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Schwartz BD, Rogers SL, Michels N, Van Winkle LJ. Substantial Increases in Healthcare Students' State Empathy Scores Owing to Participation in a Single Improvisation Session. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:531. [PMID: 38791746 PMCID: PMC11120652 DOI: 10.3390/ijerph21050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session. METHODS Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale. RESULTS The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively). CONCLUSIONS These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.
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Affiliation(s)
- Brian D. Schwartz
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
| | - Shane L. Rogers
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA 6027, Australia;
| | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
| | - Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
- Department of Biochemistry, Midwestern University, Downers Grove, IL 60515, USA
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Rogers SL, Van Winkle L, Michels N, Lucas C, Ziada H, Da Silva EJ, Jotangia A, Gabrielsson S, Gustafsson S, Priddis L. Further development of the reflective practice questionnaire. PeerJ 2024; 12:e16879. [PMID: 38344297 PMCID: PMC10859078 DOI: 10.7717/peerj.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
Background This article provides an update of the Reflective Practice Questionnaire (RPQ). The original RPQ consisted of 40-items with 10-sub-scales. In this article, the RPQ is streamlined into a 10-item single reflective practice construct, and a 30-item extended version that includes additional sub-scales of confidence, uncertainty/stress, and work satisfaction. Methods A total of 501 university students filled out an online questionnaire that contained the original Reflective Practice Questionnaire, and two general measures of reflection: The Self-Reflection and Insight Scale, and the Rumination-Reflection Questionnaire. Results Based on factor analysis, the RPQ was streamlined into a brief 10-item version, and an extended 30-item version. Small positive correlations were found between the RPQ reflective practice measure and the two measures of general reflection, providing discriminant validity evidence for the RPQ. The RPQ was found to be sensitive to differences among industries, whereas the general measures of reflection were not. Average reflective practice scores were higher for health and education industries compared to retail and food/accommodation industries.
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Affiliation(s)
- Shane L. Rogers
- Psychology, Edith Cowan University, Perth, Western Australia, Australia
| | - Lon Van Winkle
- Medical Humanities, Rocky Vista University, Denver, Colorado, United States of America
| | - Nicole Michels
- Medical Humanities, Rocky Vista University, Denver, Colorado, United States of America
| | - Cherie Lucas
- Pharmacy, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hassan Ziada
- Dental Medicine, University of Nevada, Las Vegas, Nevada, United States of America
| | | | | | | | - Silje Gustafsson
- Health, Education and Technology, Lulea University of Technology, Lulea, Sweden
| | - Lynn Priddis
- Law School, The University of Western Australia, Perth, Western Australia, Australia
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Saffran L, Doobay-Persaud A. 'You just emotionally break': understanding COVID-19 narratives through public health humanities. MEDICAL HUMANITIES 2023; 49:537-544. [PMID: 37419677 DOI: 10.1136/medhum-2022-012607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
News reports that feature the experiences of healthcare workers have shaped public conversations about the pandemic from its earliest days. For many, stories of the pandemic have been an introduction to the way public health emergencies intersect with cultural, social, structural, political and spiritual determinants. Such stories often feature clinicians and other providers as characters in pandemic tales of heroism, tragedy and, increasingly, frustration. Examining three common categories of provider-focused news narratives-the clinician as a uniquely vulnerable front-line worker, clinician frustration with vaccine and masking resistance, and the clinician as a hero-the authors argue that the framework of public health humanities offers useful tools to understand and potentially shift public conversation of the pandemic. Close reading of these stories illuminates frames that relate to the role of providers, responsibility for the spread of the virus and how the US health system functions in a global context. Public conversations of the pandemic are shaped by and shape news stories and have important implications for policy. Acknowledging that contemporary health humanities in all its iterations considers how non-clinical factors, such as culture, embodiment and power, impact our understanding of health, illness and healthcare delivery, the authors locate their argument amid critiques that focus on social and structural factors. They argue that it is still possible to shift our understanding of and telling of those stories towards a more population-focused frame.
