Training tomorrow's doctors

Which social accountability competencies make a good physician? A qualitative investigation of the patient perspective on social accountability

OBJECTIVE

Social accountability is an emerging theme in health care education. In previous literature, the perspectives of patients regarding the competencies that they think are required for physicians to demonstrate in this domain are scarce. This study aims to get insight into the competencies in the domain of social accountability that, according to patients, should be demonstrated by physicians.

METHODS

Online semi-structured interviews with 18 patients in the Netherlands were conducted as part of an exploratory qualitative study. Snowballing and convenience sampling techniques were used to recruit participants. The grounded theory method was used to qualitatively analyze the interviews.

RESULTS AND CONCLUSION

Patients identified five competencies of a physician in the domain of social accountability: (1) Taking patient's characteristics into account and tailoring care to the individual patient, (2) Taking the broader community into account, (3) Balancing between care for the individual patient versus concern for society, (4) Providing guidance to patients in the navigation within the health system, and (5) Taking climate impact into account. Patients stated that the importance of these competencies are dependent on the specialism.

PRACTICE IMPLICATIONS

The formulated competencies can be used to better align medical education focussing on social accountability to the expectations of patients.

Impact of teaching, learning, and assessment of medical law on cognitive, affective and psychomotor skills of medical students: a systematic review

BACKGROUND

It is necessary to improve medical students' legal cognitive, affective, and psychomotor skills to prevent further legal issues in the medical profession. Choosing the proper teaching and assessment methods is crucial in this matter. This study aimed to investigate the impact of teaching, learning, and assessment of medical law on the cognitive, affective, and psychomotor skills of medical students.

METHODS

A systematic review was conducted in PubMed, Embass, and Web of Science databases, and Google Scholar search engine using MECIR and PRISMA, AMEE Guide 94 for 1980 to 2022.12.30. Nineteen articles met the inclusion criteria. MERSQI checklist was used to assess the quality of the articles, and URSEC (theoretical underpinning of the development, resources required, setting, educational methods employed, and content) used to assess the risk of educational bias.

RESULTS

Internship courses called Medical Education Humanities and Society (MESH), clinical scenario design, seminars and small group discussions, web-based interactive training, legal training courses, PBL, and mind maps have been used to improve the medico-legal knowledge of medical students. MESH clerkship, simulation of a legal event, medico-legal advocacy program based on interdisciplinary education, group discussion, integration, and court-based learning used to improve student attitudes. Multidisciplinary training, small group discussions after the seminar, mock trial competition, and interdisciplinary education are used to teach psychomotor skills. All studies, except one on knowledge, reported positive effects of legal education on students' knowledge, attitudes, and legal performance. Written assessments were used for cognitive and affective domains, while performance was assessed by OSCE, simulated court, and evaluation of patient referrals.

CONCLUSION

There are few studies to examine the cognitive, affective, and legal psychomotor skills of medical students. The texts have not yet fully explored the high level of affective and psychomotor domains, which is evidence of a gap in this sector. Recognizing that medico-legal problems are prevented through proper education and assessment, it is recommended that this area be considered a research priority and that effective educational policies are adopted.

An online immunohematology educational resource for post-graduate hematology trainees: LearnSerology.ca

BACKGROUND

Canadian hematology residents are required to demonstrate competencies in transfusion medicine by the end of their 2-year training. Prior evaluation of final year trainees revealed significant variation in knowledge. To address the lack of standardization in serology teaching, an online educational immunohematology resource was created and evaluated.

STUDY DESIGN AND METHODS

All Canadian post-graduate trainees completing a residency program in adult hematology during the 2018/2019 academic year were invited to participate. Only trainees from one university were exposed to the program curriculum. A validated exam was administered to trainees at both exposed and unexposed sites at the start of the academic year as a pre-test and in the following year as a post-test. The effectiveness of the program was assessed by both comparing the degree of improvement from pre- to post-test, and by comparing performance on the post-test.

RESULTS

57 trainees from 13 universities completed the pre-test, and 45 trainees from 14 universities completed the post-test. A strong trend towards better performance in the exposed vs non-exposed trainees on the post-test was observed, and the difference was more pronounced, and statistically significant, when analysis was limited to two questions relating to interpretation of an antibody investigation panel.

DISCUSSION

LearnSerology.ca is effective and may be potentially superior to traditional immunohematology teaching. The interactive capability of the platform can improve skills related to the resolution of red cell antibody panels.

Self-Directed Learning in Medical Education: Training for a Lifetime of Discovery

Issue: Life-long learning is a skill that is central to competent health professionals, and medical educators have sought to understand how adult professionals learn, adapt to new information, and independently seek to learn more. Accrediting bodies now mandate that training programs teach in ways that promote self-directed learning (SDL) but do not provide adequate guidance on how to address this requirement. Evidence: The model for the SDL mandate in physician training is based mostly on early childhood and secondary education evidence and literature, and may not capture the unique environment of medical training and clinical education. Furthermore, there is uncertainty about how medical schools and postgraduate training programs should implement and evaluate SDL educational interventions. The Shapiro Institute for Education and Research, in conjunction with the Association of American Medical Colleges, convened teams from eight medical schools from North America to address the challenge of defining, implementing, and evaluating SDL and the structures needed to nurture and support its development in health professional training. Implications: In this commentary, the authors describe SDL in Medical Education, (SDL-ME), which is a construct of learning and pedagogy specific to medical students and physicians in training. SDL-ME builds on the foundations of SDL and self-regulated learning theory, but is specifically contextualized for the unique responsibilities of physicians to patients, inter-professional teams, and society. Through consensus, the authors offer suggestions for training programs to teach and evaluate SDL-ME. To teach self-directed learning requires placing the construct in the context of patient care and of an obligation to society at large. The SDL-ME construct builds upon SDL and SRL frameworks and suggests SDL as foundational to health professional identity formation.KEYWORDSself-directed learning; graduate medical education; undergraduate medical education; theoretical frameworksSupplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1938074 .

Identifying central tenets needed in our education systems: Results from a pilot integrated clinical apprenticeship

Purpose: The ability of healthcare systems to deliver world-class compassionate care depends on the quality of training and education of staff. Matching student-centered learning with patient-centered care is the focus for much curricula reform. This study explores the effect a novel longitudinal curriculum had on medical students' attitudes and experiences to better identify central tenets needed in our education system. Methods: Single-center, qualitative focus-group study conducted in 2017 of medical students in a longitudinally integrated clinical apprenticeship at a large UK medical school. Students were randomly assigned to focus groups to describe their educational journey and explore how longitudinal learning prepared them for a medical career, valuing their unique position as student participants in the healthcare system. Results: Four themes emerged from students' experiences: navigating the patient journey, their professional development, their learning journey, and the healthcare system. Conclusions: Listening to student voices lends insights for educators refining educational models to produce doctors of tomorrow. This project identified the educational value of students having authentic roles in helping patients navigate the healthcare system and the benefits of consistent mentorship and greater autonomy. The gulf between gaining skills as a future doctor and gaining skills to pass summative exams calls into question assessment methods.