey assessed the following: presence of negative HC (score 0 to 80), cynicism (score 0 to 25), burnout via Maslach Burnout Inventory depersonalization (MBI-D) (range 0 to 30), and emotional exhaustion via Maslach Burnout Inventory emotional exhaustion (MBI-EE) (range 0 to 54). Higher scores represent increased occurrences of each domain. RESULTS The mean HC score was 20 (SD 14.7), mean cynicism score was 9 (SD 5.5), MBI-D was 5.5 (SD 4.5), and MBI-EE was 24.2 (SD 12.4). Of those completing an MBI score, 40.4% (82/203) reported burnout in one area, while 15.8% (32/203) reported burnout in both areas. Residents reporting burnout had higher mean HC and cynicism scores. CONCLUSIONS Awareness to develop and grow cultures that minimize the presence of a negative HC is essential to improve postgraduate pharmacy training.
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Affiliation(s)
- Jared Butler
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Lynn Kassel
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Andrew R Miesner
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Sarah Grady
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
| | - Geoffrey C Wall
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA 50311, United States.
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Lanier C, Muller-Juge V, Dominicé Dao M, Gaspoz JM, Junod Perron N, Audétat MC. Management of residents in difficulty in a Swiss general internal medicine outpatient clinic: Change is necessary! PLoS One 2021; 16:e0254336. [PMID: 34283854 PMCID: PMC8291751 DOI: 10.1371/journal.pone.0254336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
AIMS OF THE STUDY Residents in difficulty are a major cause for concern in medical education, with a prevalence of 7-15%. They are often detected late in their training and cannot make use of remediation plans. Nowadays, most training hospitals in Switzerland do not have a specific program to identify and manage residents in difficulty. The aim of the study was to explore the challenges perceived by physicians regarding the process of identifying, diagnosing, and supporting residents in difficulty in a structured and programmatic way. We explored perceptions of physicians at different hierarchical levels (residents (R), Chief residents (CR), attending physicians (A), Chief Physician (CP)) in order to better understand these challenges. METHODS We conducted an exploratory qualitative study between December 2015 and July 2016. We asked volunteers from the Primary Care Division of the Geneva University Hospitals to partake to three focus groups (with CR, A, R) and one interview with the division's CP. We transcribed, coded, and qualitatively analyzed the three focus groups and the interview, using a content thematic approach and Fishbein's conceptual framework. RESULTS We identified similarities and differences in the challenges of the management of residents in difficulty on a programmatic way amongst physicians of different hierarchical levels. Our main findings: Supervisors (CR, A, CP) have good identification skills of residents in difficulty, but they did not put in place systematic remediation strategies.Supervisors (CR, A) were concerned about managing residents in difficulty. They were aware of the possible adverse effects on patient care, but "feared to harm" resident's career by documenting a poor institutional assessment.Residents "feared to share" their own difficulties with their supervisors. They thought that it would impact their career negatively.The four physician's hierarchical level reported environmental constraints (lack of funding, time constraint, lack of time and resources…). CONCLUSION Our results add two perspectives to specialized recommendations regarding the implementation of remediation programs for residents in difficulty. The first revolves around the need to identify and fully understand not only the beliefs but also the implicit norms and the feeling of self-efficacy that are shared by teachers and that are likely to motivate them to engage in the management of residents in difficulty. The second emphasizes the importance of analyzing these elements that constitute the context for a change and of identifying, in close contact with the heads of the institutions, which factors may favor or hinder it. This research action process has fostered awareness and discussions at different levels. Since then, various actions and processes have been put in place at the Faculty of Medicine in Geneva.
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Affiliation(s)
- Cédric Lanier
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- Family Medicine Unit (UIGP), University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Olvet DM, Willey JM, Bird JB, Rabin JM, Pearlman RE, Brenner J. Third year medical students impersonalize and hedge when providing negative upward feedback to clinical faculty. MEDICAL TEACHER 2021; 43:700-708. [PMID: 33657329 DOI: 10.1080/0142159x.2021.1892619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Medical students provide clinical teaching faculty with feedback on their skills as educators through anonymous surveys at the end of their clerkship rotation. Because faculty are in a position of power, students are hesitant to provide candid feedback. Our objective was to determine if medical students were willing to provide negative upward feedback to clinical faculty and describe how they conveyed their feedback. A qualitative analysis of third year medical students' open-ended comments from evaluations of six clerkships was performed using politeness theory as a conceptual framework. Students were asked to describe how the clerkship enhanced their learning and how it could be improved. Midway through the academic year, instructions to provide full names of faculty/residents was added. Overall, there were significantly more comments on what worked well than suggestions for improvement regarding faculty/residents. Instructing students to name-names increased the rate of naming from 35% to 75% for what worked well and from 13% to 39% for suggestions for improvement. Hedging language was included in 61% of suggestions for improvement, but only 2% of what worked well. Students described the variability of their experience, used passive language and qualified negative experiences with positive ones. Medical students may use linguistic strategies, such as impersonalizing and hedging, to mitigate the impact of negative upward feedback. Working towards a culture that supports upward feedback would allow students to feel more comfortable providing candid comments about their experience.
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Affiliation(s)
- Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Joanne M Willey
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeffrey B Bird
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jill M Rabin
- Department of Obstetrics & Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - R Ellen Pearlman
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Judith Brenner
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. Virtual patients reflecting the clinical reality of primary care - a useful tool to improve cultural competence. BMC MEDICAL EDUCATION 2021; 21:270. [PMID: 33975581 PMCID: PMC8112065 DOI: 10.1186/s12909-021-02701-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context. METHODS Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis. RESULTS The analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one's own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants. CONCLUSIONS Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.
