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Hsu D, Rassbach C, Leaming-Van Zandt K, Morrow A, Rubenstein J, Tatem A, Turner DA, Poitevien P, Barone MA. Competency based medical education and trust in the learning environment. Curr Probl Pediatr Adolesc Health Care 2024:101640. [PMID: 38876832 DOI: 10.1016/j.cppeds.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Affiliation(s)
- Deborah Hsu
- Stanford University School of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Palo Alto CA, United States.
| | - Carrie Rassbach
- Stanford University School of Medicine, Department of Pediatrics, Division of Hospital Medicine, Palo Alto CA, United States
| | - Katherine Leaming-Van Zandt
- Penn State College of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Hershey PA, United States
| | - Asha Morrow
- Baylor College of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Houston TX, United States
| | - Jared Rubenstein
- Baylor College of Medicine, Department of Pediatrics, Division of Palliative Care, Houston TX, United States
| | - Andria Tatem
- Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Department of Pediatrics, Norfolk VA, United States
| | - David A Turner
- American Board of Pediatrics, Chapel Hill NC, United States
| | - Patricia Poitevien
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
| | - Michael A Barone
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
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2
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Brown W, Santhosh L, Stewart NH, Adamson R, Lee MM. The ABCs of Cultivating Psychological Safety for Clinical Learner Growth. J Grad Med Educ 2024; 16:124-127. [PMID: 38993303 PMCID: PMC11234300 DOI: 10.4300/jgme-d-23-00589.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Affiliation(s)
- Wade Brown
- is Assistant Professor of Medicine and Associate Program Director, Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Lekshmi Santhosh
- is Associate Professor of Medicine and Associate Program Director, Divisions of Pulmonary and Critical Care Medicine and Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nancy H Stewart
- is Assistant Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Rosemary Adamson
- is Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Healthcare System, and Associate Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; and
| | - May M Lee
- is Associate Professor of Medicine and Program Director, Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Richardson D, Landreville JM, Trier J, Cheung WJ, Bhanji F, Hall AK, Frank JR, Oswald A. Coaching in Competence by Design: A New Model of Coaching in the Moment and Coaching Over Time to Support Large Scale Implementation. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:33-43. [PMID: 38343553 PMCID: PMC10854464 DOI: 10.5334/pme.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/23/2023] [Indexed: 02/15/2024]
Abstract
Coaching is an increasingly popular means to provide individualized, learner-centered, developmental guidance to trainees in competency based medical education (CBME) curricula. Aligned with CBME's core components, coaching can assist in leveraging the full potential of this educational approach. With its focus on growth and improvement, coaching helps trainees develop clinical acumen and self-regulated learning skills. Developing a shared mental model for coaching in the medical education context is crucial to facilitate integration and subsequent evaluation of success. This paper describes the Royal College of Physicians and Surgeons of Canada's coaching model, one that is theory based, evidence informed, principle driven and iteratively and developed by a multidisciplinary team. The coaching model was specifically designed, fit for purpose to the postgraduate medical education (PGME) context and implemented as part of Competence by Design (CBD), a new competency based PGME program. This coaching model differentiates two coaching roles, which reflect different contexts in which postgraduate trainees learn and develop skills. Both roles are supported by the RX-OCR process: developing Relationship/Rapport, setting eXpectations, Observing, a Coaching conversation, and Recording/Reflecting. The CBD Coaching Model and its associated RX-OCR faculty development tool support the implementation of coaching in CBME. Coaching in the moment and coaching over time offer important mechanisms by which CBD brings value to trainees. For sustained change to occur and for learners and coaches to experience the model's intended benefits, ongoing professional development efforts are needed. Early post implementation reflections and lessons learned are provided.
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Affiliation(s)
- Denyse Richardson
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jason R. Frank
- University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, ON, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
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Hopson LR, Branzetti J, Gisondi MA, Regan L. What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10943. [PMID: 38504804 PMCID: PMC10950025 DOI: 10.1002/aet2.10943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 12/03/2023] [Indexed: 03/21/2024]
Abstract
Objectives The Master Adaptive Learner (MAL) model postulates that learners develop adaptive expertise through cycles of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors of MALs are not well characterized. We sought to define behaviors that characterize MALs within emergency medicine (EM) training. Methods Using a constructivist grounded theory approach, we analyzed semistructured interviews with expert EM educators. These experts reflected on observable behaviors as well as factors in the clinical learning environment that may modulate these behaviors. We recruited using purposive sampling until thematic saturation. Results We identified four overall themes, of which three described groups of learner behaviors and a fourth described modifiers of these behaviors. Learner behaviors include: (1) critical interrogation of practice, (2) intellectual risk-taking, and (3) intentional curation of a learning network. Critical interrogation of practice encompasses several observable behaviors including learner-driven feedback conversations, independent synthesis of clinical information, appropriate deviation from algorithms based on their conceptual understanding of core principles, intentional use of case variation and hypothetical questioning, and continuous refinement of decisions. MALs also engage in intellectual risk-taking for their development by communicating clinical decision-making processes even at the risk of being wrong, openly addressing errors and gaps, and intentionally seeking out uncomfortable experiences. Intentional curation of a learning network is the deliberate development of a consortium of trusted individuals who serve as mentors and sounding boards. We also identified a fourth theme related to the expression of learner behaviors: learning environment modulates behaviors. Active promotion of psychological safety is necessary for learners to express these behaviors. This safety is mediated through trusting relationships and expert supervisors who serve as colearners and role models. Conclusions We present several behaviors that allow identification of MALs among EM trainees. These data expand our understanding of MALs and the critical influence of the learning environment. Identification of these behaviors may allow for more precise categorization of targeted curricular interventions and meaningful learning outcomes.
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Affiliation(s)
- Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Michael A. Gisondi
- Department of Emergency MedicineStanford School of MedicinePalo AltoCaliforniaUSA
| | - Linda Regan
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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McClintock AH, Fainstad T, Blau K, Jauregui J. Psychological safety in medical education: A scoping review and synthesis of the literature. MEDICAL TEACHER 2023; 45:1290-1299. [PMID: 37266963 DOI: 10.1080/0142159x.2023.2216863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed. MATERIALS AND METHODS In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed. RESULTS Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration. DISCUSSION Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.
