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Ellaway RH, O'Brien BC, Sherbino J, Maggio LA, Artino AR, Nimmon L, Park YS, Young M, Thomas A. Is There a Problem With Evidence in Health Professions Education? Acad Med 2024:00001888-990000000-00830. [PMID: 38574241 DOI: 10.1097/acm.0000000000005730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume the knowledge produced as evidence might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris' learning loops framework.From a single-loop perspective ("How are we doing?"), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective ("Could we do better?") suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more systemwide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective ("Are we asking the right questions?") highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations, as well as influencing decisions.
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Affiliation(s)
- Rachel H Ellaway
- R.H. Ellaway is professor, Department of Community Health Sciences, and director, Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: orcid.org/0000-0002-3759-6624
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: orcid.org/0000-0001-9591-5243
| | - Jonathan Sherbino
- J. Sherbino is professor, Department of Medicine, and assistant dean of health professions education research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lauren A Maggio
- L.A. Maggio is professor, Department of Medicine and Health Professions Education, Uniformed Services University, Bethesda, Maryland; ORCID: orcid.org/0000-0002-2997-6133
| | - Anthony R Artino
- A.R. Artino Jr is professor, Department of Health, Human Function, and Rehabilitation Sciences, and associate dean for educational research, School of Medicine and Health Sciences, George Washington University, Washington, DC; ORCID: orcid.org/0000-0003-2661-7853
| | - Laura Nimmon
- L. Nimmon is scientist, Centre for Health Education Scholarship, and associate professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: orcid.org/0000-0002-7291-603X
| | - Yoon Soo Park
- Y.S. Park is Ilene B. Harris Endowed Professor and head, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: orcid.org/0000-0001-8583-4335
| | - Meredith Young
- M. Young is associate professor, Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ORCID: orcid.org/0000-0002-2036-2119
| | - Aliki Thomas
- A. Thomas is associate professor, School of Physical and Occupational Therapy and Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; ORCID: orcid.org/0000-0001-9807-6609
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Stalmeijer RE, Brown MEL, O'Brien BC. How to discuss transferability of qualitative research in health professions education. Clin Teach 2024:e13762. [PMID: 38497107 DOI: 10.1111/tct.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
Transferability is commonly identified as a quality criterion for qualitative research. This criterion was introduced by Lincoln and Guba to describe the degree to which a study's findings can be transferred to other contexts, settings or respondents. In this How To paper, we present a more nuanced, multidimensional view of transferability and explain relevant concepts, reflexive approaches and specific techniques to guide researchers in discussing transferability. We identify three dimensions of transferability for use in many approaches to qualitative research: applicability, resonance and theoretical engagement. Transferability as applicability relates to providing sufficient information for readers to evaluate the relevance of findings to other contexts. Transferability as resonance requires the researcher to present the research in a way that evokes a sense of familiarity or shared experience. Transferability as theoretical engagement refers to ways the researcher uses theory to frame a problem, connects findings to existing constructs and/or proposes a model or theory that could explain a process or phenomenon. We encourage researchers to consider all three dimensions of transferability when developing and presenting their work, keeping in mind that some dimensions may be more relevant than others based on study methodology and project goals.
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Affiliation(s)
- Renée E Stalmeijer
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Erickson JA, O'Brien BC, Nouri S. How Primary Care Clinicians Process Patient Death: Logistics, Emotions, and Opportunities for Structural Support. J Gen Intern Med 2024:10.1007/s11606-024-08702-0. [PMID: 38459411 DOI: 10.1007/s11606-024-08702-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Navigating the logistics and emotional processing of a patient's death is an inevitable part of many physicians' roles. While research has primarily examined how inpatient clinicians cope with patient loss, little work has explored how primary care clinicians (PCCs) handle patient death in the outpatient setting, and what support resources could help PCCs process loss. OBJECTIVE To explore PCCs' experiences with the logistics and emotional processing of patient deaths and suggestions for supportive resources. DESIGN Qualitative study using semi-structured interviews conducted between March and May 2023. PARTICIPANTS Recruitment emails were sent to 136 PCCs (physicians and nurse practitioners) at three San Francisco academic primary care clinics. Twelve clinicians participated in the study. APPROACH This study used a template analysis approach. Interview transcripts were analyzed in an iterative fashion to identify themes for how PCCs navigate patient death. RESULTS Participants (n=12) described outpatient death notification as inconsistent, delayed, and rife with uncertainty regarding subsequent actions. They felt various emotions, notably sadness and guilt, especially with deaths of young, vulnerable patients or those from preventable illnesses. Participants identified strategies for emotional processing and recommended improvements including clear procedural guidance, peer debriefings, and formal acknowledgements of deceased patients. CONCLUSIONS Interviewing PCCs about their experiences following a patient death revealed key themes in logistical and emotional processing, and clinic resource recommendations to better support PCCs. Given the distinct characteristics of primary care-such as enduring patient relationships, greater isolation in ambulatory settings compared to inpatient environments, and rising burnout rates-enhancing guidance and support for PCCs is crucial to mitigate administrative burdens and grief after patient loss.
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Affiliation(s)
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Center for Faculty Educators, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Cianciolo AT, O'Brien BC, Klamen DL, Mellinger J. Building on Strengths: An Affirmational and Systems-Level Approach to Revisiting Character in Medicine. Acad Med 2024:00001888-990000000-00767. [PMID: 38466581 DOI: 10.1097/acm.0000000000005670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
ABSTRACT Although U.S. medical education has continued to place increased emphasis on defining competency standards and ensuring accountability to the public, health care inequities have persisted, several basic health outcomes have worsened, public trust in the health care system has eroded, and moral distress, burnout, and attrition among practicing physicians have escalated. These opposing trends beg the question of how the "good doctor" concept may be strengthened. In this perspective, the authors argue that revisiting the construct of physician character from an affirmational perspective could meaningfully improve medical education's impact on overall health by more holistically conceptualizing what-and who-a good doctor is. The authors introduce positive psychology's framework of character strengths, probe the distinction between character strengths and medical professionalism, and summarize the role of character strengths in promoting physician engagement and well-being in health care work. They contend that a systems-level approach to cultivating character strengths will foster physician moral agency and well-being and, by extension, transformational change in health care. Consistent with best practice in modern character education, the authors propose that institutions mindfully cultivate moral community among all stakeholders (students, faculty, staff, postgraduate trainees, and patients) and that moral community interaction centers on each member's personal aspirations with respect to living a good life, guided by the character strengths framework and informed by patient perspectives.
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Affiliation(s)
- Anna T Cianciolo
- A.T. Cianciolo is professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois; ORCID: https://orcid.org/0000-0001-5948-9304
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Department of Medicine, and education scientist, Center for Faculty Educators, School of Medicine, University of California, San Francisco, California; ORCID: https://orcid.org/0000-0001-9591-5243
| | - Debra L Klamen
- D.L. Klamen is professor and chair, Department of Medical Education, and senior associate dean for education and curriculum, Southern Illinois University School of Medicine, Springfield, Illinois; ORCID: https://orcid.org/0000-0001-5471-6635
| | - John Mellinger
- J. Mellinger is vice president, American Board of Surgery, and professor emeritus, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois; ORCID: https://orcid.org/0000-0002-4230-311X
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Ajjawi R, Bearman M, Luong V, O'Brien BC, Varpio L. Researching lived experience in health professional education. Med Educ 2024. [PMID: 38439162 DOI: 10.1111/medu.15361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Qualitative approaches have flourished in medical education research. Many research articles use the term 'lived experience' to describe the purpose of their study, yet we have noticed contradictory uses and misrepresentations of this term. In this conceptual paper, we consider three sources of these contradictions and misrepresentations: (1) the conflation of perspectives with experiences; (2) the conflation of experience with lived experience; and (3) the conflation of researching lived experience with phenomenology. We offer suggestions to facilitate more precise use of terminology. ARGUMENT Our starting point is to free researchers from unnecessary shackles: Not every problem in medical education should be studied through experience, nor should every study of experience be phenomenological. Data based on participants' perceptions, beliefs, opinions and thoughts, while based on reflections of experiences, are not in and of themselves accounts of experience. Lived experiences are situated, primal and pre-reflective; perspectives are more abstract. Lived experience-as opposed to experiences as such-deeply attune to bodies, relationality, space and time. There is also a difference between experiences as lived, how a person makes sense of these and what the researcher interprets and represents. Phenomenology is a meaningful approach to the study of lived experience, but other approaches, such as narrative inquiry and self-study, can also offer useful avenues for undertaking this type of research. DISCUSSION We aim to broaden researchers' scope with this paper and equip researchers with the information they need to be clear about the meaning and use of the terms experience and lived experience. We also hope to open new methodological possibilities for researching experiences as lived and, through highlighting tensions, to prompt researchers of lived experience to strive for ontological closeness and resonance.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia
| | - Victoria Luong
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bridget C O'Brien
- Center for Faculty Educators and Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lara Varpio
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Boscardin C, Larsen D, O'Brien BC, Hauer KE. How Teachers Can Promote Assessment for Learning During All Phases of Learning. Acad Med 2024; 99:122. [PMID: 36972113 DOI: 10.1097/acm.0000000000005219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Assessment for Learning (AFL) includes all educational activities designed to improve teaching and learning through gathering, sharing, and acting on information. AFL expands on the concept of formative assessment-which focuses mainly on an in-the-moment assessment activity-to include all processes that facilitate teachers and learners actively seeking and interpreting evidence to guide learning. AFL involves teachers and learners as partners and uses evidence to identify what the learner needs to learn (planning), review where the learner is in their learning (observing), and strategize how to maximize learning (supporting). 1 We provide the following guidelines for teachers to implement AFL within these 3 phases of a learning activity. Teachers should tailor their choice of AFL strategies to suit their relationship with the learner and learning environment context, aiming to support the development of self-regulated learning and metacognitive skills.
