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Balmer DF, Rosenblatt SA, Blalock AE. Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine. MEDICAL TEACHER 2024:1-8. [PMID: 38460500 DOI: 10.1080/0142159x.2024.2326096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work. METHODS AND MATERIALS We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together. RESULTS In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program. CONCLUSIONS Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.
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Affiliation(s)
- Dorene F Balmer
- Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel A Rosenblatt
- Department of Anaesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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Buléon C, Minehart RD, Rudolph JW, Blanié A, Lilot M, Picard J, Plaud B, Pottecher J, Benhamou D. Strategy to Develop a Common Simulation Training Program: Illustration with Anesthesia and Intensive Care Residency in France. TEACHING AND LEARNING IN MEDICINE 2023; 35:537-549. [PMID: 36251797 DOI: 10.1080/10401334.2022.2127730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: The urgency of having fair and trustworthy competency-based assessment in medical training is growing. Simulation is increasingly recognized as a potent method for building and assessing applied competencies. The growing use of simulation and its application in summative assessment calls for comprehensive and rigorously designed programs. Defining the current baseline of what is available and feasible is a crucial first step. This paper uses anesthesia and intensive care (AIC) in France as a case study in how to document this baseline. Approach: An IRB-approved, online anonymous closed survey was submitted to AIC residency program directors and AIC simulation program directors in France from January to February 2021. The researcher-developed survey consisted of 65 questions across five sections: centers' characteristics, curricular characteristics, courses' characteristics, instructors' characteristics, and simulation perceptions and perspectives. Findings: The participation rate was 31/31 (100%) with 29 centers affiliated with a university hospital. All centers had AIC simulation activities. Resident training was structured in 94% of centers. Simulation uses were training (100%), research and development (61%), procedural or organizational testing (42%), and summative assessment (13%). Interprofessional full-scale simulation training existed in 90% of centers. Procedural training on simulators prior to clinical patients' care was performed "always" in 16%, "most often" in 45%, "sometimes" in 29% and "rarely" or "not" in 10% of centers. Simulated patients were used in 61% of centers. Main themes were identified for procedural skills, full-scale and simulated patient simulation training. Simulation activity was perceived as increasing in 68% of centers. Centers expressed a desire to participate in developing and using a national common AIC simulation program. Insights: Based on our findings in AIC, we demonstrated a baseline description of nationwide simulation activities. We now have a clearer perspective on a decentralized approach in which individual institutions or regional consortia conduct simulation for a discipline in a relatively homogeneous way, suggesting the feasibility for national guidelines. This approach provides useful clues for AIC and other disciplines to develop a comprehensive and meaningful program matching existing expectations and closing the identified gaps.
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Affiliation(s)
- Clément Buléon
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Caen Normandy University Hospital, Caen, France
- Medical School, University of Caen Normandy, Caen, France
- Center for Medical Simulation, Boston, MA, USA
| | - Rebecca D Minehart
- Center for Medical Simulation, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenny W Rudolph
- Center for Medical Simulation, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Antonia Blanié
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Kremlin Bicêtre University Hospital, APHP, Paris, France
| | - Marc Lilot
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Edouard Herriot University Hospital, HCL, Lyon, France
| | - Julien Picard
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Grenoble University Hospital, Grenoble, France
| | - Benoît Plaud
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Saint-Louis University Hospital, APHP, Paris, France
| | - Julien Pottecher
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Dan Benhamou
- Department of Anesthesiology, Intensive Care and Perioperative Medicine, Kremlin Bicêtre University Hospital, APHP, Paris, France
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Coria AL, Hassan A, Huang JY, Genadry KC, Kumar RK, Sergios A, Marshall RE, Russ CM. Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement. HUMAN RESOURCES FOR HEALTH 2023; 21:65. [PMID: 37592365 PMCID: PMC10433606 DOI: 10.1186/s12960-023-00852-2] [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: 11/14/2022] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement. METHODS We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating "partially present" or "absent", raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark. RESULTS A median of 56% (IQR 43-77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15-39%) were partially present; and 8.3% (IQR 5.5-21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching. CONCLUSIONS Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.
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Affiliation(s)
- Alexandra L Coria
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA.
- Department of Population Health, Maimonides Medical Center and Division of Hospital Medicine, Maimonides Children's Hospital, 4802 10th Ave, Brooklyn, NY, 11219, USA.
| | - Areej Hassan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jui-Yen Huang
- Division of Adolescent Medicine, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan, ROC
| | - Katia C Genadry
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Rashmi K Kumar
- University of Nairobi, P.O Box 30197, GPO, Nairobi, Kenya
- Kenyatta National Hospital, P.O Box 20723-00202, Nairobi, Kenya
| | - Ayten Sergios
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA
| | - Roseda E Marshall
- AM Dogliotti College of Medicine, Capitol Hill, P.O Box 10-9020, 1000, Monrovia 10, West Africa, Liberia
| | - Christiana M Russ
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Intermediate Care Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Dutta D, Ibrahim H, Cofrancesco J, Archuleta S, Stadler DJ. The Gendered Work/Role of Program Directors in International Graduate Medical Education. QUALITATIVE HEALTH RESEARCH 2023; 33:154-164. [PMID: 36527203 DOI: 10.1177/10497323221145832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.
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Affiliation(s)
- Debalina Dutta
- School of Communication, Journalism and Marketing, 6420Massey University, New Zealand
| | - Halah Ibrahim
- Department of Medicine Khalifa of Medicine and Health Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Joseph Cofrancesco
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine Institute for Excellence in Education, Baltimore, MD, USA
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophia Archuleta
- Department of Medicine, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
- Division of Infectious Diseases, National University Health System, Singapore
| | - Dora J Stadler
- 8395Walter Reed National Military Medical Center, Uniformed Services University, Bethesda, MD, USA
- Weill Cornell Medicine-Qatar, Doha, Qatar
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