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Affiliation(s)
- Lise Saffran
- Department of Public Health, University of Missouri Columbia, Columbia, Missouri, USA
| | - Ashti Doobay-Persaud
- Department of Medicine and Medical Education, Northwestern University, Evanston, Illinois, USA
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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Zhang X, Pang HF, Duan Z. Educational efficacy of medical humanities in empathy of medical students and healthcare professionals: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2023; 23:925. [PMID: 38057775 DOI: 10.1186/s12909-023-04932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Medical humanities education is an important part of medical education. The purpose of this study was to determine the effectiveness of medical humanities in improving empathy among medical students and healthcare professionals. METHODS PubMed, Embase, EBSCO-ERIC, Web of Science were searched systematically for studies in the English language. The last retrieval date is May 1, 2023. Best Evidence Medical Education (BEME) Global Rating Scale and Kirkpatrick-based results were used to evaluate the quality of literature. In this study, a meta-analysis of continuous data was conducted. RESULTS The pooled results by single-arm test meta-analysis showed a benefit with medical humanities programs in empathy (SMD 1.33; 95% CI 0.69-1.96). For single-arm trials of medical humanities program interventions of less than 4 months, 4 months to 12 months, and more than one year, the standardized mean differences(SMD) between post-test and pre-test were 1.74 (P < 0.05), 1.26 (P < 0.05), and 0.13 (P = 0.46), respectively. The results showed a significant difference in the effect of medical humanities programs on male and female empathy (SMD - 1.10; 95% CI -2.08 - -0.13). The SMDs for the study of course, the course combined reflective writing, and the course combined reflective writing and practice as intervention modalities for medical humanities programs were 1.15 (P < 0.05), 1.64 (P < 0.05), and 1.50 (P < 0.05), respectively. CONCLUSION Medical humanities programs as a whole can improve the empathy of medical students and health professionals. However, different intervention durations and different intervention methods produce different intervention effects.
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Affiliation(s)
- Xin Zhang
- School of Mangement, Shanxi Medical University, TaiYuan, 030001, China
| | - Hui-Fang Pang
- Shanxi Cardiovascular Disease Hospital, TaiYuan, 030024, China
| | - Zhiguang Duan
- School of Mangement, Shanxi Medical University, TaiYuan, 030001, China.
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Khoshgoftar Z, Barkhordari-Sharifabad M. Translation and psychometric evaluation of the reflective capacity scale in Iranian medical education. BMC MEDICAL EDUCATION 2023; 23:809. [PMID: 37891530 PMCID: PMC10604778 DOI: 10.1186/s12909-023-04791-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education. METHODS This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS. RESULTS "Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98. CONCLUSION The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.
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Affiliation(s)
- Zohreh Khoshgoftar
- School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maasoumeh Barkhordari-Sharifabad
- School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- School of Medical Sciences, Yazd Branch, Islamic Azad University, Yazd, Iran.
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Rezaei S, Childress A, Kaul B, Rosales KM, Newell A, Rose S. Using Visual Arts Education and Reflective Practice to Increase Empathy and Perspective Taking in Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11346. [PMID: 37745278 PMCID: PMC10514245 DOI: 10.15766/mep_2374-8265.11346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/13/2023] [Indexed: 09/26/2023]
Abstract
Introduction Empathy is a critical competency for health care providers. However, empathy levels in medical students and residents have been shown to paradoxically decrease during training. Arts and humanities education and reflective practice may reduce burnout and promote empathy during medical school. Methods We developed and implemented an art education elective for medical students focusing on observation and reflective practice and measured its impact on empathy. Between 2017 and 2022, first-year medical students were offered an annual, 4-week elective led by art educators that featured visualization exercises and discussions on the role of bias and perspective in art interpretation. Curriculum effectiveness and impact on empathy were measured using the validated Interpersonal Reactivity Index (IRI) and self-assessments. Results One hundred twenty-eight students participated in the elective over a 5-year period; 89 (70%) completed assessments. Students reported improvements in empathic communication, recognition of bias, and observation skills. IRI data demonstrated a significant increase in perspective taking (19.0 vs. 20.2; p < .0125). Discussion Participation in the elective was associated with self-reported improvements in visual observation, awareness of bias, and empathetic communication. IRI results showed that participants also demonstrated improved perspective taking. Since perspective taking is a cognitive component of empathy, we have provided some empirical evidence that arts education in medical school can promote empathic attitudes and skills.