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Fulton TB, Nixon LJ, Wilson-Delfosse AL, Harris DM, Ngo KD, Fall LH, O'Brien BC. Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design. Med Teach 2023:1-7. [PMID: 38100767 DOI: 10.1080/0142159x.2023.2289848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them. MATERIALS AND METHODS We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project. RESULTS BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions. CONCLUSIONS BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - L James Nixon
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - David M Harris
- Department of Medical Education, University of Central Florida, Orlando, FL, USA
| | - Khiet D Ngo
- Departments of Medical Education and Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Departments of Pediatrics and Undergraduate Medical Education, University of California, Riverside, CA, USA
| | - Leslie H Fall
- Center for Medical Education, Case Western Reserve University, Cleveland, OH, USA
- Aquifer, Inc, Hanover, NH, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, CA, USA
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Maristany D, Hauer KE, Leep Hunderfund AN, Elks ML, Bullock JL, Kumbamu A, O'Brien BC. The Problem and Power of Professionalism: A Critical Analysis of Medical Students' and Residents' Perspectives and Experiences of Professionalism. Acad Med 2023; 98:S32-S41. [PMID: 37983394 DOI: 10.1097/acm.0000000000005367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Professionalism has historically been viewed as an honorable code to define core values and behaviors of physicians, but there are growing concerns that professionalism serves to control people who do not align with the majority culture of medicine. This study explored how learners, particularly those from historically marginalized groups, view the purpose of professionalism and how they experience professionalism as both an oppressive and valuable force. METHOD The authors conducted a qualitative study with a critical orientation. In 2021 and 2022, they interviewed fourth-year medical students and senior residents at 3 institutions about their perceptions and experiences of professionalism. After cataloguing participants' stories, the authors combined critical theory with narrative and thematic analysis to identify mechanisms by which professionalism empowered or disempowered individuals or groups based on identities. RESULTS Forty-nine trainees (31 medical students and 18 senior residents from multiple specialties) participated in interviews; 17 identified as a race/ethnicity underrepresented in medicine and 15 as people of color not underrepresented in medicine. Their stories, especially those of participants underrepresented in medicine, identified professionalism as an oppressive, homogenizing force that sometimes encoded racism through various mechanisms. These mechanisms included conflating differences with unprofessionalism, enforcing double standards of professionalism, and creating institutional policies that regulated appearance or hindered advocacy. Participants described deleterious consequences of professionalism on their learning and mental health. However, participants also described useful aspects of professionalism as a means of advocating for marginalized groups. Additionally, participants described how they reconceived professionalism to include their own identities and values. CONCLUSIONS Trainees, especially those from historically marginalized groups, experience professionalism as a restrictive, assimilative force while also finding value in and constructive adaptations for professionalism. Understanding both the destructive and empowering aspects of professionalism on individual and institutional levels can help improve the framing of professionalism in medical education.
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Affiliation(s)
- Daniela Maristany
- D. Maristany is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0009-0000-3928-3608
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
| | - Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and medical director, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-7784-504X
| | - Martha L Elks
- M.L. Elks is professor of medical education and senior associate dean of educational affairs, Morehouse School of Medicine, Atlanta, Georgia; ORCID: https://orcid.org/0000-0003-2239-025X
| | - Justin L Bullock
- J.L. Bullock is a research fellow, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4240-9798
| | - Ashok Kumbamu
- A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2538-2618
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-3050-0108
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Fulton TB, Collins S, van der Schaaf M, O'Brien BC. Connecting Biochemistry Knowledge to Patient Care in the Clinical Workplace: Senior Medical Students' Perceptions about Facilitators and Barriers. Teach Learn Med 2023; 35:398-410. [PMID: 35796605 DOI: 10.1080/10401334.2022.2084400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: Medical students have difficulties applying knowledge about biomedical mechanisms learned before clerkships to patient care activities. Many studies frame this challenge as a problem of basic science knowledge transfer predominantly influenced by students' individual cognitive processes. Social cognitive theory would support extending this framing to the interplay between the individual's cognition, the environment, and their behaviors. This study investigates senior medical students' experiences of biochemistry knowledge use during workplace learning and examines how their experiences were influenced by interactions with people and other elements of the clinical learning environment. Approach: The authors used a qualitative approach with a constructivist orientation. From September to November 2020 they conducted semi-structured interviews with 11 fourth-year medical students at one institution who had completed the pre-clerkship curriculum, core clinical clerkships, and the United States Medical Licensing Exam Step 1. The authors identified themes using thematic analysis. Findings: Participants reported that they infrequently used or connected to biochemistry knowledge in workplace patient care activities, yet all had examples of such connections that they found valuable to learning. Most participants felt the responsibility for making connections between biochemistry knowledge and activities in the clinical workplace should be shared between themselves and supervisors, but connections were often recognized and acted on only by the student. Connections that participants described prompted their effort to retrieve knowledge or fill a perceived learning gap. Participants identified multiple barriers and facilitators to connecting, including supervisors' behaviors and perceived knowledge, and "patients seen" in clerkships. Participants also reported learning biochemistry during USMLE Step 1 study that did not connect to patient care activities, underscoring a perception of disconnect. Insights: This study identifies specific personal, social, and physical environmental elements that influence students' perceived use of biochemistry during patient care activities. Though these findings may be most significant for biochemistry, they likely extend to other basic science disciplines. Students' self-directed efforts to connect to their biochemistry knowledge could be augmented by increased social support from clinical supervisors, which in turn likely requires faculty development. Opportunities for connection could be enhanced by embedding into the environment instructional strategies or technologies that build on known authentic connections between biochemistry and "patients seen" in clerkships. These efforts could strengthen student learning, improve clinical supervisors' self-efficacy, and better inform curriculum design.
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Affiliation(s)
- Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sally Collins
- Center for Faculty Educators, University of California, San Francisco, California, USA
| | - Marieke van der Schaaf
- Faculty of Medicine, Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Abstract
PURPOSE Studies of workplace learning largely focus on how individuals (clinicians and trainees) learn in the clinical workplace. By focusing on individuals, these studies miss opportunities to explore the co-constructive nature of learning that may result in clinician-educators and trainees learning alongside each other (co-learning). The purpose of this study was to explore whether and how co-learning occurs in the workplace and what value co-learning holds. METHOD Using a constructivist grounded theory approach, the authors interviewed 34 faculty clinician-educators from 10 specialties at one academic institution to explore whether and how co-learning occurred in their practice and how faculty perceived its value for faculty and for trainees. Interviews were conducted and recorded June to December 2019. Through iterative analysis, the authors refined a conceptual model of co-learning. RESULTS In a 3-part model of co-learning derived from faculty interviews, faculty and trainees jointly identify learning opportunities during work-related activities and choose learning strategies for learning that lead to interpretation and construction of meaning; these activities produce learning outcomes, such as understanding or insight. The model also accounts for asymmetry in experience and position between faculty and trainees. All faculty participants valued co-learning and elucidated barriers and facilitators to using it in the workplace. How faculty managed asymmetries shaped the nature of the co-learning. When faculty worked to lessen asymmetry between teacher and trainee, co-learning was often collaborative. CONCLUSIONS The model of co-learning makes explicit the concept of asymmetry in workplace learning and aids consideration of how related dynamics affect the nature of learning. Faculty must be intentional in managing asymmetries to fully leverage learning opportunities afforded by the workplace.