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Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tyra Fainstad
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin Blau
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [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: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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John M, Camac E. Group Feedback for Faculty: Turning the Wheels of Change. ATS Sch 2023; 4:247-249. [PMID: 37795126 PMCID: PMC10547033 DOI: 10.34197/ats-scholar.2023-0059ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Mira John
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; and
| | - Erin Camac
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky
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Hitchner L, Yore M, Burk C, Mason J, Sawtelle Vohra S. The resident experience with psychological safety during interprofessional critical event debriefings. AEM EDUCATION AND TRAINING 2023; 7:e10864. [PMID: 37013133 PMCID: PMC10066498 DOI: 10.1002/aet2.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety. METHODS The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory. RESULTS Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace. CONCLUSIONS Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
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Affiliation(s)
- Lily Hitchner
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Mackensie Yore
- UCLA National Clinician Scholars Program, Department of Emergency MedicineGreater Los Angeles VA Medical CenterCaliforniaLos AngelesUSA
| | - Charney Burk
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Jessica Mason
- Department of Emergency MedicineJohn Peter Smith HospitalFort WorthTexasUSA
| | - Stacy Sawtelle Vohra
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
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Chodoff A, Conyers L, Wright S, Levine R. "I never should have been a doctor": a qualitative study of imposter phenomenon among internal medicine residents. BMC MEDICAL EDUCATION 2023; 23:57. [PMID: 36694199 PMCID: PMC9875476 DOI: 10.1186/s12909-022-03982-8] [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: 09/21/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents. METHODS In 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale. RESULTS Informants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management. DISCUSSION Internal medicine residents routinely experience imposter phenomenon; these feelings distort residents' sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.
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Affiliation(s)
- Alaina Chodoff
- Division of General Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Lynae Conyers
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Levine
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Puder D, Dominguez C, Borecky A, Ing A, Ing K, Martinez AE, Pereau M, Kashner TM. Assessing Interpersonal Relationships in Medical Education: the Connection Index. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:683-691. [PMID: 35064549 DOI: 10.1007/s40596-021-01574-0] [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: 07/12/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The relationship between a resident physician and his/her supervising attending is foundational to graduate medical education and may impact the clinical learning environment and resident well-being. This paper focuses on how to measure connection between a resident and their clinical supervisor. Connection includes the subdomains of psychological safety, empathy, educational alliance, and feedback. METHODS After reviewing the literature, the authors designed the 12-item, 7-point Connection Index (CI12) to quantitatively measure connections between a resident and his/her supervisor during a 6-month period (supervision dyad), and based on educational alliance, empathy, psychological safety, and effective feedback. A 9-criteria evaluation framework was applied to assess its reliability and validity on a sample of psychiatry residents at a residency program, July 2016 through June 2018. RESULTS Out of a total possible number of 50 residents, 100% participated to rate 41 supervisors over 201 supervision dyads; the CI12 satisfied all eight of the eight testable criteria, including high scalability (H = 0.78), consistency (alpha = 0.98), test-retest validity (ICC = 0.95), and construct validity where CI12 was found to have statistically significant correlations with outcomes measures (greater connection was associated with less negative emotional experiences, less mistreatment or bias, less burnout, and higher attendance to supervision sessions). CONCLUSION The authors showed the CI12 can be a valid and reliable instrument to quantify whether a resident and his/her supervisor connects during a 6-month supervision with respect to empathy, psychological safety, educational alliance, and feedback. We recommend assessing connections as part of the overall evaluation of a resident's experience with the clinical learning environment.
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Affiliation(s)
- David Puder
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Chloe Dominguez
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Adam Borecky
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Alice Ing
- University of California at Irvine, Irvine, CA, USA
| | - Kevin Ing
- University of California at Irvine, Irvine, CA, USA
| | | | - Melissa Pereau
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - T Michael Kashner
- Loma Linda University School of Medicine, Loma Linda, CA, USA
- Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, USA
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Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:1190-1198. [PMID: 36215043 PMCID: PMC9552049 DOI: 10.1001/jamainternmed.2022.4373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/06/2022] [Indexed: 12/14/2022]
Abstract
Importance In large academic centers, medical residents work on multiple clinical floors with transient interactions with nursing colleagues. Although teamwork is critical in delivering high-quality medical care, little research has evaluated the effect of interprofessional familiarity on inpatient team performance. Objective To determine the effectiveness of increased familiarity between medical residents and nurses on team performance, psychological safety, and communication. Design, Setting, and Participants A 12-month randomized clinical trial in an inpatient general medical service at a large academic medical center was completed from June 25, 2019, to June 24, 2020. Participants included 33 postgraduate year (PGY)-1 residents in an internal medicine residency program and 91 general medicine nurses. Interventions Fifteen PGY-1 residents were randomized to complete all 16 weeks of their general medicine inpatient time on 1 medical nursing floor (intervention group with 43 nurses). Eighteen PGY-1 residents completed 16 weeks on 4 different general medical floors as per usual care (control group with 48 nurses). Main Outcomes and Measures The primary outcome was an assessment of team performance in physician-nurse simulation scenarios completed at 6 and 12 months. Interprofessional communication was assessed via a time-motion study of both work rounds and individual resident clinical work. Psychological safety and teamwork culture were assessed via surveys of both residents and nurses at multiple time points. Results Of the intervention and control PGY-1 residents, 8 of 15 (54%) and 8 of 18 (44%) were women, respectively. Of the nurses in the intervention and control groups with information available, 37 of 40 (93%) and 34 of 38 (90%) were women, respectively, and more than 70% had less than 10 years of clinical experience. There was no difference in overall team performance during the first simulation. At the 12-month simulation, the intervention teams received a higher mean overall score in leadership and management (mean [SD], 2.47 [0.53] vs 2.17 [0.39]; P = .045, Cohen d = 0.65) and on individually rated items were more likely to work as 1 unit (100% vs 62%; P = .003), negotiate with the patient (61% vs 10%; P = .001), support other team members (61% vs 24%; P = .02), and communicate as a team (56% vs 19%; P = .02). The intervention teams were more successful in achieving the correct simulation case outcome of negotiating a specific insulin dose with the patient (67% vs 14%; P = .001). Time-motion analysis noted intervention teams were more likely to have a nurse present on work rounds (47% vs 28%; P = .03). At 6 months, nurses in the intervention group were more likely to report their relationship with PGY-1 residents to be excellent to outstanding (74% vs 40%; P = .003), feel that the input of all clinical practitioners was valued (95% vs 53%; P < .001), and say that feedback between practitioners was delivered in a way to promote positive interactions (90% vs 60%; P = .003). These differences diminished at the 12-month survey. Conclusions and Relevance In this randomized clinical trial, increased familiarity between nurses and residents promoted more rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations. Medical centers should consider team familiarity as a potential metric to improve physician-nursing teamwork and patient care. Trial Registration ClinicalTrials.gov Identifier: NCT05213117.
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Affiliation(s)
- Christiana A. Iyasere
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Wing
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - J. Naomi Martel
- General Medicine Unit at Massachusetts General Hospital, Boston
| | - Michael G. Healy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kathleen M. Finn
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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12
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Williamson AJH, Jensen RM, Smith BK. Educational Safety for the Surgical Learner. JOURNAL OF SURGICAL EDUCATION 2022; 79:1083-1087. [PMID: 35525777 DOI: 10.1016/j.jsurg.2022.04.007] [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] [Received: 02/12/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Psychological safety is known to improve team performance and organizational learning. The related concept of "educational safety" has recently emerged to describe an environment in which learners can unreservedly focus on learning and professional growth, without worrying about the potential repercussions of interpersonal risk-taking. Educational safety is crucial for optimal learning in clinical environments, and yet is difficult to establish due to constant performance assessment, fear of failure, and pervasive hierarchies. In this perspective, we propose a framework for conceptualizing educational safety in surgical learning environments, and explore current threats to educational safety. We also discuss strategies for combating these threats, as well as the importance of further research to evaluate the impact of educational safety on surgical learning outcomes.