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Affiliation(s)
- Sina Rezaei
- Fourth-Year Resident, Department of Ophthalmology, Henry Ford Hospital
| | - Andrew Childress
- Assistant Professor, Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Bhavika Kaul
- Assistant Professor, Department of Medicine, University of California, San Francisco, School of Medicine
| | | | - Alana Newell
- Assistant Professor, Center for Educational Outreach, Baylor College of Medicine
| | - Stacey Rose
- Associate Professor, Department of Internal Medicine, and Associate Director, Center for Professionalism, Baylor College of Medicine
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Thompson J, Bujalka H, McKeever S, Lipscomb A, Moore S, Hill N, Kinney S, Cham KM, Martin J, Bowers P, Gerdtz M. Educational strategies in the health professions to mitigate cognitive and implicit bias impact on decision making: a scoping review. BMC MEDICAL EDUCATION 2023; 23:455. [PMID: 37340395 DOI: 10.1186/s12909-023-04371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cognitive and implicit biases negatively impact clinicians' decision-making capacity and can have devastating consequences for safe, effective, and equitable healthcare provision. Internationally, health care clinicians play a critical role in identifying and overcoming these biases. To be workforce ready, it is important that educators proactively prepare all pre-registration healthcare students for real world practice. However, it is unknown how and to what extent health professional educators incorporate bias training into curricula. To address this gap, this scoping review aims to explore what approaches to teaching cognitive and implicit bias, for entry to practice students, have been studied, and what are the evidence gaps that remain. METHODS This scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Databases were searched in May 2022 and included CINAHL, Cochrane, JBI, Medline, ERIC, Embase, and PsycINFO. The Population, Concept and Context framework was used to guide keyword and index terms used for search criteria and data extraction by two independent reviewers. Quantitative and qualitative studies published in English exploring pedagogical approaches and/or educational techniques, strategies, teaching tools to reduce the influence of bias in health clinicians' decision making were sought to be included in this review. Results are presented numerically and thematically in a table accompanied by a narrative summary. RESULTS Of the 732 articles identified, 13 met the aim of this study. Most publications originated from the United States (n=9). Educational practice in medicine accounted for most studies (n=8), followed by nursing and midwifery (n=2). A guiding philosophy or conceptual framework for content development was not indicated in most papers. Educational content was mainly provided via face-to-face (lecture/tutorial) delivery (n=10). Reflection was the most common strategy used for assessment of learning (n=6). Cognitive biases were mainly taught in a single session (n=5); implicit biases were taught via a mix of single (n=4) and multiple sessions (n=4). CONCLUSIONS A range of pedagogical strategies were employed; most commonly, these were face-to-face, class-based activities such as lectures and tutorials. Assessments of student learning were primarily based on tests and personal reflection. There was limited use of real-world settings to educate students about or build skills in biases and their mitigation. There may be a valuable opportunity in exploring approaches to building these skills in the real-world settings that will be the workplaces of our future healthcare workers.
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Affiliation(s)
- John Thompson
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia.
| | - Helena Bujalka
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Stephen McKeever
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Adrienne Lipscomb
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Sonya Moore
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nicole Hill
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sharon Kinney
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Martin
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Patrick Bowers
- Department of Audiology and Speech Pathology, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
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Geiser E, Schilter LV, Carrier JM, Clair C, Schwarz J. Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:3521-3528. [PMID: 36075808 DOI: 10.1016/j.pec.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/18/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Gender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching. METHODS We conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master's students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach. RESULTS The reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange. CONCLUSIONS Our study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care. PRACTICE IMPLICATIONS All gender and medicine curricula should include teaching such as this linking theory and practice through reflexivity.