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Affiliation(s)
- Lindsey Haddock
- L. Haddock is assistant professor, Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Josette Rivera
- J. Rivera is professor, Department of Medicine, Division of Geriatrics, University of California, San Francisco, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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Leep Hunderfund AN, Kumbamu A, O'Brien BC, Starr SR, Dekhtyar M, Gonzalo JD, Rennke S, Ridinger H, Chang A. "Finding My Piece in That Puzzle": A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems. Acad Med 2022; 97:1804-1815. [PMID: 35797546 DOI: 10.1097/acm.0000000000004799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become "systems citizens"), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation. METHOD Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives. RESULTS Most students anticipated enacting one or more systems-related roles as a future physician, categorized as "bottom-up" efforts enacted at a patient or community level (humanist, connector, steward) or "top-down" efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences). CONCLUSIONS This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and director, Learning Environment and Educational Culture, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Ashok Kumbamu
- A. Kumbamu is assistant professor of biomedical ethics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
| | - Stephanie R Starr
- S.R. Starr is associate professor of pediatrics, Mayo Clinic College of Medicine and Science, and director, Science of Health Care Delivery Education, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Michael Dekhtyar
- M. Dekhtyar is research associate, Department of Medical Education, University of Illinois College of Medicine at Chicago; ORCID: https://orcid.org/0000-0002-8548-3624
| | - Jed D Gonzalo
- J.D. Gonzalo is professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/0000-0003-1253-2963
| | - Stephanie Rennke
- S. Rennke is professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Heather Ridinger
- H. Ridinger is assistant professor of medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Chang
- A. Chang is professor of medicine, Division of Geriatrics, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Lee SL, Rees CE, O'Brien BC, Palermo C. Identities and roles through clinician-educator transitions: A systematic narrative review. Nurse Educ Today 2022; 118:105512. [PMID: 36054976 DOI: 10.1016/j.nedt.2022.105512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To synthesise the literature exploring nurse and other clinicians' conceptualisations and experiences of roles and identities as they transition to educator positions and to identify facilitators/barriers to, and consequences of, successful transitions. DESIGN A systematic narrative review of empirical research reporting clinician-educator transitions was conducted from database inception to December 2020. DATA SOURCES Our search employed ERIC, CINAHL, PsycINFO, Scopus, Ovid MEDLINE® Plus, ERIC (ProQuest), and Sociological Abstracts (ProQuest). We used search terms and synonyms relating to 'identity', 'role' and 'transitions'. REVIEW METHODS Using the PRISMA protocol for systematic reviews, we reviewed titles and abstracts for inclusion, then used the Critical Appraisal Skills Program tool to evaluate article quality. We extracted evidence from included articles, synthesising data thematically by exploring similarities and differences between studies. RESULTS We screened 2753 articles. 23 studies (across 25 articles) matched our inclusion criteria, 20 of which included nursing clinician-educator transitions. We identified four themes describing clinician-educator transitions: (i) multiple ways of conceptualising roles and identities, (ii) clinician-educator transitions as complex, emotion-laden processes, (iii) personal, interpersonal, and organisational facilitators and barriers of clinician-educator transitions, and (iv) positive and negative consequences of clinician-educator transitions. CONCLUSION Our review supports deeper understandings of transition processes that can be used by organisations to better support clinicians as they adapt to their new educator roles and identities.
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Affiliation(s)
- Sarah L Lee
- MCSHE, Faculty of Medical, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia.
| | - Charlotte E Rees
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, San Francisco, CA 94143, United States of America.
| | - Claire Palermo
- Faculty of Medical, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia.
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14
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Phinney LB, Fluet A, O'Brien BC, Seligman L, Hauer KE. Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships. Acad Med 2022; 97:1511-1520. [PMID: 35703235 DOI: 10.1097/acm.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation. METHOD This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school's evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school's evaluation system. RESULTS Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning. CONCLUSIONS Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.
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Affiliation(s)
- Lauren B Phinney
- L.B. Phinney is a first-year internal medicine resident, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Angelina Fluet
- A. Fluet is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California
| | - Lee Seligman
- L. Seligman is a second-year internal medicine resident, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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15
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O'Brien BC, Zapata J, Chang A, Pierluissi E. Bridging medical education goals and health system outcomes: An instrumental case study of pre-clerkship students' improvement projects. Perspect Med Educ 2022; 11:179-186. [PMID: 35394613 PMCID: PMC9391531 DOI: 10.1007/s40037-022-00711-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Many medical schools engage students in health system improvement (HSI) efforts. Evaluation of these efforts often focuses on students' learning outcomes and rarely considers the impact on health systems, despite the significant commitment health systems make to these efforts. Our study identified and evaluated system-level outcomes of pre-clerkship medical students' engagement in HSI efforts. METHODS We used an instrumental case study approach to examine the effects of pre-clerkship medical students' engagement in HSI projects as part of a 15-month experiential curriculum. We extracted data from 53 project summaries and posters completed during the 2017-18 academic year and follow-up survey data collected in May 2019 from physician coaches and health system professionals who mentored students, contributed to these projects, and worked in the clinical microsystems where the projects occurred. RESULTS We identified three categories and ten indicators of health system outcomes relevant to medical student engagement in HSI. Using these indicators, our evaluation found multiple benefits to the microsystems in which projects occurred. These included achievement of project aims, perceived immediate and sustained project impact on the health system, and development and implementation of projects with aims that aligned with national and health system priorities. CONCLUSION Evaluation of HSI curricula needs to include effects on health systems so that program design can optimize the experience for all involved. Our study offers a framework others can use to evaluate system-level effects of project-based HSI curricula and shows several ways in which students' engagement can add value to health systems.
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Affiliation(s)
- Bridget C O'Brien
- Department of Medicine and Education Scientist, Center for Faculty Educators, University of California San Francisco, San Francisco, CA, USA.
| | - Josué Zapata
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Anna Chang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edgar Pierluissi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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16
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Konopasky A, O'Brien BC, Artino AR, Driessen EW, Watling CJ, Maggio LA. I, we and they: A linguistic and narrative exploration of the authorship process. Med Educ 2022; 56:456-464. [PMID: 34796535 DOI: 10.1111/medu.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION While authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be a contested space where individuals must exercise agency-a dynamic and emergent process, embedded in context-to negotiate potentially conflicting norms among published criteria, disciplines and informal practices. This study explores how authors narrate their own and others' agency in making authorship decisions. METHOD We conducted a mixed-methods analysis of 24 first authors' accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a 'moral' and 'title' for each account; and (3) dialectic integration of (1) and (2). RESULTS Descriptive statistics suggested that female participants used we subjects and material verbs (of doing) more than men and that full professors used relational verbs (of being and having) more than assistant and associate. Three broad types of agency were narrated: distributed (n = 15 participants), focusing on how resources and work were spread across team members; individual (n = 6), focusing on the first author's action; and collaborative (n = 3), focusing on group actions. These three types of agency contained four subtypes, e.g. supported, contested, task-based and negotiated. DISCUSSION This study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point-the stated rules of the authorship game; this paper offers us a next step-the enacted and narrated approach to the game.
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Affiliation(s)
- Abigail Konopasky
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Center for Health Professions Education, Bethesda, Maryland, USA
- Uniformed Services University, Bethesda, Maryland, USA
| | - Bridget C O'Brien
- School of Medicine, University of California, San Francisco, California, USA
| | - Anthony R Artino
- School of Medicine and Health Sciences, George Washington University, Washington, D.C., USA
| | - Erik W Driessen
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
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17
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Santhosh L, Abdoler E, O'Brien BC, Schwartz B. How do internal medicine subspecialty societies support clinician-educator careers? A qualitative exploratory study. BMC Med Educ 2022; 22:222. [PMID: 35361197 PMCID: PMC8973507 DOI: 10.1186/s12909-022-03287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Internal Medicine (IM) subspecialty professional societies can provide valuable community, recognition, resources, and leadership opportunities that promote career success. Historically, this support focused on clinical and research dimensions of academic careers, but educational dimensions have gained more attention recently. This study explores how IM subspecialty professional societies support their clinician-educator members. METHODS Using a qualitative study with two phases, the authors collected information from each IM subspecialty society's website about support for medical education. Using information from the first phase, we developed an interview guide for subspecialty society leaders. We used inductive thematic analysis to analyze interview transcripts. RESULTS Website analysis identified various mechanisms used by several IM subspecialty societies to promote medical education. These included websites focused on medical education, dedicated medical education poster/abstract sessions at annual meetings, and strategies to promote networking among clinician-educators. Interviews with eight subspecialty society leaders about the professional societies' roles with respect to medical education yielded four main themes: [1] varying conceptions of "medical education" in relation to the society [2] strategies to advance medical education at the society level [3] barriers to recognizing medical education [4] benefits of clinician-educators to the societies. Integrating these themes, we describe recommended strategies for professional societies to better serve clinician-educators. CONCLUSIONS We explore how IM subspecialty societies attend to a growing constituency of clinician-educators, with increasing recognition and support of the career path but persistent barriers to its formalization. These conversations shed light on opportunities for professional subspecialty societies to better serve the needs of their clinician-educator members while also enabling these members to make positive contributions in return.