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Affiliation(s)
| | - Rachel M Jensen
- Department of Surgery, Stanford University, Stanford, California
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Pham TV, Kim HH, Kritzer MD, Mankad M, Gagliardi JP. Perceived Stalking by a Patient: An Educational Case Report. J Grad Med Educ 2022; 14:394-397. [PMID: 35991111 PMCID: PMC9380637 DOI: 10.4300/jgme-d-21-01201.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tony V. Pham
- Tony V. Pham, MD, MScGH, is Instructor, Massachusetts General Hospital
| | - Hyun-Hee Kim
- Hyun-Hee Kim, MD, is Instructor, Massachusetts General Hospital
| | - Michael D. Kritzer
- Michael D. Kritzer, MD, PhD, is Instructor, Massachusetts General Hospital
| | - Mehul Mankad
- Mehul Mankad, MD, is Adjunct Assistant Professor, Duke University Medical Center
| | - Jane P. Gagliardi
- Jane P. Gagliardi, MD, MHS, is Director, Medicine-Psychiatry Residency Training Program, Duke University Medical Center
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Trier J, Turnnidge J, McGuire CS, Côté J, Dagnone JD. It's a 'two-way street': resident perspectives of effective coaching relationships in the clinical learning environment. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:5-12. [PMID: 35875451 PMCID: PMC9297249 DOI: 10.36834/cmej.72940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coaching has gained traction in postgraduate medical education to enhance interactions between residents and clinical teachers, but these relationships present unique challenges and tensions. In order to realize the promises of coaching in medical education, we must understand how coaching relationships can be enacted to optimize resident development. The purpose of this study was to explore residents' perceptions of key characteristics for effective clinical teacher-resident (CT-R) coaching relationships. METHODS We conducted four focus groups and eight interviews with residents at a Canadian academic center. Using a social constructionist approach, focus groups and interviews were audio recorded, transcribed verbatim, and thematically analyzed. RESULTS Residents described three main characteristics that contributed to effective CT-R coaching relationships: safe, meaningful, and collaborative. Residents emphasized that these characteristics needed to be bidirectional in nature to be most effective, in that both the resident and clinical teacher embodied these characteristics. CONCLUSIONS Residents identified that effective coaching relationships were shaped not only by clinical teacher behaviours, but importantly, the quality of the interpersonal relationship that was fostered. Thus, it is imperative to consider the bidirectional nature of the CT-R coaching relationship when striving to enhance resident development.
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Affiliation(s)
- Jessica Trier
- Department of Physical Medicine and Rehabilitation, Queen’s University, Ontario, Canada
- Providence Care Hospital, Ontario, Canada
| | - Jennifer Turnnidge
- Office of Professional Development and Educational Scholarship, Queen’s University, Ontario, Canada
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - Cailie S McGuire
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - Jean Côté
- School of Kinesiology and Health Studies, Queen’s University, Ontario, Canada
| | - J Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
- Kingston Health Sciences Centre, Ontario, Canada
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Bavare AC, Thomas JK, Yeppez D, Gazzaneo MC, Guffey D, Thammasitboon S. Evaluation of a Theory-Informed Pediatric Rapid Response Training Program Using the Logic Model. Hosp Pediatr 2021:hpeds.2021-005895. [PMID: 34807975 DOI: 10.1542/hpeds.2021-005895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The activators of rapid-response (RR) events tasked with recognition of clinical decompensation, initial management, and response activation seldom receive RR training. RR activators often experience negative emotions of "failure to rescue" that can compromise team performance during RRs. We used the logic model framework for development and evaluation of an educational program grounded in self-determination theory for pediatric RR activators. METHODS The program unfolded in a large quaternary pediatric hospital to impart knowledge and skills; foster autonomy, competence, and relatedness; and improve participants' satisfaction with performance in RRs. Logic model-guided inputs-activities-outputs-outcomes-context for program evaluation. Preintervention-postintervention follow-up surveys and interviews generated data to determine outcomes and impact of the program. The evaluation instruments were tested for validity and internal consistency. RESULTS Over 4 years, 207 multidisciplinary RR activators were trained. Iterative modifications yielded a workshop that incorporated multiple learning modalities, a standardized learner-centered case bank, formalized evaluation tools, and a database to track participation. Significant improvements in RR-related knowledge, self-efficacy, and self- determination were noted. Workshop evaluation yielded a mean score of 4.85 (0.27) on a 5-point scale. At 6-months follow-up survey and interviews, participants reported application of the knowledge and increased confidence with participation in real-life RR events. The workshop gained traction across the hospital, was associated with improved RR clinical outcomes, and contributed to professional advancement of the educators. CONCLUSIONS We successfully implemented a self-determination theory-informed RR training program for pediatric RR activators, and the logic model framework was used to facilitate comprehensive evaluation.
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Affiliation(s)
- Aarti C Bavare
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Jenilea K Thomas
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Denae Yeppez
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Maria C Gazzaneo
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Satid Thammasitboon
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
- Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital, Houston, Texas
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16
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Ito A, Sato K, Yumoto Y, Sasaki M, Ogata Y. A concept analysis of psychological safety: Further understanding for application to health care. Nurs Open 2021; 9:467-489. [PMID: 34651454 PMCID: PMC8685887 DOI: 10.1002/nop2.1086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 12/14/2022] Open
Abstract
AIM To clarify the concept of psychological safety in a healthcare context and to provide the first theoretical framework for improving interpersonal relationships in the workplace to better patient care. DESIGN A Rodgers' concept analysis. METHODS The concept analysis was conducted using a systematic search strategy on PubMed, CINAHL, PsycINFO and Ichushi-Web. RESULTS An analysis of 88 articles studying psychological safety in health care identified five attributes: perceptions of the consequences of taking interpersonal risks, strong interpersonal relationships, group-level phenomenon, safe work environment for taking interpersonal risks and non-punitive culture. The antecedents included structure/system factors, interpersonal factors and individual factors. The four consequences included performance outcomes, organizational culture outcomes, and psychological and behavioural outcomes.