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Affiliation(s)
- Elisa Geiser
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland.
| | | | - Jean-Michel Carrier
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Joëlle Schwarz
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
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Kruse JA, Collins JL, Vugrin M. Educational strategies used to improve the knowledge, skills, and attitudes of health care students and providers regarding implicit bias: An integrative review of the literature. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100073. [PMID: 38745633 PMCID: PMC11080399 DOI: 10.1016/j.ijnsa.2022.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background The thoughts, feelings, and attitudes health care professionals unconsciously have about patients can negatively impact patients' health outcomes. Systematic reviews related to implicit bias in health care providers have uncovered negative implicit bias towards older adults, people of color, people with disabilities, psychiatric patients, patients who are obese, people of low socioeconomic status, and women. Implicit bias impacts the quality, safety, and competence of care delivered; interactions between patients and providers; and patient approval of treatment recommendations. Health care professions students and health care providers need to participate in evidence-based educational strategies to manage and diminish bias. Objective To review the evidence regarding educational strategies used with health care professions students and providers to improve their knowledge of implicit bias, reduce bias, and improve attitudes about bias. Design Integrative review. Methods The literature review was completed in July 2020 with two updates performed in February 2021 and June 2021 using nine databases including Academic Search Complete™, Embase®, ERIC®, Ovid, PubMed®, Scopus®, and Web of Science™. Key terms used related to education, health care professions' students, health care providers, implicit, bias, incivility, microaggression, and microassult. Publications dates from 2011 to 2021 were included. Covidence software was used for the initial screening and for full-text analysis. Results Thirty-nine articles were analysed for this review. The most commonly used educational strategies to instruct about principles of implicit bias include discussion groups, simulation and case-based learning, pre-tests for awareness, use of expert facilitators, commitment to action/change, and debriefing. Common components of successful strategies include thoughtful program planning, careful selection of program facilitators (who are content experts), support of participants, and a system-level investment. Conclusions Diverse educational strategies successfully addressed implicit bias across studies. Recommendations for future studies includes addressing limitations in sampling strategies and data collection to clarify relationships between educational strategies and participant outcomes. Educational opportunities are warranted that challenge health care professionals to explore their implicit bias towards others in an effort to provide care that considers diversity, equity, and inclusion and also limits personal implicit bias.
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Affiliation(s)
| | | | - Margaret Vugrin
- Health Sciences Center- Preston Smith Library, Texas Tech University, United States
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Van Winkle LJ, Thornock BO, Schwartz BD, Horst A, Fisher JA, Michels N. Critical reflection on required service to the community propels prospective medical students toward higher empathy, compassion, and bias mitigation but are these gains sustainable? Front Med (Lausanne) 2022; 9:976863. [PMID: 36160142 PMCID: PMC9500161 DOI: 10.3389/fmed.2022.976863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We observed increased cognitive empathy and reflective capacity scores when prospective medical students wrote critical reflections on mandatory team service-learning in a Medical Humanities course, but these findings did not include a control group. Here we compare these survey results in similar courses with and without required service-learning. Methods Forty-three prospective medical students completed a Medical Humanities course requiring critical reflection on team service-learning. In comparison, 32 students finished a similar course in which service to the community was not mandatory. Before starting the courses, students completed reliable surveys of their cognitive empathy and reflective capacity, and more than 93% of the students completed the same surveys after finishing the courses. Results Students' cognitive empathy and reflective capacity scores increased significantly when service-learning was required, but the scores did not increase significantly when service to the community was not required. The effect size for the empathy increase was of crucial practical importance (r = 0.50), whereas it was of moderate practical importance for the increase in reflective capacity (r = 0.34). Conclusions These and prior findings strongly support the conclusion that students' critical reflection on mandatory team service-learning fosters development of their cognitive empathy and reflective capacity. We present a model program to incorporate critical reflection on service to the community throughout the curricula of all healthcare professions trainees.