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Affiliation(s)
- Lekshmi Santhosh
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA.
| | - Emily Abdoler
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA
| | - Brian Schwartz
- Department of Medicine, University of California-San Francisco, CA, San Francisco, USA
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18
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O'Brien BC, Lypson ML, Chan TM, Coverdale J, DeVilbiss MB, West CP, Roberts LW. Academic Olympism and Authorship: Honoring Contributions to Collaborative Scholarship. Acad Med 2022; 97:315-318. [PMID: 35212673 DOI: 10.1097/acm.0000000000004560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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19
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Zhao NW, Haddock LM, O'Brien BC. Are You Thinking What I'm Thinking? Exploring Response Process Validity Evidence for a Workplace-based Assessment for Operative Feedback. J Surg Educ 2022; 79:475-484. [PMID: 34666934 DOI: 10.1016/j.jsurg.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Workplace-based assessments (WBAs) are used in multiple surgical specialties to facilitate feedback to residents as a form of formative assessment. The validity evidence to support this purpose is limited and has yet to include investigations of how users interpret the assessment and make rating decisions (response processes). This study aimed to explore the validity evidence based on response processes for a WBA in surgery. DESIGN Semi-structured interviews explored the reasonings and strategies used when answering questions in a surgical WBA, the System for Improving and Measuring Procedural Learning (SIMPL). Interview questions probed the interpretation of the three assessment questions and their respective answer categories (level of autonomy, operative performance, case complexity). Researchers analyzed transcripts using directed qualitative content analysis to generate themes. SETTING Single tertiary academic medical center. PARTICIPANTS Eight residents and 13 faculty within the Department of Otolaryngology-Head and Neck Surgery participating in a 6-month pilot of SIMPL. RESULTS We identified four overarching themes that that characterized faculty and resident response processes while completing SIMPL: (1) Faculty and resident users had similar content-level interpretations of the questions and corresponding answer choices; (2) Users employed a variety of cognitive, behavioral, and emotional processes to make rating decisions; (3) Contextual factors influenced ratings; and (4) Tensions during interpretation contributed to rating uncertainty. CONCLUSIONS Response processes are a key source of evidence to support the validity for the formative use of WBAs. Evaluating response process evidence should go beyond basic content-level analysis as contextual factors and tensions that arise during interpretation also play a large role in rating decisions. Additional work and a continued critical lens are needed to ensure that WBAs can truly meet the needs for formative assessment.
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Affiliation(s)
- Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco, San Francisco, California; Department of Otolaryngology-Head and Neck Surgery, University of California - Davis, Sacramento, California.
| | - Lindsey M Haddock
- Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Bridget C O'Brien
- Department of Medicine, University of California - San Francisco, San Francisco, California
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20
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Robertson K, Ju M, O'Brien BC, van Schaik SM, Bochatay N. Exploring the role of power during debriefing of interprofessional simulations. J Interprof Care 2022:1-9. [PMID: 35109751 DOI: 10.1080/13561820.2022.2029371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Interprofessional simulation aims to improve teamwork and patient care by bringing participants from multiple professions together to practice simulated patient care scenarios. Yet, power dynamics may influence interprofessional learning during simulation, which typically occurs during the debriefing. This issue has received limited attention to date but may explain why communication breakdowns and conflicts among healthcare teams persist despite widespread adoption of interprofessional simulation. This study explores the role of power during interprofessional simulation debriefings. We collected data through observations of seven interprofessional simulation sessions and debriefings, four focus groups with simulation participants, and four interviews with simulation facilitators. We identified ways in which power dynamics influenced discussions during debriefing and sometimes limited participants' willingness to share feedback and speak up. We also found that issues related to power that arose during interprofessional simulations often went unacknowledged during the debriefing, leaving healthcare professionals unprepared to navigate power discrepancies with other members of healthcare teams in practice. Given that the goal of interprofessional simulation is to allow professionals to learn together about each other, explicitly addressing power in debriefing after interprofessional simulation may enhance learning.
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Affiliation(s)
- Kathryn Robertson
- Department of Pediatrics, University of California, San Francisco, CA, USA
- Department of Pediatrics, Kaiser Permanente, Santa Clara, CA, USA
| | - Mindy Ju
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Naike Bochatay
- Department of Pediatrics, University of California, San Francisco, CA, USA
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21
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Sawatsky AP, O'Brien BC, Hafferty FW. Autonomy and developing physicians: Reimagining supervision using self-determination theory. Med Educ 2022; 56:56-63. [PMID: 34091940 DOI: 10.1111/medu.14580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
In this article, we address the question, 'What is the role of autonomy in physician development?' Medical education is a developmental process, and autonomy plays a motivational role in physician development. Calls for increased supervision of residents have raised concerns that the resulting decreased autonomy might interfere with resident development, leading the authors to explore the relationship between supervision and autonomy. The medical education literature posits a simple inverse relationship between supervision and autonomy. Within competency frameworks, autonomy is operationalised as independence and viewed as the end goal of training. Alternatively, there is emerging empirical literature describing autonomy and supervision as dynamic and developmental constructs and point towards more complex relationship between supervision and autonomy. Self-determination theory (SDT) presents a framework for understanding this dynamic relationship and the role of autonomy in physician development. Within SDT, autonomy is a fundamental psychological need, associated with motivation for learning, self-regulation and an internal locus of control. Supporting learner autonomy can afford learners the opportunity to internalise the values and norms of the profession, leading to an integrated regulation of their behaviours and actions. Conceptualising autonomy through the lens of SDT provides an avenue for education interventions and future research on supervision and autonomy. Educators can integrate supervision and autonomy support in the clinical setting, seeking to motivate learner development by balancing optimal challenge and support and integrating autonomy support with 'hands-on' approaches to supervision. SDT also provides a theoretical framework relevant to current discussions regarding feedback conversations and coaching in medical education. Lastly, conceptualising autonomy using SDT opens new avenues for investigation, exploring the complex relationship between supervision and autonomy and developing efforts to integrate autonomy support with clinical supervision.
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Affiliation(s)
- Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
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22
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Gruenberg K, Abdoler E, O'Brien BC, Schwartz BS, MacDougall C. How do pharmacists select antimicrobials? A model of pharmacists' therapeutic reasoning processes. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Katherine Gruenberg
- Department of Clinical Pharmacy University of California San Francisco San Francisco California USA
| | - Emily Abdoler
- Department of Medicine University of Michigan Ann Arbor Michigan USA
| | - Bridget C. O'Brien
- Department of Medicine University of California San Francisco San Francisco California USA
| | - Brian S. Schwartz
- Department of Medicine University of California San Francisco San Francisco California USA
| | - Conan MacDougall
- Department of Clinical Pharmacy University of California San Francisco San Francisco California USA
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23
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Zaidi Z, Henderson RR, O'Brien BC. Exploring how physician educators approach politically charged topics with learners. Med Educ 2021; 55:1261-1272. [PMID: 34013562 DOI: 10.1111/medu.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/02/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
CONTEXT Medical educators hold and encounter different beliefs and values on politically charged health-related topics such as reproductive rights and immigration. Their views on these topics have implications for how they approach them with learners, yet little work has explored medical educators' views and pedagogical approaches. In this study, we used Hess's approaches to controversial topics (avoidance, denial, privilege, balance) as a guiding conceptual framework to explore physician educators' views on and approaches to politically charged topics. We used this understanding to provide guidance on how best to address politically charged issues within medical education. METHOD We used a constructivist qualitative approach to explore medical educators' approaches to politically charged topics. We interviewed 37 physician educators from two medical schools in different regions of the United States. In these semi-structured interviews, we presented participants with vignettes depicting politically charged topics arising in an educational setting. Participants described and explained their response to each vignette. Interviews were recorded, transcribed and analysed using constructivist-oriented thematic analysis. RESULTS Participants were thoughtful about preparing learners for participation in a professional community that holds certain responsibilities to a politically and culturally diverse society. Although some adopted clear approaches on politically charged topics and declared their stance on the topic to learners, others took a balanced approach, focused only on the medical aspects and withheld their views. The context and location of practice played a role in the approaches participants adopted. Additionally, they had varied views on which topics had a place in medical education. CONCLUSION Our findings provide insights that can help guide medical educators and training programmes in decisions about their role in facilitating conversations about politically charged, health-related topics and helping learners form their own perspectives and approaches to such topics.
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Affiliation(s)
- Zareen Zaidi
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Rebecca R Henderson
- College of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, CA, USA
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24
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Colbert-Getz JM, Bierer SB, Berry A, Bradley E, Han H, Mooney C, Szauter K, Teal CR, Youm J, O'Brien BC. What Is an Innovation Article? A Systematic Overview of Innovation in Health Professions Education Journals. Acad Med 2021; 96:S39-S47. [PMID: 34348369 DOI: 10.1097/acm.0000000000004293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Innovation articles have their own submission category and guidelines in health professions education (HPE) journals, which suggests innovation might be a unique genre of scholarship. Yet, the requirements for innovation submissions vary among journals, suggesting ambiguity about the core content of this type of scholarship. To reduce this ambiguity, the researchers conducted a systematic overview to identify key features of innovation articles and evaluate their consistency in use across journals. Findings from this review may have implications for further development of innovation scholarship within HPE. METHOD In this systematic overview, conducted in 2020, the researchers identified 13 HPE journals with innovation-type articles and used content analysis to identify key features from author guidelines and publications describing what editors look for in innovation articles. The researchers then audited a sample of 39 innovation articles (3/journal) published in 2019 to determine presence and consistency of 12 innovation features within and across HPE journals. Audit findings informed the researchers' evaluation of innovation as a genre in HPE. RESULTS Findings show variability of innovation feature presence within and across journals. On average, articles included 7.8 of the 12 innovation features (SD 2.1, range 3-11). The most common features were description of: how the innovation was implemented (92%), a problem (90%), what was new or novel (79%), and data or outcomes (77%). On average, 5.5 (SD 1.5) out of 12 innovation features were consistently used in articles within each journal. CONCLUSIONS The authors identified common features of innovation article types based on journal guidelines, but there was variability in presence and consistency of these features, suggesting HPE innovations are in an emerging state of genre development. The authors discuss potential reasons for variability within this article type and highlight the need for further discussion among authors, editors, and reviewers to improve clarity.
