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Sternszus R, Snell L, Razack S. Critically re-examining professional norms: Medicine's urgent need to look inwards. MEDICAL EDUCATION 2024; 58:775-777. [PMID: 38380532 DOI: 10.1111/medu.15318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
'Are physicians who they ought to be?' This commentary advocates for a critical re‐examination of what is at the core of being a physician via a process of inclusive co‐construction
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Affiliation(s)
- Robert Sternszus
- Department of Pediatrics and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Linda Snell
- Department of Medicine and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Saleem Razack
- Division of Critical Care, Department of Pediatrics and Scholar in the Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ryan A, Moran CN, Byrne D, Hickey A, Boland F, Harkin DW, Guraya SS, Bensaaud A, Doyle F. Do professionalism, leadership, and resilience combine for professional identity formation? Evidence from confirmatory factor analysis. Front Med (Lausanne) 2024; 11:1385489. [PMID: 38938377 PMCID: PMC11208471 DOI: 10.3389/fmed.2024.1385489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Professional identity formation (PIF) is an ongoing, self-reflective process involving habits of thinking, feeling and acting like a physician and is an integral component of medical education. While qualitative work has suggested that PIF is informed by professionalism, resilience, and leadership, there is a dearth of quantitative work in this area. Multiple methods build rigor and the present study aimed to quantitatively assess the relative psychometric contributions of professionalism, resilience, and leadership constructs to informing PIF, using a latent factor analysis approach. Methods We analyzed data from the PILLAR study, which is an online cross-sectional assessment of a pre-clinical cohort of medical students in the RCSI University of Medicine and Health Sciences, Dublin, using established and validated quantitative measures in each area of interest: PIF, professionalism, leadership and resilience. A total of 76 items, combining four validated scales, along with a selection of demographic questions, were used. The hypothesis that PIF is informed by, and correlates with, professionalism, resilience and leadership was examined by conducting a confirmatory factor analysis of a proposed three-factor higher-order model. Model estimation used Maximum Likelihood Method (MLM) with geomin rotation. The hypothesized (measurement) model was examined against an alternative (saturated) model, as well as a three-factor model. Results Latent variable analysis from 1,311 students demonstrated that a three-factor higher-order model best fit the data; suggesting PIF is informed by professionalism, resilience, and leadership, and that these constructs are statistically distinct and account for differential aspects of PIF. This higher-order model of PIF outperformed both the saturated model and the three-factor model. The analysis of which component may be the most or least influential was inconclusive, and the overall model was not influenced by year of training. Discussion Building upon existing conceptual contentions, our study is the first to quantitatively support the contribution of professionalism, resilience, and leadership to the development of professional identity, and to delineate the inter-relationships between PIF and these constructs. This information can be used by medical educators when designing curricula and educational strategies intended to enhance PIF. Future work should seek to assess the influence of these constructs longitudinally.
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Affiliation(s)
- Aine Ryan
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine N. Moran
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - David Byrne
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W. Harkin
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Shaista S. Guraya
- Institute of Learning, Mohammad Bin Rashid University, Dubai, United Arab Emirates
| | - Abdelsalam Bensaaud
- Centre for Professionalism in Medicine and Health Sciences at Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Birman NA, Vashdi DR, Miller-Mor Atias R, Riskin A, Zangen S, Litmanovitz I, Sagi D. Unveiling the paradoxes of implementing post graduate competency based medical education programs. MEDICAL TEACHER 2024:1-8. [PMID: 38803298 DOI: 10.1080/0142159x.2024.2356826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation. METHOD A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards. RESULTS Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators. CONCLUSIONS Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.