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Affiliation(s)
- Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
- Department of Biochemistry, Midwestern University, Downers Grove, IL, United States
| | - Bradley O. Thornock
- Department of Medical Humanities, Rocky Vista University, Ivins, UT, United States
| | - Brian D. Schwartz
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Alexis Horst
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Jensen A. Fisher
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
| | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, Parker, CO, United States
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Alkhaifi M, Clayton A, Kangasjarvi E, Kishibe T, Simpson JS. Visual art-based training in undergraduate medical education: A systematic review. MEDICAL TEACHER 2022; 44:500-509. [PMID: 34807802 DOI: 10.1080/0142159x.2021.2004304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Visual art has been increasingly incorporated into medical education and has been shown to enhance important competencies, such as empathy. However, limited evidence on effective visual art program design and evaluation processes remain. This systematic review examines the format, content, and espoused outcomes of visual art-based training programs in undergraduate medical education. METHODS A comprehensive literature search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ProQuestERIC on undergraduate medical education and visual arts retrieved 1703 articles published from 2014 to 2020. After reviewing inclusion and exclusion criteria, 23 articles were chosen for full review and synthesis. RESULTS Program format and content varied, ranging from 1-day specific competency focused programs to well-structured comprehensive 6-12-week programs. 6 areas of program foci were identified: observation skills, empathy, tolerance to uncertainty, cultural sensitivity, team building and collaboration, and wellness and resiliency. Although several programs used validated measures to assess skills acquisition, they seldom addressed long-term outcomes. CONCLUSIONS Our findings indicate that visual art-based education hold a promise to enhance important competencies in medical education, particularly empathy. Clinical observation, in particular, had the strongest evidence of its effectiveness compared to the other competencies. Future programs incorporating visual arts will benefit from a longitudinal (greater than 6 weeks) program which incorporates guided artworks, reflection exercises, and a group discussion to provide a stronger foundation for the development of core competencies. We propose using validated scales to measure outcomes in future studies and follow-up with participants to better assess Kirkpatrick Level 3 and 4 outcomes.
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Affiliation(s)
- Muna Alkhaifi
- Division of General Surgery, Faculty of Medicine, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Adam Clayton
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, Faculty of Medicine, University of Toronto at St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
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Xu X, Liu Z, Gong S, Wu Y. The Relationship between Empathy and Attachment in Children and Adolescents: Three-Level Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1391. [PMID: 35162410 PMCID: PMC8835466 DOI: 10.3390/ijerph19031391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/20/2023]
Abstract
Empathy is one of the leading social abilities to understand or feel the emotions of other people. Attachment is thought to be a critical influential factor of empathy, as revealed by attachment theory and experimental studies, while empathy is also believed to facilitate the quality of attachment. Although many studies are conducted concerning the two subjects, the direction and magnitude of their relationship still remain unclear. In order to clarify the discrepant results in the previous study and explore the moderators in the empathy-attachment association, three-level meta-analyses were conducted in the present work. Based on 212 effect sizes from 59 samples in 50 studies with a total of 24,572 participants, random effect model analyses showed that empathy was insignificantly correlated with anxious attachment, significantly negatively correlated with avoidant attachment, and significantly positively correlated with secure attachment. The meta-analytic results indicated that children and adolescents with high secure attachment tend to show more empathy than those with low secure attachment. The meta-regression model revealed significant effects of the empathy dimension, culture, empathy measurement tools, and publication state. Additionally, implications and future directions for the empathy-attachment relationship were also discussed.
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Affiliation(s)
- Xizheng Xu
- School of Psychology, Central China Normal University (CCNU), Wuhan 430079, China; (X.X.); (Z.L.)