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Affiliation(s)
- Jorie M Colbert-Getz
- J.M. Colbert-Getz is associate professor and assistant dean of education quality improvement, University of Utah School of Medicine, Salt Lake City, Utah
| | - S Beth Bierer
- S.B. Bierer is associate professor and director of assessment and evaluation, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Andrea Berry
- A. Berry is executive director of faculty life, University of Central Florida College of Medicine, Orlando, Florida
| | - Elizabeth Bradley
- E. Bradley is associate professor of medical education and director of curriculum evaluation, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Heeyoung Han
- H. Han is associate professor, Department of Medical Education, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Christopher Mooney
- C. Mooney is assistant professor of medicine and director of assessment, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Karen Szauter
- K. Szauter is assistant dean of educational affairs, University of Texas Medical Branch, Galveston, Texas
| | - Cayla R Teal
- C.R. Teal is assistant dean of assessment and evaluation, Office of Medical Education, University of Kansas School of Medicine, Kansas City, Kansas
| | - Julie Youm
- J. Youm is assistant dean of education compliance and quality, University of California, Irvine School of Medicine, Irvine, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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25
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Phinney LB, Fluet A, O'Brien BC, Seligman L, Hauer KE. Using Activity Theory to Explore How Changes in a Work-Based Assessment Tool Can Alter Feedback Systems in Clerkships. Acad Med 2021; 96:S212-S213. [PMID: 34705714 DOI: 10.1097/acm.0000000000004322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lauren B Phinney
- Author affiliations: L.B. Phinney, B.C. O'Brien, University of California, San Francisco
| | - Angelina Fluet
- A. Fluet, K.E. Hauer, University of California, San Francisco, School of Medicine
| | - Bridget C O'Brien
- Author affiliations: L.B. Phinney, B.C. O'Brien, University of California, San Francisco
| | - Lee Seligman
- L. Seligman New York-Presbyterian Hospital, Columbia University Irving Medical Center
| | - Karen E Hauer
- A. Fluet, K.E. Hauer, University of California, San Francisco, School of Medicine
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Byerly LK, Floren LC, Yukawa M, O'Brien BC. Getting outside the box: exploring role fluidity in interprofessional student groups through the lens of activity theory. Adv Health Sci Educ Theory Pract 2021; 26:253-275. [PMID: 32705403 DOI: 10.1007/s10459-020-09983-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 07/13/2020] [Indexed: 05/15/2023]
Abstract
Health professionals' roles and scopes often overlap, creating a need for role clarity in interprofessional teamwork. Yet, such clarity does not mean roles are fixed within teams and some literature suggests role flexibility can enhance team functioning. Interprofessional practice competencies and learning activities often emphasize knowledge and definition of roles, but rarely attend to the dynamic nature of roles and influential contextual factors. This study explores role fluidity in interprofessional student groups using an activity theory framework. Using a collective instrumental case study approach, the authors examine the fluidity of one physical therapy (PT) student's role within 3 different interprofessional (medical, pharmacy, PT) student groups completing nursing home patient care plans. Field notes, group debriefing interviews, and care plans were collected and coded from all care planning sessions. Codes mapped to group-specific activity systems that compared role-influencing interactions and tensions. The PT student's role fluidity varied in each group's activity system, influenced primarily by system tensions from implicit rules (e.g., encouraging questions), division of labor (e.g., rigid profession-based task assignment), and tool use (e.g., computers). Attention to modifiable system elements, such as tool use and explicit rules of inclusivity, could foster role fluidity and improve interprofessional teamwork and learning environments.
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Affiliation(s)
- Laura K Byerly
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-475, Portland, OR, 97239, USA.
| | - Leslie C Floren
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Michi Yukawa
- Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Irby DM, O'Brien BC, Stenfors T, Palmgren PJ. Selecting Instruments for Measuring the Clinical Learning Environment of Medical Education: A 4-Domain Framework. Acad Med 2021; 96:218-225. [PMID: 32590472 DOI: 10.1097/acm.0000000000003551] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Learning environments shape the experiences of learners and practitioners, making them an important component of program evaluation. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose. To assist educators with these decisions, the authors compared clinical learning environment instruments based on their characteristics, underlying constructs, and degree to which items reflect 4 domains (personal, social, organizational, material) from a recently developed model for conceptualizing learning environments in the health professions. Building on 3 prior literature reviews as well as a literature search, the authors identified 6 clinically oriented learning environment instruments designed for medical education. They collected key information about each instrument (e.g., number of items and subscales, conceptual frameworks, operational definitions of the learning environment) and coded items from each instrument according to the 4 domains. The 6 instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. Most instruments focused heavily on the organizational and social domains and less on the personal and material domains (half omitted the material domain entirely). The variations in these instruments suggest that educators might consider several guiding questions. How will they define the learning environment and which theoretical lens is most applicable (e.g., personal vitality, sociocultural learning theory)? What aspects or domains of the learning environment do they most wish to capture (e.g., personal support, social interactions, organizational culture, access to resources)? How comprehensive do they want the instrument to be (and correspondingly how much time do they expect people to devote to completing the instrument and how frequently)? Whose perspective do they wish to evaluate (e.g., student, resident, fellow, attending, team, patient)? Each of these considerations is addressed.
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Affiliation(s)
- David M Irby
- D.M. Irby is professor emeritus of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California, and affiliate faculty member, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; ORCID: http://orcid.org/0000-0001-5753-8918
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
| | - Terese Stenfors
- T. Stenfors is associate professor, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; ORCID: http://orcid.org/0000-0002-0854-8631
| | - Per J Palmgren
- P.J. Palmgren is university lecturer and educational scientist, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; ORCID: http://orcid.org/0000-0001-7499-9329
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van Schalkwyk S, O'Brien BC, van der Vleuten C, Wilkinson TJ, Meyer I, Schmutz AMS, Varpio L. Exploring perspectives on health professions education scholarship units from sub-Saharan Africa. Perspect Med Educ 2020; 9:359-366. [PMID: 32930985 PMCID: PMC7718360 DOI: 10.1007/s40037-020-00619-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION There has been a marked increase in institutional structures developed to support health professions education scholarship recently. These health professions education scholarship units (HPESUs) engage in a diverse range of activities. Previous work provided insight into factors that influence the functioning of such units, but data from European, Asian, Latin American, and African contexts was absent, potentially leading to a single world-view informing international standards for HPESUs. This aim of this study was to explore perspectives from sub-Saharan Africa (SSA) in response to this omission. METHODS Situated within an interpretivist paradigm, the research team conducted semi-structured interviews with nine HPESU leaders in SSA, exploring how participants experienced and understood the functioning of their units. Despite efforts to have representation from across the region, most participants were from South Africa. The researchers analysed data thematically using the theory of institutional logics as an analytical frame. RESULTS Several aspects of the HPESUs aligned with the previously identified logics of academic research, service and teaching; and of a cohesive education continuum. By contrast, leaders described financial sustainability as a more prominent logic than financial accountability. DISCUSSION The similarities identified in this study may reflect isomorphism-a process which sees institutions within a similar field becoming more alike, particularly as newer institutions seek to acquire legitimacy within that field. An important caveat, however, is that isomorphism tends to occur across similar institutional contexts, which was not the case in this study. Understanding these differences is key as these HPESUs move to foster scholarship that can respond to the region's unique context.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Bridget C O'Brien
- Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Cees van der Vleuten
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
| | | | - Ilse Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Anna M S Schmutz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lara Varpio
- Department of Medicine and Center for Health Professions Education, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Moore KA, O'Brien BC, Thomas LR. "I Wish They Had Asked": a Qualitative Study of Emotional Distress and Peer Support During Internship. J Gen Intern Med 2020; 35:3443-3448. [PMID: 32232665 PMCID: PMC7728891 DOI: 10.1007/s11606-020-05803-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Interns are vulnerable to emotional distress and burnout. Little is known about the extent to which interns' well-being can be influenced by peer support provided by their senior residents. OBJECTIVE To elucidate contributors to interns' emotional distress and ways that peer support from senior residents may impact intern well-being. DESIGN Qualitative study using semi-structured interviews conducted December 2017-March 2018. PARTICIPANTS Second year residents (n = 11) in internal medicine at a major academic medical center during the data collection period. APPROACH Constructivist grounded theory approach in which transcripts were analyzed in an iterative fashion using constant comparison to identify themes and to create a conceptual model. KEY RESULTS The investigators identified three themes around emotional distress and two themes around resident peer support. Distress was a pervasive experience among participants, caused by a combination of contextual factors that decreased emotional resilience (e.g., sleep deprivation) and acute triggers (e.g., patient death) that led to an abrupt increase in distress. Participants grappled with identity reconciliation throughout internship. Reaching clinical competency reinforced self-efficacy for participants. With regard to peer support, participants recalled that resident support was ad hoc, primarily involving task support and debriefing traumatic events. Participants reflected that their intern experiences shaped their supervisory support style once they became senior residents; they did not perceive any formalized, systematic approach to supporting interns. CONCLUSIONS We propose a model illustrating key points at which near-peers can make an impact in reducing interns' distress and suggest strategies they can use. Given the substantial role peer learning plays in intern development, senior residents can impact their interns by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. A formalized peer support skill-building curriculum for senior residents may empower them to provide more effective support as part of their supervisory efforts.