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Affiliation(s)
- Ayano Ito
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kana Sato
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yoshie Yumoto
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Miki Sasaki
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yasuko Ogata
- Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Park JE, Kim JH. Nursing students' Psychological Safety in High fidelity Simulations: Development of a new scale for psychometric evaluation. NURSE EDUCATION TODAY 2021; 105:105017. [PMID: 34174511 DOI: 10.1016/j.nedt.2021.105017] [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: 01/15/2021] [Revised: 04/18/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In high fidelity simulation used in an educational context, measuring the psychological safety levels of students enables the understanding and analysis of the relation between the characteristics of simulation design and the factors that create a psychologically safe environment. OBJECTIVE To develop a new measurement of psychological safety in simulation-based learning settings using high fidelity manikins and to validate its reliability and validity. METHODS This is a methodological study to develop a scale of Psychological Safety in High Fidelity Simulation. A convenience sample of 242 participants recruited from four universities in Korea was analyzed. The content validity of the scale and feasibility test were conducted to assess the scale's relevance, and comprehensiveness. An exploratory factor analysis with the principal component method and a varimax rotation, a concurrent validity analysis, and known group comparisons were conducted. Reliability was evaluated through the scale's internal consistency. RESULTS Four factors were extracted, and 14 items were retained for these four factors, accounting for 72% of the total variance: (1) "Dealing with uncertainty (four items)," (2) "being exposed (four items)," (3) "being unsupported (three items)," and (4) "interpersonal risk (three items)." The Psychological Safety in High Fidelity Simulation scale score exhibited a statistically significant positive correlation with the Academic Safety Assessment tool and the Educational Satisfaction Scale in Simulation scores (p 〈001). Cronbach's α was .91 and ranged from .75 to .88 for the sub-factors. CONCLUSION The Psychological Safety in High Fidelity Simulation scale is a reliable and valid tool for assessing the psychological safety of nursing students during high fidelity simulation. The scale reflects the nature of psychological safety based on the elements of simulation education and measures the degree to which specific guidance is useful for nursing educators fostering psychological safety in students.
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Affiliation(s)
- Ji Eun Park
- Simulation Education & Research Institute for Nursing, Kyungbok University, Wangsan-ro 6, Dongdaemun-gu, Seoul, Republic of Korea.
| | - Jung-Hee Kim
- College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea.
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18
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Vercio C, Loo LK, Green M, Kim DI, Beck Dallaghan GL. Shifting Focus from Burnout and Wellness toward Individual and Organizational Resilience. TEACHING AND LEARNING IN MEDICINE 2021; 33:568-576. [PMID: 33588654 DOI: 10.1080/10401334.2021.1879651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Burnout is reported to be epidemic among physicians and medical trainees, and wellness has been the predominant target for intervention in academic medicine over the past several years. However, both burnout and wellness suffer from a lack of standardized definition, often making interventions difficult to generalize and extrapolate to different sites. Although well-meaning, current frameworks surrounding wellness and burnout have limitations in fully addressing the challenges of improving physician mental health. Wellness as a framework does not inherently acknowledge the adversity inevitably experienced in the practice of medicine and in the lives of medical trainees. During a crisis such as the current pandemic, wellness curricula often do not offer adequate frameworks to address the personal, organizational, or societal crises that may ensue. This leaves academic institutions and their leadership ill-equipped to appropriately address the factors that contribute to burnout. More recently, resilience has been explored as another framework to positively influence physician wellness and burnout. Resilience acknowledges the inevitable adversity individuals encounter in their life and work, allowing for a more open discussion on the tensions and flexibility between facets of life. However, emphasizing personal resiliency without addressing organizational resiliency may leave physicians feeling alienated or marginalized from critical support and resources that organizations can and should provide. Despite intense focus on wellness and burnout, there have not been significant positive changes in physicians' mental health. Many interventions have aimed at the individual level with mindfulness or other reflective exercises; unfortunately these have demonstrated only marginal benefit. Systems level approaches have demonstrated more benefit but the ability of organizations to carry out any specific intervention is likely to be limited by their own unique constraints and may limit the spread of innovation. We believe the current use of these conceptual lenses (wellness and burnout) has been clouded by lack of uniformity of definitions, an array of measurement tools with no agreed-upon standard, a lack of understanding of the complex interaction between the constructs involved, and an over-emphasis on personal rather than organizational interventions and solutions. If the frameworks of burnout and wellness are limited, and personal resilience by itself is inadequate, what framework would be helpful? We believe that focusing on organizational resilience and the connecting dimensions between organizations and their physicians could be an additional framework helpful in addressing physician mental health. An organization connects with its members along multiple dimensions, including communication, recognition of gifts, shared vision, and sense of belonging. By finding ways to positively affect these dimensions, organizations can create change in the culture and mental health of physicians and trainees. Educational institutions specifically would be well-served to consider organizational resilience and its relationship to individuals.
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Affiliation(s)
- Chad Vercio
- Pediatrics, Loma Linda University, Loma Linda, California, USA
| | - Lawrence K Loo
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Morgan Green
- Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Daniel I Kim
- Internal Medicine, Loma Linda University, Loma Linda, California, USA
- Internal Medicine, Riverside University Health System, Moreno Valley, California, USA
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Krzyzaniak SM, Kaplan B, Lucas D, Bradley E, Wolf SJ. Unheard Voices: A Qualitative Study of Resident Perspectives on Remediation. J Grad Med Educ 2021; 13:507-514. [PMID: 34434511 PMCID: PMC8370372 DOI: 10.4300/jgme-d-20-01481.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/31/2021] [Accepted: 05/01/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Remediation is an important component of residency training that ensures residents are progressing toward competency and unsupervised practice. There is literature describing educators' attitudes about remediation; however, little is known about residents' perspectives regarding peers who are struggling and remediation. Understanding this perspective is critical to supporting struggling residents and developing successful remediation programs. OBJECTIVE The objective of this study was to describe residents' perspectives on peers who are struggling and remediation processes within graduate medical education programs. METHODS In 2015, we conducted focus groups of residents in a multi-institutional exploratory qualitative study designed to investigate resident perspectives on remediation. Focus groups included questions on identification of residents who are struggling, reasons residents face difficulty in training, attitudes toward remediation, and understanding of the remediation process. Using conventional content analysis, we analyzed the focus group data to discover common themes. RESULTS Eight focus groups were performed at 3 geographically distinct institutions. A total of 68 residents participated, representing 12 distinct medical specialties. Four major themes emerged from the participants' discussion: lack of transparency, negative stigma, overwhelming emotions, and a need for change. CONCLUSIONS Resident perspectives on remediation are affected by communication, culture, and emotions. The resident participants called for change, seeking greater understanding and transparency about what it means to struggle and the process of remediation. The residents also believed that remediation can be embraced and normalized.