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Affiliation(s)
- Erica Rothlind
- Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Solvig Ekblad
- Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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Almairi SOA, Sajid MR, Azouz R, Mohamed RR, Almairi M, Fadul T. Students' and Faculty Perspectives Toward the Role and Value of the Hidden Curriculum in Undergraduate Medical Education: a Qualitative Study from Saudi Arabia. MEDICAL SCIENCE EDUCATOR 2021; 31:753-764. [PMID: 34457924 PMCID: PMC8368115 DOI: 10.1007/s40670-021-01247-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/13/2023]
Abstract
A hidden medical curriculum is defined as the unwritten, unofficial, and unintended learning that students experience in medical school along with more formal aspects of education. This term describes the behaviours, attitudes, assumptions and beliefs conveyed by teachers, peers and the surrounding environment. However, more research is needed to evaluate its impact on student and faculty interactions in this context. We conducted this qualitative study utilizing focus group and semi-structured interviews of students and faculty to evaluate the perspectives of medical students and faculty toward the role and impact of the hidden medical curriculum in medical education at Alfaisal University, Riyadh, Saudi Arabia. Data was analysed using open-, axial- and selective-coding using thematic framework analysis. Interviewees consisted of 24 students in years 1-3 during the spring semester 2018-2019, 8 faculty members and 4 teaching assistants. We identified six core themes of hidden curriculum at Alfaisal University (Appendix). Role and behavioural modelling, value-based teaching, interpersonal faculty-student interactions, effects of diversity and socialization, teaching methodologies and hidden curriculum, mentoring and student support systems. Although some of the themes identified in these focus group interviews were similar to previously published studies, the novel themes that we identified were diversity, socialization and interpersonal faculty-student interactions. We conclude that identifying the issues pertaining to hidden curriculum is important for the development of medical students and for nurturing and upholding the values that we want to instil in our future physicians.
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Affiliation(s)
| | - Muhammad Raihan Sajid
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Rand Azouz
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Reem Ramadan Mohamed
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Mohammed Almairi
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Tarig Fadul
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
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Röcker N, Lottspeich C, Braun LT, Lenzer B, Frey J, Fischer MR, Schmidmaier R. Implementation of self-directed learning within clinical clerkships. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc43. [PMID: 33763528 PMCID: PMC7958912 DOI: 10.3205/zma001439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/03/2020] [Accepted: 09/30/2020] [Indexed: 05/28/2023]
Abstract
Background: The main aim of medical curricula is to prepare students for the first day at the work place. While teaching clinical competence is pivotal, clinical clerkships are often the last chance to close knowledge gaps with the help of clinical teachers. Self-directed learning is a dynamic field for research within medical education, though its curricular implementation is rare. This study focuses on the needs assessment of clinical clerkships using the concept of self-directed learning. Methods: The study comprised an educational experience at the Ludwig-Maximilians Universität (LMU) Munich. Medical students (n=1446, 59% female) in their second clinical year were instructed to specify learning objectives (LOs) by Doran`s SMART criteria and to gauge the probability of their fulfilment prior to the mandatory clerkship. In a second questionnaire one week later, the students rated the actual subjective fulfilment of the LOs. Data was coded with regards to the German National Catalogue of Competence-Based Learning Objectives for Undergraduate Medical Education (NKLM) and investigated qualitatively. Factors that determine goal achievement were collected and coded binary (barrier vs. enabler). Univariate analysis was used when appropriate. Results: The acquisition of "clinically practical abilities" (29%), "diagnostic methods" (21%) and "professional communication" (13%) were the LOs mentioned most. Throughout the week, subjective fulfilment diminished. Rich (vs. poor) availability to "practical exercise" (31%), "engagement of the physicians and other medical staff" (27%) and "personal initiative" (23%) resulted in higher subjective fulfilment. Conclusions: The self-chosen LOs reflect the needs of students for which the clinical teacher should be prepared. Considering these findings, it seems possible to close practical training gaps. We support the consideration of establishing curricular anchored self-directed learning in clinical clerkships. Further empirical studies would be beneficial in revealing its positive effects on the learning progress.
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Affiliation(s)
- Navina Röcker
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Christian Lottspeich
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Leah T. Braun
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
- LMU München, Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
| | - Benedikt Lenzer
- LMU München, Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
- Charité – Universitätsmedizin Berlin, Klinische Chemie und Pathobiochemie, Institut für Laboratoriumsmedizin, Berlin, Germany
| | - Jessica Frey
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
| | - Martin R. Fischer
- LMU München, Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
| | - Ralf Schmidmaier
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, Munich, Germany
- LMU München, Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Munich, Germany
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Paige JT, Garbee DD, Yu Q, Zahmjahn J, Baroni de Carvalho R, Zhu L, Rusnak V, Kiselov VJ. Brick in the wall? Linking quality of debriefing to participant learning in team training of interprofessional students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:360-365. [DOI: 10.1136/bmjstel-2020-000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/03/2022]
Abstract
BackgroundThe evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.MethodsForty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.ResultsStatistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.ConclusionsQuality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.
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Educator’s Guide for Addressing Cultural Awareness, Humility, and Dexterity in Occupational Therapy Curricula. Am J Occup Ther 2020. [DOI: 10.5014/ajot.2020.74s3005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Occupational therapists are ethically bound to provide quality care to assist all people across the life course to engage in meaningful occupations. This sense of purpose, however, is challenged by institutional, systemic, and attitudinal barriers to equitable care for racial and ethnic minorities and other marginalized identities. Future practitioners must learn how to provide culturally appropriate care characterized by awareness, humility, and dexterity in client interactions. This guide offers information, strategies, and resources for enhancing learner knowledge, skills, and attitudes through intentional and effective curriculum design practices. It is intended to assist educators with integrating cultural awareness, humility, and dexterity into intended learning outcomes; course topics; formal, informal, and hidden curricula; teaching approaches; and instructional strategies.
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Shi R, Marin-Nevarez P, Hasty B, Roman-Micek T, Hirx S, Anderson T, Schmiederer I, Fanning R, Goldhaber-Fiebert S, Austin N, Lau JN. Operating Room In Situ Interprofessional Simulation for Improving Communication and Teamwork. J Surg Res 2020; 260:237-244. [PMID: 33360307 DOI: 10.1016/j.jss.2020.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Effective teamwork and communication are correlated with improved patient care quality and outcomes. The belief that each team member contributes to excellent patient care in the operating room (OR) leads to a more productive work environment. However, poor teamwork and communication lead to poorer OR outcomes. We qualitatively and quantitatively explored perspectives of three OR professions (nursing, anesthesiology, and surgery) on teamwork and communication in the OR preinterprofessional and postinterprofessional in situ OR simulation. MATERIALS AND METHODS One-on-one semi-structured interviews were conducted; 14 pre-in situ simulations during July-October 2017 (three surgery, four anesthesiology, and six nursing staff), and 10 post-in situ simulations during August-November 2017 (five surgery, four anesthesiology, and one nursing staff). Themes were identified inductively to create a codebook. The codebook was used to consensus code all interviews. This analysis informed the development of a quantitative survey distributed to all contactable interviewees (22). RESULTS Presimulation and postsimulation interview participants concurred on teamwork and communication importance, believed communication to be key to effective teamwork, and identified barriers to communication: lack of cordiality, lack of engagement from other staff, distractions, role hierarchies, and lack of familiarity with other staff. The large majority of survey participants-all having participated in simulations-believed they could use effective communication in their workplace. CONCLUSIONS Establishing methods for improving and maintaining the ability of OR professionals to communicate with each other is imperative for patient safety. Effective team communication leads to safe and successful outcomes, as well as a productive and supportive OR work environment.