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Affiliation(s)
- Kendra A Moore
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Center for Faculty Educators, University of California, San Francisco, San Francisco, CA, USA
| | - Larissa R Thomas
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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O'Brien BC, West CP, Coverdale JH, Durning SJ, Roberts LW. On the Use and Value of Reporting Guidelines in Health Professions Education Research. Acad Med 2020; 95:1619-1622. [PMID: 33109958 DOI: 10.1097/acm.0000000000003666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Park YS, Zaidi Z, O'Brien BC. RIME Foreword: What Constitutes Science in Educational Research? Applying Rigor in Our Research Approaches. Acad Med 2020; 95:Si-Sv. [PMID: 32769461 DOI: 10.1097/acm.0000000000003636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Yoon Soo Park
- Y.S. Park is chair, Research in Medical Education (RIME) Program Planning Committee, and director of health professions education research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Zareen Zaidi
- Z. Zaidi is incoming chair, Research in Medical Education (RIME) Program Planning Committee, and associate chief for faculty development, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Bridget C O'Brien
- B.C. O'Brien is immediate past chair, Research in Medical Education (RIME) Program Planning Committee, professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
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Durning SJ, O'Brien BC, West CP, Coverdale J, DeVilbiss MB, Roberts LW. Innovation Reports: Guidance From the Editors. Acad Med 2020; 95:1623-1625. [PMID: 33109959 DOI: 10.1097/acm.0000000000003667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Floren LC, Ten Cate O, Irby DM, O'Brien BC. An interaction analysis model to study knowledge construction in interprofessional education: proof of concept. J Interprof Care 2020; 35:736-743. [PMID: 32811214 DOI: 10.1080/13561820.2020.1797653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A goal of interprofessional clinical learning experiences is to facilitate learning through co-construction of knowledge in support of patient care. Yet, little is known about knowledge construction processes among health professions students working together to care for patients. Understanding knowledge construction processes can guide health professions educators in the design of interventions to support knowledge construction and high-quality learning in clinical placements. In this article, we describe findings from a proof of concept study that explores the feasibility and utility of using Gunawardena's Interaction Analysis Model (IAM) to evaluate health professions students' knowledge construction processes in clinical placements. The IAM has been used to study knowledge construction processes in computer-supported collaborative learning environments, but not in interprofessional education. The IAM describes five phases of knowledge construction - sharing/comparing; exploring dissonance; co-constructing meaning; testing; coming to agreement/applying co-constructed knowledge - each representing a progressively higher-level learning process. Application of the IAM to learner dialogue proved labor-intensive but feasible and useful as a research tool to characterize learners' knowledge construction behaviors. Our findings suggest that the IAM warrants further study and may offer a framework to guide the design of clinical placements and analysis of interprofessional learning behaviors.
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Affiliation(s)
| | - Olle Ten Cate
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Center for Research and Development of Education at University Medical Center Utrecht, Utrecht, The Netherlands
| | - David M Irby
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Bowen JL, Chiovaro J, O'Brien BC, Boscardin CK, Irby DM, Ten Cate O. Exploring current physicians' failure to communicate clinical feedback back to transferring physicians after transitions of patient care responsibility: A mixed methods study. Perspect Med Educ 2020; 9:236-244. [PMID: 32514883 PMCID: PMC7459044 DOI: 10.1007/s40037-020-00585-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION After patient care transitions occur, communication from the current physician back to the transferring physician may be an important source of clinical feedback for learning from outcomes of previous reasoning processes. Factors associated with this communication are not well understood. This study clarifies how often, and for what reasons, current physicians do or do not communicate back to transferring physicians about transitioned patients. METHODS In 2018, 38 physicians at two academic teaching hospitals were interviewed about communication decisions regarding 618 transitioned patients. Researchers recorded quantitative and qualitative data in field notes, then coded communication rationales using directed content analysis. Descriptive statistics and mixed effects logistic regression analyses identified communication patterns and examined associations with communication for three conditions: When current physicians 1) changed transferring physicians' clinical decisions, 2) perceived transferring physicians' clinical uncertainty, and 3) perceived transferring physicians' request for communication. RESULTS Communication occurred regarding 17% of transitioned patients. Transferring physicians initiated communication in 55% of these cases. Communication did not occur when current physicians 1) changed transferring physicians' clinical decisions (119 patients), 2) perceived transferring physicians' uncertainty (97 patients), and 3) perceived transferring physicians' request for communication (12 patients). Rationales for no communication included case contextual, structural, interpersonal, and cultural factors. Perceived uncertainty and request for communication were positively associated with communication (p < 0.001) while a changed clinical decision was not. DISCUSSION Current physicians communicate infrequently with transferring physicians after assuming patient care responsibilities. Structural and interpersonal barriers to communication may be amenable to change. Clarity about transferring physicians' uncertainty and desire for communication back may improve clinical feedback communication.
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Affiliation(s)
- Judith L Bowen
- Department of Medical Education and Clinical Sciences, Elson S Floyd College of Medicine, Washington State University, Spokane, WA, USA.
| | - Joseph Chiovaro
- Department of Medicine, Division of Hospital Medicine, Oregon Health and Science University, and Portland Veterans Affairs Healthcare System, Portland, OR, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Christy Kim Boscardin
- Department of Medicine and Center for Faculty Educators, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - David M Irby
- Department of Medicine and Center for Faculty Educators, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Faculty Educators, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Abdoler EA, O'Brien BC, Schwartz BS. Following the Script: An Exploratory Study of the Therapeutic Reasoning Underlying Physicians' Choice of Antimicrobial Therapy. Acad Med 2020; 95:1238-1247. [PMID: 32379146 DOI: 10.1097/acm.0000000000003498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Physicians frequently prescribe antimicrobials inappropriately, leading to an increase in the rate of resistance, which in turn, harms patients. To better understand why physicians prescribe specific antimicrobials in particular cases, the authors investigated the decision-making processes underlying physicians' antimicrobial choice (i.e., their antimicrobial reasoning). METHOD Applying a clinical reasoning framework, the authors conducted semi-structured, qualitative interviews with a purposive sample of attending physicians in infectious diseases and hospital medicine at 2 hospitals in fall 2018. An interviewer asked participants to describe how they would choose which antimicrobial to prescribe in 3 clinical vignettes, to recall how they chose an antimicrobial in an example from their own practice, and to indicate their steps in antimicrobial selection generally. The authors identified steps and factors in antimicrobial reasoning through thematic analysis of interviews and the note cards that participants used to delineate their general antimicrobial reasoning processes. RESULTS Sixteen participants described 3 steps in the antimicrobial reasoning process: naming the syndrome, delineating pathogens, and selecting the antimicrobial (therapy script). They mentioned 25 different factors in their reasoning processes, which the authors grouped into 4 areas: preexisting patient characteristics, current case features, provider and health care system factors, and treatment principles. Participants used antimicrobial (therapy) scripts that included 14 different drug characteristics. The authors present the steps and factors in a framework for antimicrobial reasoning. CONCLUSIONS Through this exploratory study, the authors identified steps and factors involved in physicians' antimicrobial reasoning process, as well as the content of their antimicrobial (therapy) scripts. They organized all these findings into a framework for antimicrobial decision making. This information may ultimately be adapted into educational tools to improve antimicrobial prescribing across the spectrum of learners and practicing physicians.