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Affiliation(s)
- Sara M. Krzyzaniak
- Sara M. Krzyzaniak, MD, is Clinical Associate Professor and Residency Program Director, Department of Emergency Medicine, Stanford University
| | - Bonnie Kaplan
- Bonnie Kaplan, MD, MS, is Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine, and Residency Program Director, Department of Emergency Medicine, Denver Health Medical Center
| | - Daniella Lucas
- Daniella Lucas, MD, is a Resident, Department of Emergency Medicine, Cook County Health and Hospitals System
| | - Elizabeth Bradley
- Elizabeth Bradley, PhD, is Associate Professor of Medical Education, University of Virginia School of Medicine
| | - Stephen J. Wolf
- Stephen J. Wolf, MD, is Professor and Vice Chair, Department of Emergency Medicine, University of Colorado School of Medicine, and Director of Service, Department of Emergency Medicine, Denver Health Medical Center
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Ng V, Gupta A, Erlich D. Brought about by necessity: how the pandemic accelerated a transformation of continuing professional development. EDUCATION FOR PRIMARY CARE 2021; 33:2-5. [PMID: 33988069 DOI: 10.1080/14739879.2021.1920474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The COVID-19 pandemic has had a profound impact on medical education and accelerated an evolution in continuing professional development that was already underway. Physicians around the world have had to quickly learn a new evolving clinical entity and do so in a virtual manner. As local and international travel ceased, academic and practice deliberations on diagnosis and treatment of novel diseases which historically have occurred during in-person conferences have shifted to virtual forums enabled with technology and social media. Medical educators have the added complexity of learning to teach and assess trainees virtually as remote learning has become a necessity. National and international organisations have increased collaborative efforts to ensure the latest clinical information is disseminated promptly to front-line physicians. The shift to virtual learning has democratised clinical information, allowing for wider global participation and transforming how we approach continuing professional development.
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Affiliation(s)
- Victor Ng
- Associate Director, Programs and Practice Support, College of Family Physicians of Canada.,Assistant Professor, Department of Family and Community Medicine, University of Toronto
| | - Archna Gupta
- Adjunct Assistant Clinical Professor, Department of Family Medicine, McMaster University
| | - Deborah Erlich
- Associate Professor, Department of Family Medicine, Tufts University School of Medicine
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21
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Deemer DA, Byrne JM, Loo LK, Puder D, Torralba KD, Lee SC, Kashner TM. Calibration Bias and the Interpretation of Clinical Learning Environment Perceptions Surveys. J Grad Med Educ 2020; 12:727-736. [PMID: 33391597 PMCID: PMC7771586 DOI: 10.4300/jgme-d-20-00237.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/28/2020] [Accepted: 09/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The clinical learning environment (CLE) is frequently assessed using perceptions surveys, such as the AAMC Graduation Questionnaire and ACGME Resident/Fellow Survey. However, these survey responses often capture subjective factors not directly related to the trainee's CLE experiences. OBJECTIVE The authors aimed to assess these subjective factors as "calibration bias" and show how it varies by health professions education discipline, and co-varies by program, patient-mix, and trainee factors. METHODS We measured calibration bias using 2011-2017 US Department of Veterans Affairs (VA) Learners' Perceptions Survey data to compare medical students and physician residents and fellows (n = 32 830) with nursing (n = 29 758) and allied and associated health (n = 27 092) trainees. RESULTS Compared to their physician counterparts, nursing trainees (OR 1.31, 95% CI 1.22-1.40) and allied/associated health trainees (1.18, 1.12-1.24) tended to overrate their CLE experiences. Across disciplines, respondents tended to overrate CLEs when reporting 1 higher level (of 5) of psychological safety (3.62, 3.52-3.73), 1 SD more time in the CLE (1.05, 1.04-1.07), female gender (1.13, 1.10-1.16), 1 of 7 lower academic level (0.95, 1.04-1.07), and having seen the lowest tercile of patients for their respective discipline who lacked social support (1.16, 1.12-1.21) and had low income (1.05, 1.01-1.09), co-occurring addictions (1.06, 1.02-1.10), and mental illness (1.06, 1.02-1.10). CONCLUSIONS Accounting for calibration bias when using perception survey scores is important to better understand physician trainees and the complex clinical learning environments in which they train.
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Affiliation(s)
| | - John M Byrne
- Associate Chief of Staff for Education and Informatics, VA Loma Linda Healthcare System
| | - Lawrence K Loo
- Staff Physician, VA Loma Linda Healthcare System, and Vice Chair for Education and Faculty Development, Department of Medicine
| | - David Puder
- Assistant Professor, Departments of Psychiatry and Internal Medicine, Loma Linda University School of Medicine
| | | | - Sonny C Lee
- Program Director, Loma Linda University Health Education Consortium Internal Medicine Residency
| | - T Michael Kashner
- Health Science Specialist, Office of Academic Affiliations, Department of Veterans Affairs
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22
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Welch CE. Development and Validation of a Theory-Informed Group Learning Environment Assessment Tool for Graduate Medical Education Programs. J Grad Med Educ 2020; 12:447-454. [PMID: 32879685 PMCID: PMC7450759 DOI: 10.4300/jgme-d-19-00748.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/01/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Recent studies showed that psychological safety is important to resident perception of the work environment, and improved psychological safety improves resident satisfaction survey scores. However, there is no evidence in medical education literature specifically addressing relationships between psychological safety and learning behaviors or its impact on learning outcomes. OBJECTIVE We developed and gathered validity evidence for a group learning environment assessment tool using Edmondson's Teaming Theory and Webb's Depth of Knowledge model as a theoretical framework. METHODS In 2018, investigators developed the preliminary tool. The authors administered the resulting survey to neonatology faculty and trainees at Baylor College of Medicine morning report sessions and collected validity evidence (content, response process, and internal structure) to describe the instrument's psychometric properties. RESULTS Between December 2018 and July 2019, 450 surveys were administered, and 393 completed surveys were collected (87% response rate). Exploratory factor analysis and confirmatory factor analysis testing the 3-factor measurement model of the 15-item tool showed acceptable fit of the hypothesized model with standardized root mean square residual = 0.034, root mean square error approximation = 0.088, and comparative fit index = 0.987. Standardized path coefficients ranged from 0.66 to 0.97. Almost all absolute standardized residual correlations were less than 0.10. Cronbach's alpha scores showed internal consistency of the constructs. There was a high correlation among the constructs. CONCLUSIONS Validity evidence suggests the developed group learning assessment tool is a reliable instrument to assess psychological safety, learning behaviors, and learning outcomes during group learning sessions such as morning report.
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Brewer ML, Flavell H. High and low functioning team-based pre-licensure interprofessional learning: an observational evaluation. J Interprof Care 2020; 35:538-545. [PMID: 32615830 DOI: 10.1080/13561820.2020.1778652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Interprofessional education (IPE) is embedded in many health professional training programs, often with a focus on collaborative teamwork. Most studies into whether IPE delivers the desired collaborative teamwork capabilities has tended to rely on short term, self-assessed changes in learners' attitudes, knowledge and skills. This study adopted overt ethnographic observation to understand how a convenience sample of students behave in groups during interprofessional team-based clinical placements. Interprofessional student teams were observed by two independent observers on eight occasions (a total of 720 hours) across three sites. Thematic analysis of the observational data indicates that student teams fell into two categories: higher and lower functioning. Higher functioning teams were observed using humor to build rapport, reduce tension and express humility, and evidenced a greater emphasis on shared client goals. In contrast, lower functioning teams were more formal, with no evidence of humor and less interaction. The higher functioning teams, therefore, not only demonstrated greater interprofessional collaboration they also appeared to have higher levels of psychological safety. Participants in the higher functioning teams also demonstrated mutual trust and confidence and took more risks, often speaking up to provide suggestions, share knowledge and skills, and seek or offer feedback. The results suggest that further explicit training in, and assessment of, psychological safety in IPE needs to be undertaken.