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Affiliation(s)
- Robert Shi
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Paloma Marin-Nevarez
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Brittany Hasty
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Teresa Roman-Micek
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Sarah Hirx
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Tiffany Anderson
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Ingrid Schmiederer
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Ruth Fanning
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | | | - Naola Austin
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - James N Lau
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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Kisiel MA, Kühner S, Stolare K, Lampa E, Wohlin M, Johnston N, Rask-Andersen A. Medical students' self-reported gender discrimination and sexual harassment over time. BMC MEDICAL EDUCATION 2020; 20:503. [PMID: 33302936 PMCID: PMC7731624 DOI: 10.1186/s12909-020-02422-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Gender discrimination (GD) and sexual harassment (SH) occur at all academic institutions worldwide. Medical students report high prevalence of GD and SH, which may negatively affect their education and health. There are indications that policies and reforms on reducing GD/SH are insufficient. Swedish medical students' experiences of GD/SH are monitored by course-evaluations and bi-annual student union evaluations; however, the response rate is usually low. The aim of this study was to compare the exposure to and context of self-reported GD/SH over an 11-year period amongst medical students at a Swedish university. METHODS In 2002, a questionnaire (n = 622) was mailed to medical students' home addresses. It was repeated in 2013 and then distributed during mandatory lectures (n = 856). The questions used a behavioristic approach and asked about specific GH/SH experiences. Participation was voluntary and anonymous. The changes in prevalence over time were calculated by sampling weights in order to obtain comparable estimates, representative of both cohorts. RESULTS The response frequency was 55% (62% women) in 2002 and 81% (59% women) in 2013. The prevalence of GD tended to decrease for male and clinical students in comparison to female and pre-clinical peers. However, the prevalence of SH increased for female compared to male students. The ratio of SH for female pre-clinical students doubled in many instances; most often, the mistreatment occurred in the clinic. Medical doctors were indicated as perpetrators up to five times more often by all students in 2013. CONCLUSION Our results show a disproportional change in exposure to GD/SH between female and male medical students, resulting in a widening of the gender gap regarding prevalence of GD and SH between 2002 and 2013. In particular, personal experiences of SH increased for both sexes. It is proof that institutional efforts to fight mistreatment might be ineffective.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden.
| | - Sofia Kühner
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Stolare
- Department of Psychiatry, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nina Johnston
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Anna Rask-Andersen
- Department of Medical Sciences, Environmental and Occupational Medicine, Uppsala University, Dag Hammarskjölds Väg, 60 751 85, Uppsala, Sweden
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Barratt R, Wyer M, Hor SY, Gilbert GL. Medical interns' reflections on their training in use of personal protective equipment. BMC MEDICAL EDUCATION 2020; 20:328. [PMID: 32967669 PMCID: PMC7509499 DOI: 10.1186/s12909-020-02238-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/09/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates' experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. METHODS This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns' self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. RESULTS 80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. CONCLUSIONS Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.
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Affiliation(s)
- Ruth Barratt
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Mary Wyer
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW Australia
| | - Su-yin Hor
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Gwendolyn L. Gilbert
- Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145 Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Toupchian A, Sarbakhsh P, Ghaffari R, Kazemi A, Mahmoodi H, Shaghaghi A. Development and Psychometric Analysis of the Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: Trainee Version (PAMETHIC-CLIN-T). Patient Prefer Adherence 2020; 14:1615-1621. [PMID: 32943853 PMCID: PMC7481275 DOI: 10.2147/ppa.s258132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was conducted to develop and assess psychometric properties of the "Measure of Perceived Adherence to the Principles of Medical Ethics in Clinical Educational Settings: trainee version (PAMETHIC-CLIN-T)" as a data collection tool to enhance research performance rigor in future medical ethics studies. PATIENTS AND METHODS A multi-tiered six stage procedure was applied to develop the PAMETHIC-CLIN-T and assess its psychometric properties in a sample of Iranian medical science undergraduate students (n=263). The final constructed item pool contained 16 questions with the response options in five Likert-type categories. The higher total score indicated better compliance with the ethics and professional conduct regulations. Internal consistency reliability was examined and exploratory factor analysis (EFA) with direct oblimin rotation and principal components analysis (PCA) were carried out to reduce the overall constructed items into latent factors based on commonalities within the data set. FINDINGS Factor analysis results revealed a 4-factor solution. All 16 items had factor loading greater than absolute value of 0.3 that accounted for 60.57% of the variance. The value of Kaiser Meyer Olkin (KMO) measure of sampling adequacy for factor analysis (0.909) and also Bartlett's test of sphericity (X2=1630.63, df=120, P-value<0.001) approved interpretability of the EFA output. CONCLUSION Feasibility testing and psychometric analysis of the constructed scale yielded research evidence to support a four-factor model to be applied in future studies about the extent of perceived adherence to the principles of medical ethics in clinical educational settings.