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Affiliation(s)
- Emily A Abdoler
- E.A. Abdoler is assistant professor, Department of Medicine, University of Michigan, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-0938-0527
| | - Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0001-9591-5243
| | - Brian S Schwartz
- B.S. Schwartz is professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0003-2852-6808
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Hafferty FW, O'Brien BC, Tilburt JC. Beyond High-Stakes Testing: Learner Trust, Educational Commodification, and the Loss of Medical School Professionalism. Acad Med 2020; 95:833-837. [PMID: 32079955 DOI: 10.1097/acm.0000000000003193] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
With ever-growing emphasis on high-stakes testing in medical education, such as the Medical College Admission Test and the United States Medical Licensing Examination Step 1, there has been a recent surge of concerns on the rise of a "Step 1 climate" within U.S. medical schools. The authors propose an alternative source of the "climate problem" in current institutions of medical education. Drawing on the intertwined concepts of trust and professionalism as organizational constructs, the authors propose that the core problem is not hijacking-by-exam but rather a hijackable learning environment weakened by a pernicious and under-recognized tide of commodification within the U.S. medical education system. The authors discuss several factors contributing to this weakening of medicine's control over its learning environments, including erosion of trust in medical school curricula as adequate preparation for entry into the profession, increasing reliance on external profit-driven sources of medical education, and the emergence of an internal medical education marketplace. They call attention to breaches in the core tenets of a profession-namely a logic that differentiates its work from market and managerial forces, along with related slippages in discretionary decision making. The authors suggest reducing reliance on external performance metrics (high-stakes exams and corporate rankings), identifying and investing in alternative metrics that matter, abandoning the marketization of medical education "products," and attending to the language of educational praxis and its potential corruption by market and managerial lexicons. These steps might salvage some self-governing independence implied in the term "profession" and make possible (if not probable) a recovery of a public trust becoming of the term and its training institutions.
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Affiliation(s)
- Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5604-7268. B.C. O'Brien is professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California. J.C. Tilburt is professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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O'Brien BC, Battista A. Situated learning theory in health professions education research: a scoping review. Adv Health Sci Educ Theory Pract 2020; 25:483-509. [PMID: 31230163 DOI: 10.1007/s10459-019-09900-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/20/2019] [Indexed: 05/18/2023]
Abstract
At a time when cognitive and behavioral theories dominated the landscape of learning theories, Lave and Wenger's situated learning theory (SLT) opened new territory by illuminating social and cultural learning processes. Many researchers and educators in the health professions embraced this theory, but few have considered how SLT has been used and what has been learned or improved through its use in health professions education (HPE). In this scoping review, the authors examine these questions and consider opportunities for future work with SLT in HPE. The authors followed Levac's modified scoping review framework. They conducted a search of CINAHL, ERIC, PubMed, Scopus, and Web of Science for articles referencing SLT or related concepts in HPE between 2006 and 2016. Two reviewers screened all titles and abstracts, then screened full text for inclusion based on substantive treatment of SLT. Two authors extracted, analyzed and synthesized data from the final set of 193 articles. The authors identified two patterns of theory use. One sought an understanding of social learning processes in a specific context. The other aimed to design and/or evaluate interventions associated with communities of practice. These patterns are similar to other literatures (e.g., general education, healthcare, and organizational development) and, according to Lave and Wenger, may reflect confusion about the purpose, stance, and terminology of SLT. The authors discuss their findings in relation to primary source literature and consider opportunities for HPE researchers to employ and contribute to SLT going forward.
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Affiliation(s)
- Bridget C O'Brien
- Department of Medicine, Center for Faculty Educators, University of California, San Francisco, 533 Parnassus Avenue, Suite U-80, Box 0710, San Francisco, CA, 94143, USA.
| | - Alexis Battista
- Graduate Programs in Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4712, USA
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Bowen JL, Boscardin CK, Chiovaro J, Ten Cate O, Regehr G, Irby DM, O'Brien BC. A view from the sender side of feedback: anticipated receptivity to clinical feedback when changing prior physicians' clinical decisions-a mixed methods study. Adv Health Sci Educ Theory Pract 2020; 25:263-282. [PMID: 31552531 DOI: 10.1007/s10459-019-09916-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/30/2019] [Indexed: 05/23/2023]
Abstract
When physicians transition patients, the physician taking over may change the diagnosis. Such a change could serve as an important source of clinical feedback to the prior physician. However, this feedback may not transpire if the current physician doubts the prior physician's receptivity to the information. This study explored facilitators of and barriers to feedback communication in the context of patient care transitions using an exploratory sequential, qualitative to quantitative, mixed methods design. Twenty-two internal medicine residents and hospitalist physicians from two teaching hospitals were interviewed and data were analyzed thematically. A prominent theme was participants' reluctance to communicate diagnostic changes. Participants perceived case complexity and physical proximity to facilitate, and hierarchy, unfamiliarity with the prior physician, and lack of relationship to inhibit communication. In the subsequent quantitative portion of the study, forty-one hospitalists completed surveys resulting in 923 total survey responses. Multivariable analyses and a mixed-effects model were applied to survey data with anticipated receptivity as the outcome variable. In the mixed-effects model, four factors had significant positive associations with receivers' perceived receptivity: (1) feedback senders' time spent on teaching services (β = 0.52, p = 0.02), (2) receivers' trustworthiness and clinical credibility (β = 0.49, p < 0.001), (3) preference of both for shared work rooms (β = 0.15, p = 0.006), and (4) receivers being peers (β = 0.24, p < 0.001) or junior colleagues (β = 0.39, p < 0.001). This study suggests that anticipated receptivity to feedback about changed clinical decisions affects clinical communication loops. Without trusting relationships and opportunities for low risk, casual conversations, hospitalists may avoid such conversations.
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Affiliation(s)
- Judith L Bowen
- Department of Medical Education and Clinical Sciences, Spokane Academic Center, Elson S Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.
- Portland Veterans Affairs Health Care System, Portland, OR, USA.
| | - Christy Kim Boscardin
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
| | - Joseph Chiovaro
- Portland Veterans Affairs Health Care System, Portland, OR, USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olle Ten Cate
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Glenn Regehr
- Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, British Columbia, Canada
| | - David M Irby
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
| | - Bridget C O'Brien
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco, CA, USA
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Sheu L, Hauer KE, Schreiner K, van Schaik SM, Chang A, O'Brien BC. "A Friendly Place to Grow as an Educator": A Qualitative Study of Community and Relationships Among Medical Student Coaches. Acad Med 2020; 95:293-300. [PMID: 31348059 DOI: 10.1097/acm.0000000000002900] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The rise of coaching programs in medical education sparks questions about ways to support physician coaches in learning new educational practices specific to coaching. How coaches learn from one another is of particular interest considering the potential value of social learning. Using communities of practice as a conceptual framework, the authors examine the sense of community and relationships among coaches in a new medical student coaching program, the value of this community, and the facilitators and barriers influencing community development. METHOD In this qualitative study, investigators conducted 34 interviews with physician coaches at 1 institution over 2 years (2017-2018) and observed 36 coach meetings. Investigators analyzed interview transcripts using thematic analysis and used observation field notes for context and refinement of themes. RESULTS Coaches described a sense of community based on regular interactions; shared commitment to medical education; and new roles with similar experiences, joys, and challenges. They valued the sense of camaraderie and support, learning from one another, and opportunities for professional growth that strengthened their identities as educators and enhanced job satisfaction. Facilitators of community included regular meetings, leadership and administrative support, and informal opportunities to interact outside of meetings. Barriers included time constraints and geographic challenges for coaches at off-site locations. CONCLUSIONS The sense of community among coaches was a valued and beneficial part of their coaching experience. Coaches' interactions and relationships promoted skill acquisition, knowledge transfer, professional development, and career satisfaction. Thus, incorporating support for social learning in coaching programs promotes coach faculty development.
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Affiliation(s)
- Leslie Sheu
- L. Sheu is assistant professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K.E. Hauer is associate dean for assessment and professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K. Schreiner is a medical student, George Washington University School of Medicine, Washington, DC. S.M. van Schaik is Baum Presidential Chair of Experiential Learning and professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. A. Chang is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B.C. O'Brien is associate professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
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Maggio LA, Artino AR, Watling CJ, Driessen EW, O'Brien BC. Exploring researchers' perspectives on authorship decision making. Med Educ 2019; 53:1253-1262. [PMID: 31475382 DOI: 10.1111/medu.13950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/28/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Authorship has major implications for researchers' careers. Hence, journals require researchers to meet formal authorship criteria. However, researchers frequently admit to violating these criteria, which suggests that authorship is a complex issue. This study aims to unpack the complexities inherent in researchers' conceptualisations of questionable authorship practices and to identify factors that make researchers vulnerable to engaging in such practices. METHODS A total of 26 North American medical education researchers at a range of career stages were interviewed. Participants were asked to respond to two vignettes, of which one portrayed honorary authorship and the other described an author order scenario, and then to describe related authorship experiences. Data were analysed using thematic analysis. RESULTS Participants conceptualised questionable authorship practices in various ways and articulated several ethically grey areas. Personal and situational factors were identified, including hierarchy, resource dependence, institutional culture and gender; these contributed to participants' vulnerability to and involvement in questionable authorship practices. Participants described negative instances of questionable authorship practices as well as situations in which these practices were used for virtuous purposes. Participants rationalised engagement in questionable authorship practices by suggesting that, although technically violating authorship criteria, such practices could be reasonable when they seemed to benefit science. CONCLUSIONS Authorship guidelines portray authorship decisions as being black and white, effectively sidestepping key dimensions that create ethical shades of grey. These findings show that researchers generally recognise these shades of grey and in some cases acknowledge having bent the rules themselves. Sometimes their flexibility is driven by benevolent aims aligned with their own values or prevailing norms such as inclusivity. At other times participation in these practices is framed not as a choice, but rather as a consequence of researchers' vulnerability to individual or system factors beyond their control. Taken together, these findings provide insights to help researchers and institutions move beyond recognition of the challenges of authorship and contribute to the development of informed, evidence-based solutions.