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Affiliation(s)
- Margo L Brewer
- Pro-Vice Chancellor's Office, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Helen Flavell
- Pro-Vice Chancellor's Office, Faculty of Health Sciences, Curtin University, Perth, Australia
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Torralba KD, Cannella AC, Kissin EY, Bolster MB, Salto LM, Higgs J, Samuels J, Nishio MJ, Kaeley GS, Evangelisto A, De Marco P, Kohler MJ. Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs. Arthritis Care Res (Hoboken) 2020; 72:859-870. [PMID: 28777891 DOI: 10.1002/acr.23336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed. METHODS A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum. RESULTS S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum. CONCLUSION MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.
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Affiliation(s)
| | | | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jay Higgs
- San Antonio Uniformed Services, San Antonio, Texas
| | | | | | | | - Amy Evangelisto
- Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey
| | - Paul De Marco
- Georgetown University School of Medicine, Washington, DC
| | - Minna J Kohler
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Price ET, Coverley CR, Arrington AK, Nfonsam VN, Morris-Wiseman L, Riall TS. Are We Making an Impact? A Qualitative Program Assessment of the Resident Leadership, Well-being, and Resiliency Program for General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:508-519. [PMID: 31859228 DOI: 10.1016/j.jsurg.2019.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/03/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE After implementing a formal resident well-being and resiliency program in our surgery residency, we performed in-depth qualitative interviews to understand residents' perceptions of: (1) the impact and benefits, (2) the essential elements for success, and (3) the desired changes to the well-being program. DESIGN The well-being program is structured to address mental, physical, and social aspects of resident well-being through monthly experiential sessions. All General Surgery residents participated in the program; content is delivered during residents' protected educational time. For this study, we conducted individual semistructured interviews: residents were asked for their feedback to understand the value, benefits, and drawbacks of program. SETTING Accreditation Council for Graduate Medical Education-accredited General Surgery residency program PARTICIPANTS: We used purposeful selection to maximize diversity in recruiting residents who had participated in program for at least 1 year. Recruitment continued until themes were saturated. Eleven residents were interviewed including 2 from each residency year. RESULTS Residents reported benefits in 3 thematic spheres: (1) Culture/Community, (2) Communication/Emotional Intelligence, and (3) Work-Life Integration Skills. Key structural elements of success for a well-being program included a committed leader, a receptive department culture, occurrence during protected time, and interactive sessions that taught applicable life skills. In discussing opportunities for improvement, residents desired more faculty-level involvement. Some residents were skeptical of the benefit of time spent learning nontechnical skills; some wanted more emphasis placed on accountability to patients and work. CONCLUSIONS Our qualitative assessment of a novel resident well-being program demonstrates reported benefits that reflect the intent of the program. Residents most benefited from sessions that were interactive, introduced readily applicable skills for their day-to-day lives, and included reinforcement of principles through experiential learning. Engagement of the department leadership is essential to the success of the program, as is ongoing feedback and modification to ensure that program is tailored to the needs of residents.
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Affiliation(s)
- Elinora T Price
- Department of Surgery, University of Arizona, Tucson, Arizona
| | | | | | | | | | - Taylor S Riall
- Department of Surgery, University of Arizona, Tucson, Arizona.
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Lateef F. Maximizing Learning and Creativity: Understanding Psychological Safety in Simulation-Based Learning. J Emerg Trauma Shock 2020; 13:5-14. [PMID: 32395043 PMCID: PMC7204954 DOI: 10.4103/jets.jets_96_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
Psychological safety refers to the belief that one can express oneself without fear of the negative consequences or feedback that their speech, comment, or action might generate. It is about the willingness of learners or workers in an organization, in expressing themselves physically, cognitively, and emotionally. Psychological safety is very dynamic and will continue to evolve and change, with the interplay of a variety of external and internal factors affecting the individual, the organization, or the community. It is also closely linked to the culture in the organization, the institution, or the department. It has become a new norm, especially in high-frequency, high-intensity, and high-performance institutions and workplaces, that psychological safety must be mainstreamed and should not be just an incidental element. It also serves as a foundation for effective learning. When people feel safe and comfortable, they are more open to development, growth, and negotiating change. This is a current opinion piece by the author, who is the Director of The SingHealth Duke NUS Institute of Medical Simulation in Singapore. This is the largest and most comprehensive facility in Singapore, which is also the largest in South-East Asia. It has accreditation by the Society for Simulation in Healthcare. The paper is unique in sharing the perspectives of psychological safety in simulation-based education as well as many of the issues related to culture, which can trump strategy. Characteristics and attributes for facilitators, team training and dynamics, as well as the issue of power and hierarchy are also addressed.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Sing Health Duke NUS Institute of Medical Simulation, Singapore.,World Academic Council in Emergency Medicine, Singapore
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Torralba KD, Jose D, Byrne J. Psychological safety, the hidden curriculum, and ambiguity in medicine. Clin Rheumatol 2020; 39:667-671. [PMID: 31902031 DOI: 10.1007/s10067-019-04889-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
Psychological safety is a feeling that individuals are comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution. It has long been recognized as part of successful patient safety and quality improvement processes. However, in the realm of medical education, psychological safety is a relatively unknown concept to many educators and learners alike. Learners, whether students or postgraduate trainees, are in a phase of cognitive apprenticeship whereby they learn not only skills and knowledge from teachers as part of an explicit and formal curriculum. At the same time, a hidden curriculum is also part of the learning environment in the form of norms, values, and behaviors exhibited by teachers. These norms, values, and behaviors become part of the culture of the clinical learning environment. The vulnerability of learners in this environment is magnified by the hierarchal nature of medicine, and the complexity, uncertainty, and the ambiguity inherent to medical conditions. This is especially true of cognitive specialties such as rheumatology. Educators who engage in unprofessional behaviors that result in learner humiliation and shame may serve to dampen productive discourse and scientific dialog. Therefore, educators must embrace psychological safety to foster learning and facilitate high-performing teams in the clinical learning environment.Key Points• Psychological safety improves communication and teamwork by allowing individuals to be comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution.• Commonly studied in the context of patient safety and quality improvement, psychological safety should extend towards medical education particularly in the context of allowing medical students and postgraduate trainees to be able to voice clinical reasoning in the face of ambiguity.• Educators take on a leadership role when having learners under their supervision; as leaders, educators are the prime movers of psychological safety• Learners in the process of developing their self-identity in the context of their chosen profession adopt not only knowledge and skills within the framework of an explicit and formal curriculum but also norms and values from daily behavior and language educators present in the clinical learning environment of learners; these norms and values are collectively part of the hidden curriculum.