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Affiliation(s)
- Arezoo Toupchian
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Department of Epidemiology and Biostatistics, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghaffari
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolhassan Kazemi
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abdolreza Shaghaghi
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Brown ME, Coker O, Heybourne A, Finn GM. Exploring the Hidden Curriculum's Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency. MEDICAL SCIENCE EDUCATOR 2020; 30:1107-1121. [PMID: 34457773 PMCID: PMC8368648 DOI: 10.1007/s40670-020-01021-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The hidden curriculum within medical education has been a topic of recent debate. Consensus opinion regarding the continued relevance of this term, what constitutes the hidden curriculum, and the nature of its impact do not exist. Further research is required to contribute to this debate. This work sets out to investigate which factors beyond taught cognitive knowledge influence medical students in clinical and educational environments and examine how this occurs. Semi-structured focus group interviews were conducted with 39 students from one UK medical school. Fourteen faculty were interviewed individually to triangulate data. Data were analysed using constructivist thematic analysis, informed by grounded theory convention. The presence of the hidden curriculum was clearly demonstrated, acting through role modelling, organizational culture, stereotyping and professional dress. Mentioned frequently were the influences of the hidden curriculum on student professionalism and identity development. Professionalism was perceived as being negatively impacted by the hidden curriculum and seen as an imposition from senior faculty to control students. Students believe medical identity formation begins prior to medical school, in a process known as "anticipatory socialization", a previously unstudied identity transition. Students felt covert institutional agendas negatively impacted their identity, pushing them further from the identity their institution was encouraging them to acquire. Key messages for educators include the need to explore the hidden curriculum through discussion with students. Improving transparency of organizational culture may allow students to interpret institutional agendas in the way institutions formally intend, reducing orthogonal interpretations of organizational culture and subsequent impact upon identity formation.
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Affiliation(s)
- Megan E.L. Brown
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Oluwafemi Coker
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Annabel Heybourne
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, John Hughlings Jackson Building, University Road, Heslington, York, YO10 5DD UK
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Herr KD, George E, Agarwal V, McKnight CD, Jiang L, Jawahar A, Pakkal M, Ulano A, Ganeshan D. Aligning the Implicit Curriculum with the Explicit Curriculum in Radiology. Acad Radiol 2020; 27:1268-1273. [PMID: 32061468 DOI: 10.1016/j.acra.2019.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
Physician education occurs through two mechanisms that operate in tandem: the explicit and the implicit curriculum. The explicit, or formal, curriculum is the official version that is usually taken as the one-and-only curriculum and which is detailed in official documentation; however, an implicit curriculum exists, comprised of subtle messaging about professional norms, values, and beliefs that are tacitly communicated through both positive and negative role modeling. Both contribute to the overall education of the medical student and physician-in-training. Despite its well-documented influence in medical education, much of the teachings of the implicit curriculum occurs in the shadows, unspoken and unarticulated, and outside the awareness of both teacher and student. As panel members of the The Implicit Curriculum in Radiology Task Force of the Association of University Radiologists-Radiology Research Alliance (AUR-RRA), we present a review of the implicit curriculum, exploring its origin and impact on medical education, and on the overall professional development of medical students, post-graduate medical trainees and practicing physicians. Strategies for recognizing and contending with the implicit curriculum in radiology training are discussed, with a special emphasis on opportunities to leverage its potential through positive role modeling.
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Affiliation(s)
- Keith D Herr
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308.
| | - Elizabeth George
- Fellow in Neuroradiology, Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Colin D McKnight
- Vanderbilt University Medical Center, R-1302 MCN, South Nashville, Tennessee
| | - Liwei Jiang
- Integrated Interventional Radiology Resident, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anugayathri Jawahar
- Clinical Instructor in Radiology, Stanford University, Palo Alto, California
| | - Mini Pakkal
- Toronto General Hospital, Department of Medical Imaging, Toronto, Ontario
| | - Adam Ulano
- Department of Radiology, University of Vermont Medical Center, The Robert Larner MD College of Medicine at the University Of Vermont, Burlington, Vermont
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Radiology, Unit 1473, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Fung R, Gallibois C, Coutin A, Wright S. Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e19-e28. [PMID: 32821299 PMCID: PMC7417822 DOI: 10.36834/cmej.53009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The transgender (trans) population is one of the most underserved in health care. Not only do they face discrimination and stigma from society as a whole, they also have difficulty accessing transition-related care, leading to adverse outcomes such as suicide. We aimed to increase understanding on how our current postgraduate education system contributes to a lack of care for trans patients. METHODS Our study consisted of 11 semi-structured interviews conducted in 2016 with residents in the following specialties: family medicine (3), endocrinology (3), psychiatry (3), and urology (2). We used Framework Analysis to qualitatively analyze our data. RESULTS Residents described a lack of trans care education in the core curriculum, in part due to a lack of exposure to experts in this area. They also expressed discomfort when dealing with trans patients, due to inexperience and lack of knowledge. Furthermore, residents in each specialty had false assumptions that other specialties had sufficient knowledge and expertise in trans care. DISCUSSION This study highlights how the lack of teaching and clinical experiences with trans patients during residency contributes to the poor access to healthcare. By systematically embedding trans care in the curriculum, medical education can play a prominent role in addressing the healthcare disparities of this underserved population.
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Affiliation(s)
- Raymond Fung
- Michael Garron Hospital, University of Toronto, Ontario, Canada
- Correspondence: Raymond Fung, Michael Garron Hospital K 302, 650 Sammon Ave, Toronto, Ontario, M4C 5M5; phone: 416-915-5460;
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Sarikhani Y, Shojaei P, Rafiee M, Delavari S. Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method. BMC MEDICAL EDUCATION 2020; 20:176. [PMID: 32487128 PMCID: PMC7269001 DOI: 10.1186/s12909-020-02094-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. OBJECTIVES This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. METHODS In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). RESULTS Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. CONCLUSION The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Shojaei
- Department of Management, School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
| | - Mohammad Rafiee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. The informal curriculum of family medicine - what does it entail and how is it taught to residents? A systematic review. BMC FAMILY PRACTICE 2020; 21:49. [PMID: 32160865 PMCID: PMC7066821 DOI: 10.1186/s12875-020-01120-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/28/2020] [Indexed: 12/03/2022]
Abstract
Background The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term “the hidden curriculum” is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners, our aim was to explore the area further, with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed? Methods We conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results. Results Twenty articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across other medical disciplines as well. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general, the quality of the few interventional studies found was low. Conclusions Important aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor’s preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum. Trial registration The systematic review was registered with Prospero; registration number CRD42018104819.