- Hunan Police Academy, Changsha 410138, China
| | - Zhiqiang Liu
- School of Psychology, Central China Normal University (CCNU), Wuhan 430079, China; (X.X.); (Z.L.)
- Center of Students’ Psychological Development, Yancheng Polytechnic College (YCPC), Yancheng 224000, China
| | - Shaoying Gong
- School of Psychology, Central China Normal University (CCNU), Wuhan 430079, China; (X.X.); (Z.L.)
| | - Yunpeng Wu
- School of Teacher Education, Dezhou University, Dezhou 253023, China;
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Implicit biases in healthcare: implications and future directions for gynecologic oncology. Am J Obstet Gynecol 2022; 227:1-9. [PMID: 35026128 DOI: 10.1016/j.ajog.2021.12.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
Health disparities have been found among patients with gynecologic cancers, with the greatest differences arising among groups based on racial, ethnic, and socioeconomic factors. Although there may be multiple social barriers that can influence health disparities, another potential influence may stem from healthcare system factors that unconsciously perpetuate bias toward patients who are racially and socioeconomically disadvantaged. More recent research suggested that providers hold these implicit biases (automatic and unconscious attitudes) for stigmatized populations with cancer, with emerging evidence for patients with gynecologic cancer. These implicit biases may guide providers' communication and medical judgments, which, in turn, may influence the patient's satisfaction with and trust in the provider. This narrative review consolidated the current research on implicit bias in healthcare, with a specific emphasis on oncology professionals, and identified future areas of research for examining and changing implicit biases in the field of gynecologic oncology.
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Nguyen-Phuong-Mai M. What Bias Management Can Learn From Change Management? Utilizing Change Framework to Review and Explore Bias Strategies. Front Psychol 2021; 12:644145. [PMID: 34975601 PMCID: PMC8714784 DOI: 10.3389/fpsyg.2021.644145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
This paper conducted a preliminary study of reviewing and exploring bias strategies using a framework of a different discipline: change management. The hypothesis here is: If the major problem of implicit bias strategies is that they do not translate into actual changes in behaviors, then it could be helpful to learn from studies that have contributed to successful change interventions such as reward management, social neuroscience, health behavioral change, and cognitive behavioral therapy. The result of this integrated approach is: (1) current bias strategies can be improved and new ones can be developed with insight from adjunct study fields in change management; (2) it could be more sustainable to invest in a holistic and proactive bias strategy approach that targets the social environment, eliminating the very condition under which biases arise; and (3) while implicit biases are automatic, future studies should invest more on strategies that empower people as "change agents" who can act proactively to regulate the very environment that gives rise to their biased thoughts and behaviors.
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Van Winkle LJ, Schwartz BD, Horst A, Fisher JA, Michels N, Thornock BO. Impact of a Pandemic and Remote Learning on Team Development and Elements of Compassion in Prospective Medical Students Taking a Medical Humanities Course. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094856. [PMID: 34063219 PMCID: PMC8124650 DOI: 10.3390/ijerph18094856] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We reported previously that when teams of students reflect on readings about communication, unconscious bias, and service-learning, their critical reflection, implicit bias mitigation, empathy, and compassionate behavior all increase. However, would these gains occur when intimate classroom settings, in-person team meetings, and direct interactions with people served were lost owing to the COVID-19 pandemic and remote learning? METHODS Before an online Medical Humanities course began in August 2020 and following the course in December 2020, 61 prospective medical students (54.1% female) completed reliable surveys of their reflective capacity (RC) and cognitive empathy (compassion). Students also completed surveys about their implicit biases and team community service in December 2020. RESULTS Both RC and empathy scores increased in students after they reflected on difficulties in communication, unconscious biases, and team service-learning experiences in the course. In written reflections, they reported how their compassionate behavior also grew owing to bias mitigation. Most students concurred that "unconscious bias might affect some of (their) clinical decisions or behaviors as a healthcare professional" and vowed to remain aware of these biases in clinical settings. CONCLUSIONS Compared to previous years, the pandemic and remote learning had minimal effects on the benefits of our Medical Humanities course.