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Affiliation(s)
- Karina D Torralba
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA.
| | - Donna Jose
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA
| | - John Byrne
- Department of Medicine, Division of Rheumatology, Loma Linda University School of Medicine, 11234 Anderson St, MC 1519, Loma Linda, CA, 92373, USA.,Loma Linda Health Care System, Loma Linda, CA, USA
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Downey C, Panikkath DR, Solomon DH. Education and Professional Development in Rheumatology: Translating Quality Improvement and Education to Clinical Practice. Rheum Dis Clin North Am 2019; 46:155-166. [PMID: 31757282 DOI: 10.1016/j.rdc.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Academic institutions play an essential role in providing physicians with the necessary skills needed to improve the quality and value of care provided. The Accreditation Council for Graduate Medical Education has several milestones in the curriculum of fellowship programs that prioritize involvement in quality improvement (QI) and patient safety efforts. This article reviews the unique benefits and challenges of involving and teaching fellows to conduct QI initiatives. Strategies and resources available to overcome these challenges and develop a successful quality driven training environment are outlined in this article.
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Affiliation(s)
- Christina Downey
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Deepa Ragesh Panikkath
- Division of Rheumatology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA
| | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Swendiman RA, Hoffman DI, Bruce AN, Blinman TA, Nance ML, Chou CM. Qualities and Methods of Highly Effective Surgical Educators: A Grounded Theory Model. JOURNAL OF SURGICAL EDUCATION 2019; 76:1293-1302. [PMID: 30879943 DOI: 10.1016/j.jsurg.2019.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/19/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify personal qualities and teaching methods of highly effective surgical educators using a novel research design. DESIGN In this qualitative study, surgical residents were sent an electronic survey soliciting nominations for faculty perceived as highly effective surgical educators. In-depth, semistructured interviews were conducted with surgeons receiving the most nominations. Grounded theory methodology identified themes for analysis. SETTING General, vascular, and plastic surgery residents and faculty at the University of Pennsylvania Health System. PARTICIPANTS A total of 77 surgical residents were surveyed. Data saturation occurred after 12 semistructured interviews with attending surgeons, corresponding to the top 15% of faculty. RESULTS Interviewees described both personal characteristics and specific teaching approaches that facilitated successful learning. These included providing exceptional surgical education as a mission, a strong influence from past mentors and role models, a love for the profession, and a low rate of self-professed burnout. Desirable teaching methods included promoting a culture of psychological safety (the perceived ability to take interpersonal risks within one's environment), progressive autonomy, accountability of trainees, and individualized teaching for the learner. Interviewees saw education as inseparable from clinical duties, and all surgeons believed providing exceptional patient care was the foundation of effective surgical teaching. The derived themes suggested that educators prefer "cognitive-based" approaches, focusing on learning processes rather than specific outcomes. CONCLUSIONS This study identified characteristics and educational styles of highly effective educators in a cohort of academic surgeons. This framework may inform the development of educational programs for residents and faculty in effective teaching methods.
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Affiliation(s)
- Robert A Swendiman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel I Hoffman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adrienne N Bruce
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thane A Blinman
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael L Nance
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carol M Chou
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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van Schaik SM, Reeves SA, Headrick LA. Exemplary Learning Environments for the Health Professions: A Vision. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:975-982. [PMID: 30844927 DOI: 10.1097/acm.0000000000002689] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this article, the authors propose a vision for exemplary learning environments in which everyone involved in health professions education and health care collaborates toward optimal health for individuals, populations, and communities. Learning environments in the health professions can be conceptualized as complex adaptive systems, defined as a collection of individual agents whose actions are interconnected and follow a set of shared "simple rules." Using principles from complex adaptive systems as a guiding framework for the proposed vision, the authors postulate that exemplary learning environments will follow four such simple rules: Health care and health professions education share a goal of improving health for individuals, populations, and communities; in exemplary learning environments, learning is work and work is learning; exemplary learning environments recognize that collaboration with integration of diverse perspectives is essential for success; and the organizations and agents in the learning environments learn about themselves and the greater system they are part of in order to achieve continuous improvement and innovation. For each of the simple rules, the authors describe the details of the vision and how the current state diverges from this vision. They provide actionable ideas about how to reach the vision using specific examples from the literature. In addition, they identify potential targets for assessment to monitor the success of learning environments, including outcome measures at the individual, team, institutional, and societal levels. Such measurements can ensure optimal alignment between health professions education and health care and inform ongoing improvement of learning environments.
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Affiliation(s)
- Sandrijn M van Schaik
- S.M. van Schaik is professor of pediatrics and Baum Family Presidential Chair for Experiential Learning, University of California, San Francisco, San Francisco, California. S.A. Reeves is professor and dean, School of Nursing and Health Professions, Colby-Sawyer College, New London, New Hampshire, and chief nurse executive, Dartmouth-Hitchcock Health, Lebanon, New Hampshire. L.A. Headrick is professor emerita of medicine, University of Missouri School of Medicine, Columbia, Missouri
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Caverzagie KJ, Goldenberg MG, Hall JM. Psychology and learning: The role of the clinical learning environment. MEDICAL TEACHER 2019; 41:375-379. [PMID: 30761927 DOI: 10.1080/0142159x.2019.1567910] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The clinical learning environment for the postgraduate education of physicians significantly influences the learning process and the outcomes of learning. Two critical aspects of the learning environment, when viewed through a psychology lens are (1) constructs from psychology relevant to learning, such as cognitive load theory and learner self-efficacy; and (2) psychological attributes of the context in which learning occurs such as psychological safety and "Just Culture". In this paper, we address selected psychological aspects of the clinical learning environment, with a particular focus on the establishment and sustainment of psychological safety in the clinical learning environment for physicians. Psychological safety is defined as individuals' perceptions that they can speak out in the learning or working context without consequences for their professional standing or risks to their status on work teams or groups. We close with seven critical strategies for use by educators, learners, health systems leaders, and other stakeholders to contribute to a clinical environment that optimizes learning. These dimensions can also provide avenues for future research to enhance the community's understanding of psychological constructs operating in the clinical learning environment.
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Affiliation(s)
- Kelly J Caverzagie
- a Division of General Internal Medicine, Department of Internal Medicine , University of Nebraska College of Medicine , Omaha , Nebraska , United States
| | - Mitchell G Goldenberg
- b Division of Urology, Department of Surgery , University of Toronto , Toronto , Ontario , Canada
| | - Jena M Hall
- c Department of Obstetrics and Gynecology , Queen's University , Kingston , Ontario , Canada
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Appelbaum NP. Psychological Safety and Support: Assessing Resident Perceptions of the Clinical Learning Environment. J Grad Med Educ 2018; 10:651-656. [PMID: 30619522 PMCID: PMC6314376 DOI: 10.4300/jgme-d-18-00286.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/03/2018] [Accepted: 09/12/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Assessments of the clinical learning environment could allow early interventions to improve graduate medical education. To date, measurement tools for this have not been identified. OBJECTIVE We established the concurrent validity of 2 instruments that assess cultural facets of the clinical learning environment by correlating them with external program evaluation data. METHODS In 2017 we surveyed residents across 19 training programs on their perceptions of organizational support by using the Short Survey of Perceived Organizational Support (SPOS), and psychological safety by using the Psychological Safety Scale (PSS). Data were aggregated to the program level and correlated with results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey. RESULTS Of 511 residents, 322 (63%) completed the survey, and 496 of 516 residents (96%) completed the ACGME Resident Survey. Perceived organizational support correlated positively with overall program evaluation score (r = 0.75, P < .001); faculty (r = 0.72, P < .001); evaluation (r = 0.73, P < .001); educational content (r = 0.52, P = .022); and resources domains (r = 0.55, P = .014). Psychological safety had a positive correlation with overall program evaluation (r = 0.57, P = .011); faculty (r = 0.50, P = .028); and evaluation (r = 0.62, P < .005). CONCLUSIONS The SPOS and PSS correlated with key ACGME Resident Survey domains. Programs showing greater support of residents were likely to show more positive ratings on program evaluation metrics. Teaching institutions may benefit from actively monitoring and improving aspects of their learning environment through internal assessments.