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Affiliation(s)
- Erica Rothlind
- Culture Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Solvig Ekblad
- Culture Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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Wang XM, Swinton M, You JJ. Medical students' experiences with goals of care discussions and their impact on professional identity formation. MEDICAL EDUCATION 2019; 53:1230-1242. [PMID: 31750573 DOI: 10.1111/medu.14006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/07/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end-of-life care. In previous research, medical learners have reported insufficient training and emotional distress about end-of-life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. METHODS Using purposive sampling at one Canadian medical school, individual semi-structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. RESULTS Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. CONCLUSIONS GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively.
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Affiliation(s)
- Xuyi Mimi Wang
- Division of Geriatric Medicine Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Healthy Aging, St Peter's Hospital, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Neville P, Zahra J, Pilch K, Jayawardena D, Waylen A. The behavioural and social sciences as hidden curriculum in UK dental education: A qualitative study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:461-470. [PMID: 31373149 DOI: 10.1111/eje.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The behavioural and social sciences (BeSS) are an integral part of dental curricula, helping students become holistic, patient-centred practitioners. Nevertheless, UK studies document that dental undergraduates struggle to see the relevance of BeSS to their training. Using the concept of hidden curriculum, this study explored dental students’ perceptions of and attitudes towards BeSS in one dental school in the UK. MATERIAL AND METHODS Six focus groups were conducted with 37 dental students from years 1 to 5. Thematic analysis was conducted revealing five themes: student attitudes towards BeSS, teaching culture, learning culture, curricular issues and student culture. RESULTS Many students recognised how BeSS contributed to their communication and patient management skills. Nevertheless, the study revealed a dental student cohort who have a strained relationship with BeSS. This negative attitude became more apparent from year 3 onwards, when the clinical phase of studies begins. It was perpetuated and legitimated by the existence of a strong student culture that openly critiqued BeSS among and between student year groups. DISCUSSION AND CONCLUSION(S) In UK dental education there is a hidden curriculum related to BeSS. By underestimating the utility of BeSS, students are failing to recognise the biopsychosocial dimensions relevant to oral health and dental practice. All UK dental schools should review their relationship with BeSS and assess whether they are perpetuating a hidden curriculum about BeSS within their curricula.
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Affiliation(s)
| | - Jez Zahra
- Centre for Surgical Research, Bristol Medical School, University of Bristol, UK
| | | | | | - Andrea Waylen
- Bristol Dental School, University of Bristol, Bristol, UK
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Weurlander M, Lönn A, Seeberger A, Hult H, Thornberg R, Wernerson A. Emotional challenges of medical students generate feelings of uncertainty. MEDICAL EDUCATION 2019; 53:1037-1048. [PMID: 31509285 PMCID: PMC6771719 DOI: 10.1111/medu.13934] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/21/2018] [Accepted: 06/10/2019] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Health care students face many situations during their education that might be emotionally challenging. Students are confronted with illness, suffering, death, patient treatment dilemmas, and witnessing unprofessional behaviour on the part of health care professionals. Few studies have focused on what these experiences lead to in relation to the process of becoming a professional. The purpose of the study was to explore medical students' main concerns relating to emotionally challenging situations during their medical education. METHODS A constructivist grounded theory approach was used to explore and analyse medical students' experiences. Data were gathered by means of focus group interviews, including two interviews in the middle and two interviews at the end of the students' undergraduate programme. A total of 14 medical students participated. RESULTS Students' main concerns relating to emotionally challenging situations were feelings of uncertainty. These feelings of uncertainty concerned: (i) insufficient knowledge and skills; (ii) the struggle to manage emotions in patient encounters; (iii) perceived negative culture and values amongst health care professionals and in the health care system, and (iv) lacking a self-evident position on the health care team. The first two aspects relate to uncertainties concerning their own capabilities and the other two aspects relate to uncertainties regarding the detached medical culture and the unclear expectations of them as students in the health care team. CONCLUSIONS In the process of becoming a physician, students develop their professional identity in constant negotiation with their own perceptions, values and norms and what they experience in the local clinical context in which they participate during workplace education. The two dimensions that students have to resolve during this process concern the questions: Do I have what it takes? Do I want to belong to this medical culture? Until these struggles are resolved, students are likely to experience worry about their future professional role.
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Affiliation(s)
- Maria Weurlander
- Department of Learning in Engineering SciencesSchool of Industrial Engineering and Management (ITM)KTH Royal Institute of TechnologyStockholmSweden
- Department of Clinical Science, Intervention and Technology (CLINTEC)Division of Renal MedicineKarolinska InstitutetStockholmSweden
| | - Annalena Lönn
- Department of Clinical Science, Intervention and Technology (CLINTEC)Division of Renal MedicineKarolinska InstitutetStockholmSweden
| | - Astrid Seeberger
- Department of Clinical Science, Intervention and Technology (CLINTEC)Division of Renal MedicineKarolinska InstitutetStockholmSweden
| | - Håkan Hult
- Department of Clinical Science, Intervention and Technology (CLINTEC)Division of Renal MedicineKarolinska InstitutetStockholmSweden
| | - Robert Thornberg
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Annika Wernerson
- Department of Clinical Science, Intervention and Technology (CLINTEC)Division of Renal MedicineKarolinska InstitutetStockholmSweden
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Silveira GL, Campos LK, Schweller M, Turato ER, Helmich E, de Carvalho-Filho MA. “Speed up”! The Influences of the Hidden Curriculum on the Professional Identity Development of Medical Students. HEALTH PROFESSIONS EDUCATION 2019. [DOI: 10.1016/j.hpe.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Coakley N, O'Leary P, Bennett D. 'Waiting in the wings'; Lived experience at the threshold of clinical practice. MEDICAL EDUCATION 2019; 53:698-709. [PMID: 31094039 DOI: 10.1111/medu.13899] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/01/2019] [Accepted: 03/28/2019] [Indexed: 05/28/2023]
Abstract