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Affiliation(s)
- Noa A Birman
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Dana R Vashdi
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Rotem Miller-Mor Atias
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Arieh Riskin
- Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Shmuel Zangen
- Ben- Gurion University of the Negev, Faculty of Health Sciences, Be'er-Sheva, Israel
| | - Ita Litmanovitz
- Tel Aviv University, Faculty of Medicine & Health Sciences, Tel-Aviv, Israel
| | - Doron Sagi
- The Israel Center for Medical Simulation, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Bransen J, Poeze M, Mak-van der Vossen MC, Könings KD, van Mook WNKA. 'Role Model Moments' and 'Troll Model Moments' in Surgical Residency: How Do They Influence Professional Identity Formation? PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:313-323. [PMID: 38800716 PMCID: PMC11122703 DOI: 10.5334/pme.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
Introduction Role models are powerful contributors to residents' professional identity formation (PIF) by exhibiting the values and attributes of the community. While substantial knowledge on different attributes of role models exists, little is known about their influence on residents' PIF. The aim of this study was to explore surgical residents' experiences with role models and to understand how these contribute to residents' PIF. Methods Adopting a social constructivist paradigm, the authors used a grounded theory approach to develop an explanatory model for residents' experiences with role models regarding PIF. Fourteen surgical residents participated in individual interviews. The authors iteratively performed data collection and analysis, and applied constant comparison to identify relevant themes. Results Role model behavior is highly situation dependent. Therefore, residents learn through specific 'role model moments'. These moments arise when residents (1) feel positive about a moment, e.g. "inspiration", (2) have a sense of involvement, and (3) identify with their role model. Negative role model moments ('troll model moments') are dominated by negative emotions and residents reject the modeled behavior. Residents learn through observation, reflection and adapting modeled behavior. As a result, residents negotiate their values, strengthen attributes, and learn to make choices on the individual path of becoming a surgeon. Discussion The authors suggest a nuance in the discussion on role modelling: from 'learning from role models' to 'learning from role model moments'. It is expected that residents' PIF will benefit from this approach since contextual factors and individual needs are emphasized. Residents need to develop antennae for both role model moments and troll model moments and acquire the skills to learn from them. Role model moments and troll model moments are strong catalysts of PIF as residents follow in the footsteps of their role models, yet learn to go their own way.
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Affiliation(s)
- Jeroen Bransen
- Department of Trauma Surgery, Maastricht University Medical Center+, The Netherlands
- School of Health Professions Educations, Maastricht University, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center+, The Netherlands
| | - Marianne C. Mak-van der Vossen
- Assistant professor in medical education, Amsterdam UMC, Department of General Practice, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Karen D. Könings
- School of Health Professions Educations, Maastricht University, The Netherlands
- School of Health Sciences, University of East Anglia, UK
| | - Walther N. K. A. van Mook
- School of Health Professions Educations, Maastricht University, The Netherlands
- Department of Intensive Care Medicine, and postgraduate dean, Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, The Netherlands
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Boudreau D, Fuks A. Transformations in medical education: A prudential perspective. HEALTH CARE SCIENCE 2024; 3:73-77. [PMID: 38939616 PMCID: PMC11080854 DOI: 10.1002/hcs2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Donald Boudreau
- Faculty of Medicine and Health SciencesInstitute of Health Sciences EducationMcGill UniversityMontrealQuébecCanada
| | - Abraham Fuks
- Department of MedicineFaculty of Medicine and Health SciencesMcGill UniversityMontrealQuébecCanada
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Tiao MM, Chang YC, Ou LS, Hung CF, Khwepeya M. An Exploration of Pediatricians' Professional Identities: A Q-Methodology Study. Healthcare (Basel) 2024; 12:144. [PMID: 38255033 PMCID: PMC10815713 DOI: 10.3390/healthcare12020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Professional identities may influence a wide range of attitudes, ethical standards, professional commitments and patient safety. This study aimed to explore the important elements that comprise pediatricians' professional identities. A Q-methodology was used to identify the similarities and differences in professional identity. Forty pediatricians were recruited from two tertiary referral hospitals in Taiwan. A list of statements was developed by five attending physicians and three residents. R software was used to analyze the Q-sorts to load the viewpoints and formulate the viewpoint arrays. Additional qualitative data-one-to-one personal interviews-were analyzed. Twenty-eight of forty pediatricians, 11 males and 17 females, with an average age of 39.9 (27-62) years, were associated with four viewpoints. We labeled the four viewpoints identified for professional identity as (1) professional recognition, (2) patient communication, (3) empathy and (4) insight. The professional recognition viewpoint comprised of youngest participants-28-36 years-with the majority as residents (77.8%), while the empathy viewpoint comprised the oldest participants-38-62 years-with all as attending physicians. All participants in the empathy and insight viewpoints were married. This study found professional identity to be a multifaceted concept for pediatricians, especially in the areas of professional recognition, patient communication, empathy and insight into patient care.
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Affiliation(s)
- Mao-Meng Tiao
- Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yu-Che Chang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Liang-Shiou Ou
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
| | - Chi-Fa Hung
- Department of Psychology, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Madalitso Khwepeya
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan;
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