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Affiliation(s)
- Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA; (B.D.S.); (A.H.); (J.A.F.); (N.M.)
- Correspondence:
| | - Brian D. Schwartz
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA; (B.D.S.); (A.H.); (J.A.F.); (N.M.)
| | - Alexis Horst
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA; (B.D.S.); (A.H.); (J.A.F.); (N.M.)
| | - Jensen A. Fisher
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA; (B.D.S.); (A.H.); (J.A.F.); (N.M.)
| | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, 8401 S. Chambers Road, Parker, CO 80134, USA; (B.D.S.); (A.H.); (J.A.F.); (N.M.)
| | - Bradley O. Thornock
- Department of Medical Humanities, Rocky Vista University, 255 E. Center Street, Ivins, UT 84738, USA;
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From Listening to Action: Academic Surgcial Departmental Response to Social Injustice Through Curricular Development. Ann Surg 2021; 274:921-924. [PMID: 33856378 DOI: 10.1097/sla.0000000000004891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the development and evaluation of a structured department wide cultural competency curriculum. SUMMARY BACKGROUND DATA Despite numerous organizational policies and statements, social injustice and bias still exists. Our department committed to assist individuals of the entire department to develop foundational knowledge and skills to combat implicit bias and systemic racism through the creation of a cultural competency curriculum. The purpose of this manuscript is to detail our curriculum and the evaluation of its effectiveness. METHODS Using a well-established curriculum development framework, a cultural competency curriculum was developed focusing on knowledge, skills and attitudes at the individual level, for all members of the department. The curriculum was implemented through six, hour-long sessions over a nine-week period. Effectiveness was assessed through a post curriculum survey. RESULTS 20% of the respondents had experienced bias based on race, ethnicity or sexual orientation in the past 12 months while 30% had experienced bias based on gender. 71% independently explored related topics. The curriculum was overall well received and generally achieved the goals and objectives. CONCLUSIONS Using a standard curriculum development framework, an effective department-wide cultural competency curriculum can be developed and implemented.
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Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J 2021; 8:40-48. [PMID: 33791459 DOI: 10.7861/fhj.2020-0233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.
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Affiliation(s)
- Dipesh P Gopal
- Barts and The London School of Medicine and Dentistry, London, UK
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Gustafsson S, Engström Å, Lindgren B, Gabrielsson S. Reflective capacity in nurses in specialist education: Swedish translation and psychometric evaluation of the Reflective Capacity Scale of the Reflective Practice Questionnaire. Nurs Open 2021; 8:546-552. [PMID: 33570291 PMCID: PMC7877226 DOI: 10.1002/nop2.659] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 11/16/2022] Open
Abstract
AIM This study aimed to test the validity and reliability of the Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire in a nursing context. DESIGN Non-experimental and cross-sectional. METHODS The instrument was translated from English to Swedish using a translation and back-translation procedure. Data for the validity and reliability analysis were collected from Registered Nurses in specialist education (n = 156) at two Swedish universities. RESULTS The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire is a valid and reliable instrument that assesses the reflective capacity of healthcare practitioners. Our findings suggest a unidimensional structure of the instrument, excellent internal consistency and good reliability. CONCLUSION The Swedish version of the Reflective Capacity Scale of the Reflective Practice Questionnaire has a degree of reliability and validity that is satisfactory, indicating that the instrument can be used as an assessment of reflective capacity in nurses.
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Affiliation(s)
- Silje Gustafsson
- Department of Health SciencesLuleå University of TechnologyLuleåSweden
| | - Åsa Engström
- Department of Health SciencesLuleå University of TechnologyLuleåSweden
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Considering Case Management Practice From a Global Perspective. Prof Case Manag 2021; 26:99-103. [PMID: 33507019 DOI: 10.1097/ncm.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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