CONTEXT The transition to clinical practice is challenging. Lack of preparedness and issues with support, responsibility and complex workplace interactions contribute to the difficulties encountered. The first year of clinical practice is associated with negative consequences for new doctors' health and well-being. The contemporaneous lived experience of new graduates on the threshold of clinical practice has not been described. Deeper understanding of this phase may inform interventions to ease the transition from student to doctor. METHODS We used interpretative phenomenological analysis (IPA) to explore the individual experience of making the transition from medical student to doctor, focusing on the period prior to commencing clinical practice. Fourteen recent graduates were purposively recruited, and semi-structured interviews were conducted with each, with respect to how they anticipated the transition. RESULTS We draw on the metaphor of the actor 'waiting in the wings' to describe participants' lived experience on the threshold of practice. The experience of the actor, about to step into the spotlight, was mirrored in participants' perceptions of an abrupt transformation to come, mixed feelings about what lay ahead, and the various strategies that they had planned to help them to perform their new role convincingly. DISCUSSION Participants in this study braced themselves for a trial by ordeal as they contemplated commencing clinical practice. The hidden curriculum shaped their understanding of what was expected of them as new doctors, and inspired dysfunctional strategies to meet expectations. Solutions to make the experience a more positive one lie in the approximation of the roles of senior medical student and newly qualified doctor, in explicitly addressing the hidden curriculum and generating cultural change. An emphasis on experience-based learning through contribution to patient care, guided reflection on the hidden curriculum and shifting cultural expectations through faculty development and strong local leadership can contribute to these objectives.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - Paula O'Leary
- School of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, National University of Ireland, Cork, Ireland
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McCarthy MW, de Asua DR, Gabbay E, Christos PJ, Fins JJ. Frequency of Ethical Issues on a Hospitalist Teaching Service at an Urban, Tertiary Care Center. J Hosp Med 2019; 14:290-293. [PMID: 30897052 PMCID: PMC7343177 DOI: 10.12788/jhm.3179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022]
Abstract
Little is known about the daily ethical conflicts encountered by hospitalists that do not prompt a formal clinical ethics consultation. We describe the frequencies of ethical issues identified during daily rounds on hospitalist teaching services at a metropolitan, tertiary-care, teaching hospital. Data were collected from September 2017 through May 2018 by two attending hospitalists from the ethics committee who were embedded on rounds. A total of 270 patients were evaluated and 113 ethical issues were identified in 77 of those patients. These issues most frequently involved discussions about goals of care, treatment refusals, decision-making capacity, discharge planning, cardiopulmonary resuscitation status, and pain management. Only five formal consults were brought to the Hospital Ethics Committee for these 270 patients. Our data are the first prospective description of ethical issues arising on academic hospitalist teaching services and are an important step in the development of a targeted ethics curriculum for hospitalists.
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Affiliation(s)
- Matthew W McCarthy
- Division of Hospital Medicine, Department of Medicine, New York–Presbyterian–Weill Cornell Medical Center, New York, New York
| | - Diego Real de Asua
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ezra Gabbay
- Division of Hospital Medicine, Department of Medicine, New York–Presbyterian–Weill Cornell Medical Center, New York, New York
| | - Paul J Christos
- Department of Healthcare Policy & Research, NewYork–Presbyterian Hospital–Weill Cornell Medicine, New York, New York
| | - Joseph J Fins
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Healthcare Policy & Research, NewYork–Presbyterian Hospital–Weill Cornell Medicine, New York, New York
- CASBI, Consortium for the Advanced Study of Brain Injury, Weill Cornell and Rockefeller University, New York, New York
- Solomon Center for Health Law & Policy, Yale Law School, New Haven, Connecticut
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Doshi RS, Gudzune KA, Dyrbye LN, Dovidio JF, Burke SE, White RO, Perry S, Yeazel M, van Ryn M, Phelan SM. Factors influencing medical student self-competence to provide weight management services. Clin Obes 2019; 9:e12288. [PMID: 30358159 PMCID: PMC6411289 DOI: 10.1111/cob.12288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/28/2018] [Accepted: 09/20/2018] [Indexed: 11/27/2022]
Abstract
This study aimed to identify factors associated with high obesity care self-competence among US medical students. The authors performed a cross-sectional analysis of 2014 survey data on fourth year medical students collected online as part of the Medical Student Cognitive Habits and Growth Evaluation Study (CHANGES). Independent variables included quality and quantity of interaction with patients and peers with obesity; hours of communication and partnership skills training; negative remarks against patients with obesity by supervising physicians, and witnessed discrimination against patients with obesity. The dependent variable was self-competence in providing obesity care. Of 5823 students invited to participate, 3689 (63%) responded and were included in our analyses. Most students were white (65%), half were women and 42% had high self-competence in caring for patients with obesity. Factors associated with high self-competence included increased interaction with peers with obesity (39% vs. 49%, P < 0.001) and increased partnership skills training (32% vs. 61%, P < 0.001). Increased partnership skills training and quantity of interactions with peers with obesity were associated with high student self-competence in providing obesity-related care to patients. Medical schools might consider increasing partnership skills training to improve students' preparedness and skill in performing obesity-related care.
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Affiliation(s)
- R S Doshi
- Duke University Medical Center, Department of Internal Medicine-Pediatrics, Duke University Hospital, Durham, North Carolina, USA
| | - K A Gudzune
- Department of General Internal Medicine, Johns Hopkins University School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - L N Dyrbye
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J F Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - S E Burke
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - R O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - S Perry
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - M Yeazel
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - M van Ryn
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - S M Phelan
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Henschen BL, Ryan ER, Evans DB, Truong A, Wayne DB, Bierman JA, Cameron KA. Perceptions of Patient-Centered Care among First-Year Medical Students. TEACHING AND LEARNING IN MEDICINE 2019; 31:26-33. [PMID: 29847155 DOI: 10.1080/10401334.2018.1468260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: Teaching patient-centered care (PCC) is a key component of undergraduate medical curricula. Prior frameworks of PCC describe multiple domains of patient-centeredness, ranging from interpersonal encounters to systems-level issues. Medical students' perceptions of PCC are thought to erode as they progress through school, but little is known about how students view PCC toward the beginning of training. This study explores the perceptions of PCC among 1st-year medical students to inform curricular development and evaluation. Approach: Medical students participated in semistructured, in-person interviews within 4 months of starting medical school as part of a longitudinal study. Transcripts were analyzed using a grounded theory approach and the constant comparative method to describe responses and characterize emergent themes. Transcripts were reviewed to compare codes and compile a final codebook. Findings: Thirty-eight students completed interviews. Students provided heterogeneous definitions of PCC, including perceptions that PCC is implicit and obvious. Many students were unable to provide a concrete definition of PCC, juxtaposing PCC with other priorities such as profit- or physician-centered care, whereas others thought the term was jargon. Some participants defined PCC as upholding patient values using hypothetical examples centered around physician behavior. Insights: Although students appeared to enter medical school with a range of perceptions about PCC, many of their descriptions were limited and only scratch the surface of existing frameworks. Rather than their perceptions of PCC eroding during medical school, students may never fully develop a foundational understanding of PCC. Our findings reinforce the need for authentic, clinically experiential learning opportunities that promote PCC from the earliest stages of medical education.