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Bynum WE, Artino AR. Who Am I, and Who Do I Strive to Be? Applying a Theory of Self-Conscious Emotions to Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:874-880. [PMID: 29068821 DOI: 10.1097/acm.0000000000001970] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The self-conscious emotions of shame, guilt, and pride are a distinct set of cognitively complex, powerful, and ubiquitous emotions that arise when an individual engages in self-evaluation. Currently, little is known about the influence or outcomes of self-conscious emotions in medical learners. In this article, the authors present a leading theory of self-conscious emotions that outlines the appraisals and attributions that give rise to and differentiate shame, guilt, and two forms of pride. The authors then apply the theory to three relevant topics in medical education: perfectionism, professional identity formation, and motivation. In doing so, the authors present novel ways of viewing these topics through the lens of self-conscious emotion, suggest areas of future research, and outline a framework for emotional resilience training. Ultimately, the goal of this article is to highlight the fundamental nature of shame, guilt, and pride, which the authors believe are underappreciated and understudied in medical education, and to inform future empirical study on the role that these emotions might play in medical education. Additionally, from a practical standpoint, this article aims to encourage educators and learners to recognize self-conscious emotions in themselves and their colleagues, and to begin developing more resilient approaches to learning-approaches that acknowledge and confront shame, guilt, and pride in medical education.
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Affiliation(s)
- William E Bynum
- W.E. Bynum IV was attending faculty, National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, at the time this article was written. He is assistant professor, Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina, now; ORCID: http://orcid.org/000-0003-3796-9301. A.R. Artino Jr is professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0003-2661-7853
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Scielzo SA. Resident Fuel Levels: Reframing, Assessing, and Addressing Well-Being. J Grad Med Educ 2018; 10:198-202. [PMID: 29686760 PMCID: PMC5901800 DOI: 10.4300/jgme-d-17-00536.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/10/2017] [Accepted: 01/08/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To optimize resident learning, programs need to readily assess resident well-being. There is a lack of easy-to-use, acceptable instruments for this task. OBJECTIVE We created a well-being "fuel gauge," and assessed the acceptability and feasibility of this weekly electronic communication pipeline for residents to report and discuss their well-being. METHODS A well-being fuel gauge assessment was administered weekly over the course of 1 academic year (July 2016 to June 2017) in a large internal medicine residency program. The well-being gauge asked residents to report their fuel levels using a 1 to 5 Likert-type scale (1, empty; 3, half tank; and 5, full tank). Residents who provided low scores (1 or 2) were contacted by program leadership, and the program director sent weekly e-mail updates that addressed residents' comments on their well-being fuel gauge. RESULTS Of 163 residents, 149 (91%) provided data on their well-being fuel gauge, with a 53% average weekly response rate. Fifty-four percent of residents (80 of 149) reported a low score over the course of the year, and 4 residents only used the assessment to report a low score. Comments on average consisted of 280 characters (SD = 357) and were lengthier and more prevalent with lower fuel gauge scores. We analyzed the relationship between scores and comments. CONCLUSIONS The well-being fuel gauge was well accepted by most residents and was easy to administer and to oversee by program directors. It facilitated ongoing monitoring of well-being and follow-up to address factors contributing to low well-being.
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Scheepers RA, van den Goor M, Arah OA, Heineman MJ, Lombarts KMJMH. Physicians' Perceptions of Psychological Safety and Peer Performance Feedback. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:250-254. [PMID: 30346339 DOI: 10.1097/ceh.0000000000000225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION For continuous professional development, it is imperative that physicians regularly receive performance feedback from their peers. Research shows that professionals are more proactive in learning and knowledge sharing with peers in teams with more psychological safety. Psychological safety has however not been studied in relation to peers' performance feedback. This study investigated the association between physicians' perceptions of psychological safety and performance feedback received from their peers. METHODS We invited physicians of cardiology, gastroenterology, obstetrics and gynecology, otorhinolaryngology, pulmonology, neurology, and neurosurgery departments of an academic medical center to participate. Physicians evaluated psychological safety using Edmondson's seven-item validated scale and performance feedback using the adapted four-item feedback subscale of the validated System for Evaluation of Teaching Qualities, including corrective and positive feedback, explanations of feedback, and suggestions for improvement from peers. We analyzed the data using multilevel linear regression analyses adjusted for physicians' sex, years since being certified a medical specialist, and months working in the clinic under the study. RESULTS This study included 105 physicians (86.8% participated). Psychological safety was positively associated with physicians' perceptions of performance feedback from peers (B = 0.54, 95% confidence interval = 0.34-0.73, P-value <.001). CONCLUSIONS Physicians who experienced more psychological safety were more likely to receive corrective and positive performance feedback from peers, explanations of feedback, and suggestions for improvement. Medical teams should consider investing in psychological safety to encourage performance feedback from peers, and thus support physicians' continuous professional development and their efforts to provide high-quality patient care.
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Affiliation(s)
- Renée A Scheepers
- Dr. Scheepers: Assistant Professor, Research Group Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University of Rotterdam, Rotterdam, the Netherlands. Van den Goor, PhD Candidate, Professional Performance Research Group, Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands Dr. Arah: Professor, Professional Performance Research Group, Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands, and Dr. Arah: Professor, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, and Dr. Arah: Professor, UCLA Center for Health Policy Research, Los Angeles, CA. Dr. Heineman: Professor, Professional Performance Research Group, Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr. Lombarts: Professor, Professional Performance Research Group, Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Torralba KD, Puder D. Psychological Safety Among Learners: When Connection Is More Than Just Communication. J Grad Med Educ 2017; 9:538-539. [PMID: 28824776 PMCID: PMC5559258 DOI: 10.4300/jgme-d-17-00195.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Karina D Torralba
- Chief and Fellowship Program Director, Division of Rheumatology, Loma Linda University Staff Rheumatologist, VA Loma Linda Healthcare System
| | - David Puder
- Assistant Professor, Department of Psychiatry, Loma Linda University
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