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Affiliation(s)
- Bruce L Henschen
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth R Ryan
- b Department of Family and Community Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Daniel B Evans
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Ashley Truong
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Diane B Wayne
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Jennifer A Bierman
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Kenzie A Cameron
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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Hopkins J, Hedlin H, Weinacker A, Desai M. Patterns of Disrespectful Physician Behavior at an Academic Medical Center: Implications for Training, Prevention, and Remediation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1679-1685. [PMID: 29319539 DOI: 10.1097/acm.0000000000002126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Physician disrespectful behavior affects quality of care, patient safety, and collaborative clinical team function. Evidence defining the demographics, ethnography, and epidemiology of disrespectful behavior is lacking. METHOD The authors conducted a retrospective analysis of reports of disrespectful physician behavior at Stanford Hospital and Clinics from March 2011 through February 2015. Events were stratified by role, gender, specialty, and location in the hospital or clinics where the event occurred. Event rate ratios were estimated using a multivariable negative binomial regression model. Correlation of rates of faculty and trainees in the same specialty was assessed. RESULTS One hundred ninety-nine events concerned faculty; 160 concerned trainees. Events were concentrated among a small number of physicians in both groups. The rates of faculty and trainee events within the same specialty were highly correlated (Spearman's rho: 0.90; P < .001). Male physicians had an adjusted event rate 1.86 (95% CI = 1.33-2.60; P < .001) times that of females. Procedural physicians were 3.67 times (95% CI = 2.63-5.13; P < .001) more likely to have a disrespectful behavior event than nonprocedural physicians when adjusting for other covariates. Most common location for faculty was the operating rooms (69 events, 34%); for trainees, the medical/surgical units (43 events, 27%). CONCLUSIONS Patterns of physician disrespectful behavior differed by role, gender, specialty, and location. Rates among faculty and trainees of the same specialty were highly correlated. These patterns can be used to create more focused education and training for specific physician groups and individualized remediation interventions.
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Affiliation(s)
- Joseph Hopkins
- J. Hopkins is clinical professor of medicine, Stanford School of Medicine, and associate chief medical officer and senior medical director for quality, Stanford Health Care, Stanford, California. H. Hedlin is senior biostatistician and associate director, Clinical Trial Program, Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, California. A. Weinacker is professor of medicine and senior vice chair for clinical affairs, Department of Medicine, Stanford School of Medicine, and associate critical care medical director, associate chief medical officer for patient care services, and interim chief quality officer and service medical director, Stanford Health Care, Stanford, California. M. Desai is professor of medicine, of biomedical data science, and (by courtesy) of health research and policy, and director, Quantitative Sciences Unit, Stanford School of Medicine, Stanford, California
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Peng J, Clarkin C, Doja A. Uncovering cynicism in medical training: a qualitative analysis of medical online discussion forums. BMJ Open 2018; 8:e022883. [PMID: 30341130 PMCID: PMC6196850 DOI: 10.1136/bmjopen-2018-022883] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The development of cynicism in medicine, defined as a decline in empathy and emotional neutralisation during medical training, is a significant concern for medical educators. We sought to use online medical student discussion groups to provide insight into how cynicism in medicine is perceived, the consequences of cynicism on medical trainee development and potential links between the hidden curriculum and cynicism. SETTING Online analysis of discussion topics in Premed101 (Canadian) and Student Doctor Network (American) forums. PARTICIPANTS 511 posts from seven discussion topics were analysed using NVivo 11. Participants in the forums included medical students, residents and practising physicians. METHODS Inductive content analysis was used to develop a data-driven coding scheme that evolved throughout the analysis. Measures were taken to ensure the trustworthiness of findings, including duplicate independent coding of a sub-sample of posts and the maintenance of an audit trail. RESULTS Medical students, residents and practising physicians participating in the discussion forums engaged in discourse about cynicism and highlighted themes of the hidden curriculum resulting in cynicism. These included the progression of cynicism over the course of medical training as a coping mechanism; the development of challenging work environments due to factors such as limited support, hierarchical demands and long work hours; and the challenge of initiating change due to the tolerance of unprofessionalism and the highly stressful nature of medicine. CONCLUSION Our unique study of North American medical discussion posts demonstrates that cynicism develops progressively and is compounded by conflicts between the hidden and formal curriculum. Online discussion groups are a novel resource to provide insight into the culture of medical training.
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Affiliation(s)
- Jenny Peng
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Chantalle Clarkin
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Asif Doja
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Gardeshi Z, Amini M, Nabeiei P. The perception of hidden curriculum among undergraduate medical students: a qualitative study. BMC Res Notes 2018; 11:271. [PMID: 29728132 PMCID: PMC5935913 DOI: 10.1186/s13104-018-3385-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
Objectives The effect of hidden curriculum on student learning has not been sufficiently recognized in most of the revised curriculums. This study is a qualitative study that measures the students’ perception of hidden curriculum through semi-structured interviews. All of the interviews were recorded and then converted into scripts. These scripts were divided to sentences and phrases and named as units. Units aggregated with similar groups and named as codes, then the similar codes were aggregated into themes. Results Four main themes emerged, role modeling, personal attitude and beliefs, hierarchy, social and ethical culture. The results of the present study showed that it is necessary to discuss the hidden curriculum. We are unaware of the hidden curriculum, but even when were are aware of it, we are unwilling to act. Information about issues related to the hidden and informal curriculum, as well as knowing the viewpoints of students is necessary. It seems necessary to provide data to students about the hidden curriculum and encouraging patient centered curriculums early in training, such as integrated curriculum.
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Affiliation(s)
- Zahra Gardeshi
- Clinical Education Research Center, Shiraz University of Medical Sciences, Neshat Street Sina Sadra Hall, Shiraz, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Neshat Street Sina Sadra Hall, Shiraz, Iran.
| | - Parisa Nabeiei
- Clinical Education Research Center, Shiraz University of Medical Sciences, Neshat Street Sina Sadra Hall, Shiraz, Iran
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Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The Hidden Curricula of Medical Education: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:648-656. [PMID: 29116981 PMCID: PMC5938158 DOI: 10.1097/acm.0000000000002004] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PURPOSE To analyze the plural definitions and applications of the term "hidden curriculum" within the medical education literature and to propose a conceptual framework for conducting future research on the topic. METHOD The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability. They extracted, coded, and analyzed key data, using grounded theory methodology. RESULTS The authors uncovered 3,747 articles relating to the hidden curriculum in medical education. Of these, they selected 197 articles for full review. Use of the term "hidden curriculum" has expanded substantially since 2012. U.S. and Canadian medical schools are the focus of two-thirds of the empirical hidden curriculum studies; data from African and South American schools are nearly absent. Few quantitative techniques to measure the hidden curriculum exist. The "hidden curriculum" is understood as a mostly negative concept. Its definition varies widely, but can be understood via four conceptual boundaries: (1) institutional-organizational, (2) interpersonal-social, (3) contextual-cultural, and/or (4) motivational-psychological. CONCLUSIONS Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term "hidden curriculum," move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.
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Affiliation(s)
- Carlton Lawrence
- C. Lawrence is researcher, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, and medical student, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-7507-5582. T. Mhlaba is public health medicine specialist, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; ORCID: http://orcid.org/0000-0002-0178-2652. K.A. Stewart is associate professor, The Practice in Global Health and Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina. R. Moletsane is professor and J.L. Dube Chair of Rural Education, Department of Rural Education, University of KwaZulu-Natal, Durban, South Africa; ORCID: http://orcid.org/0000-0002-8493-7479. B. Gaede is chair, Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. M. Moshabela is chair, Centre for Rural Health, and Discipline of Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa, and Wellcome Trust fellow, Africa Centre for Population Health, Mtubatuba, South Africa; ORCID: http://orcid.org/0000-0002-9438-7095
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Joynt GM, Wong WT, Ling L, Lee A. Medical students and professionalism - Do the hidden curriculum and current role models fail our future doctors? MEDICAL TEACHER 2018; 40:395-399. [PMID: 29268632 DOI: 10.1080/0142159x.2017.1408897] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Formal medical curricula aim to promote professionalism through learning from lectures, interactive tutorials and simulations. We report an exploratory voting exercise, conducted within a new integrated professional teaching module, examining the likely influence on students' knowledge and perceptions of truth telling. METHODS Responses were collected from cohorts of final year students over a six-year period. Students were asked to pick between two responses to a standardized clinical vignette, firstly the response that they personally thought was the more desirable action, and subsequently the response they believed would most likely result in the context of everyday real-life clinical practice. RESULTS The difference (proportional change) in voting for "avoid full disclosure" from vote 1 (more desirable action) to vote 2 (likely real-life response) was 50% (95% CI: 36-64%, p < 0.001) favoring avoidance of full disclosure. CONCLUSIONS This finding highlights a substantial inconsistency between the knowledge taught by the formal curriculum, and the perception generated by the hidden curriculum. Medical Schools should develop strategies to manage the hidden curriculum, prepare clinical teachers to be good role models, and prepare students to be discerning about the hidden curriculum and when choosing role models.
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Affiliation(s)
- Gavin Matthew Joynt
- a Department of Anaesthesia and Intensive Care , The Chinese University of Hong Kong , Shatin , Hong Kong , China
| | - Wai-Tat Wong
- a Department of Anaesthesia and Intensive Care , The Chinese University of Hong Kong , Shatin , Hong Kong , China
| | - Lowell Ling
- b Department of Anaesthesia and Intensive Care , Prince of Wales Hospital , Shatin, New Territories , Hong Kong , China
| | - Anna Lee
- a Department of Anaesthesia and Intensive Care , The Chinese University of Hong Kong , Shatin , Hong Kong , China
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Weurlander M, Lönn A, Seeberger A, Broberger E, Hult H, Wernerson A. How do medical and nursing students experience emotional challenges during clinical placements? INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:74-82. [PMID: 29587248 PMCID: PMC5952306 DOI: 10.5116/ijme.5a88.1f80] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/17/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To investigate which kinds of situations medical and nursing students found emotionally challenging during their undergraduate education, and how they managed their experiences. METHODS This study used an exploratory research design. We gathered qualitative data using an open-ended questionnaire distributed to students in the middle and at the end of their education. In total, 49 nursing and 65 medical students participated. Also, five students were interviewed individually to acquire richer data. Data were analysed using narrative thematic analysis. RESULTS Medical and nursing students experienced a range of situations during their undergraduate education that they found emotionally challenging, mainly during clinical placements. The students' narratives concerned confronting patients' illness and death, unprofessional behaviour among healthcare professionals, dilemmas regarding patient treatment, students relating to patients as individuals and not diagnoses, and using patients for their own learning. The narratives concerned both the formal and the hidden curriculum, i.e., what is included in the profession (confronting illness and death), and what is not (unprofessional behaviour among healthcare professionals). Students managed their experiences by talking to trusted peers or supervisors, and by getting used to these situations. CONCLUSIONS Despite the different knowledge, experiences, and conditions for medical and nursing students, our findings suggest that their experiences of emotional challenges are similar. Support and opportunities to talk about these experiences are important. Teachers, supervisors, and students need to be aware that students might experience emotionally difficult situations, and that the students need time for reflection and support.
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Affiliation(s)
- Maria Weurlander
- Department of Learning, School of Education and Communication in Engineering Science (ECE), KTH Royal Institute of Technology, Stockholm, Sweden
| | - Annalena Lönn
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Seeberger
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eva Broberger
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Hult
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
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McCarthy MW, Real de Asua D, Fins JJ. The Rise of Hospitalists: An Opportunity for Clinical Ethics. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017284325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
- Hilary Neve
- Plymouth University; Peninsula Schools of Medicine and Dentistry; School of Medicine; Plymouth UK
| | - Tracey Collett
- Plymouth University; Peninsula Schools of Medicine and Dentistry; School of Medicine; Plymouth UK
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