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Affiliation(s)
- Lauren A Maggio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Anthony R Artino
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christopher J Watling
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Postgraduate Medical Education, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Erik W Driessen
- Department of Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
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Bowen JL, Ilgen JS, Regehr G, Cate OT, Irby DM, O'Brien BC. Reflections From the Rearview Mirror: Internal Medicine Physicians' Reactions to Clinical Feedback After Transitions of Responsibility. Acad Med 2019; 94:1953-1960. [PMID: 31192795 DOI: 10.1097/acm.0000000000002831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Learning from practice is important for continuous improvement of practice. Yet little is known about how physicians assimilate clinical feedback and use it to refine their diagnostic approaches. This study described physicians' reactions to learning that their provisional diagnosis was either consistent or inconsistent with the subsequent diagnosis, identified emotional responses to those findings, and explored potential consequences for future practices. METHOD In 2016-2017, 22 internal medicine hospitalist and resident physicians at Oregon Health & Science University completed semistructured interviews. Critical incident prompts elicited cases of patient care transitions before the diagnosis was known. Interview questions explored participants' subsequent follow-up. Matrix analysis of case elements, emotional reactions, and perceived practice changes was used to compare patterns of responses between cases of confirming versus disconfirming clinical feedback. RESULTS Participants described 51 cases. When clinical feedback confirmed provisional diagnoses (17 cases), participants recalled positive emotions, judged their performance as sufficient, and generally reinforced current approaches. When clinical feedback was disconfirming (34 cases), participants' emotional reactions were mostly negative, frequently tempered with rationalizations, and often associated with perceptions of having made a mistake. Perceived changes in practice mostly involved nonspecific strategies such as "trusting my intuition" and "broadening the differential," although some described case-specific strategies that could be applied in similar contexts in the future. CONCLUSIONS Internists' experiences with posttransition clinical feedback are emotionally charged. Internists' reflections on clinical feedback experiences suggest they are primed to adapt practices for the future, although the usefulness of those adaptations for improving practice is less clear.
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Affiliation(s)
- Judith L Bowen
- J.L. Bowen was professor, Department of Medicine, Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon, at the time of the study. The author is now professor, Department of Medical Education and Clinical Sciences, and associate dean for curriculum, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington; ORCID: https://orcid.org/0000-0001-6914-0413. J.S. Ilgen is associate professor, Department of Emergency Medicine, and associate director, Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, Seattle, Washington. G. Regehr is professor, Department of Surgery, and senior scientist and associate director of research, Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada, and holds an affiliated appointment with the Maastricht University School of Health Professions Education, Maastricht, the Netherlands. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, and adjunct professor of medicine, School of Medicine, University of California, San Francisco, San Francisco, California. D.M. Irby is professor emeritus of medicine, School of Medicine, and senior scholar, Center for Faculty Educators, University of California, San Francisco, San Francisco, California. B.C. O'Brien is associate professor of medicine, School of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California
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O'Brien BC, Karani R, Park YS. Foreword: The Moment of Discovery: How Do You Know When You Hit a Question That's Pure Gold? Acad Med 2019; 94:Si-Siii. [PMID: 31365412 DOI: 10.1097/acm.0000000000002922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is 2019 chair, Research in Medical Education Program Planning Committee, professor, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California. R. Karani is immediate past chair, Research in Medical Education Program Planning Committee, and senior associate dean for undergraduate medical education and curricular affairs and director, Institute for Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York. Y.S. Park is incoming chair, Research in Medical Education Program Planning Committee, associate professor and associate head, Department of Medical Education, and director of research, Office of Educational Affairs, College of Medicine, University of Illinois, Chicago, Illinois
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Abstract
The prospect of a more transparent society sounds promising. Advocates of transparency envision a future in which public trust in institutions and peoples' trust in one another run high because all information worth viewing is readily available and open to scrutiny. As health professionals, administrators, and educators work to enact this vision, careful consideration must be given to complex processes through which transparency occurs. Using examples from the 2019 Academic Medicine Trainee-Authored Letters to the Editor, this Invited Commentary describes two ways of framing transparency. The first, and most common, characterizes transparency as the transmission of information and focuses primarily on the accuracy, objectivity, and comprehensiveness of this information. The second identifies transparency as a social process comprising communicative acts that involve three components: the content, the viewer, and the medium. By calling attention to the relationships, interactions, and materials involved when information is shared, the latter, more social perspective illuminates potential gaps in the current framing of transparency as an ideal and a valued source of knowledge and feedback for health professionals. Calling attention to the complexities of informational transparency, particularly as part of health professions education, may be an important step in efforts to fulfill the goals that likely lie at the heart of transparency efforts-namely, the desire to develop and nurture healthy relationships grounded in honesty and trust.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, and education scientist, Center for Faculty Educators, School of Medicine, University of California, San Francisco, San Francisco, California
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O'Brien BC, Irby DM, Durning SJ, Hamstra SJ, Hu WCY, Gruppen LD, Varpio L. Boyer and Beyond: An Interview Study of Health Professions Education Scholarship Units in the United States and a Synthetic Framework for Scholarship at the Unit Level. Acad Med 2019; 94:893-901. [PMID: 30720531 DOI: 10.1097/acm.0000000000002625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE Health professions education scholarship units (HPESUs) in the United States are large in number and diverse in purpose, activities, and contributions. Although each of these units shares a commitment to scholarship, there is no synthetic framework to accurately represent and evaluate their activities and contributions. This study aimed to provide such a framework. METHOD The authors examined data collected from 11 U.S. HPESU directors. Interviews occurred between April 2015 and February 2016. The research team used a combination of deductive and inductive qualitative techniques to analyze the interview transcripts. The deductive portion drew on Boyer's four-part framework of scholarship; the inductive portion produced a new conceptualization of scholarship at the HPESU level. RESULTS The scholarly activities of HPESUs generally align with Boyer's four types of scholarship-discovery, integration, application, and teaching. However, this categorization fails to capture the interconnectedness and variety of purposes served by these activities. Both are important when considering how best to represent the scholarly contributions made by HPESUs. From their analysis of interviews, the authors developed a three-part framework characterizing HPESU scholarly activities: supporting a scholarly approach to education, supporting educational scholarship within the institution, and supporting HPESU members' scholarship. CONCLUSIONS The authors contend that the three-part, unit-level framework for scholarship constructed in this study brings clarity and understanding to the purpose, activities, and contributions made by HPESUs in the United States. The proposed framework may allow unit directors to better justify and advocate for the resources needed to further promote the work of HPESUs.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor of medicine, Department of Medicine, and senior scholar, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243. D.M. Irby is professor emeritus of medicine, Department of Medicine, and senior scholar, Center for Faculty Educators, University of California, San Francisco, San Francisco, California. S.J. Durning is professor of medicine and director of graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. S.J. Hamstra is vice president, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, adjunct professor, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada, and adjunct professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. W.C.Y. Hu is professor of medical education, School of Medicine, and associate dean for learning and innovation, Western Sydney University, Penrith, New South Wales, Australia; ORCID: http://orcid.org/0000-0002-1711-3808. L.D. Gruppen is professor, Department of Learning Health Sciences, and director, Masters of Health Professions Education Program, University of Michigan Medical School, Ann Arbor, Michigan. L. Varpio is professor of medicine and associate director of research, graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Patel S, O'Brien BC, Dulay M, Earnest G, Shunk RL. Team Retreats for Interprofessional Trainees and Clinic Staff: Accelerating the Development of High-Functioning Teams. MedEdPORTAL 2018; 14:10786. [PMID: 30800986 PMCID: PMC6354790 DOI: 10.15766/mep_2374-8265.10786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/10/2018] [Indexed: 05/29/2023]
Abstract
Introduction Teams are critical to managing the health care needs of patients with part-time trainee providers. High-functioning teams require trusting relationships among trainees and staff and opportunities to learn and practice skills together. Irregular trainee schedules, time-limited training programs, and lack of protected time for team development during clinic can hinder development of high-functioning teams. Methods To provide time for team development, we created an annual half-day team retreat for interprofessional trainees and staff at three San Francisco Veterans Affairs primary care clinics. We used principles of high-functioning teams and relationship-centered communication to develop retreat content, then trained interprofessional faculty members to facilitate and role-model this content. Retreat objectives and content focused on building relationships, establishing team goals, clarifying roles, and learning communication skills. Postretreat surveys and qualitative content analysis of comments and team goals evaluated retreat objectives and opportunities for improvement. Results Between 2011 and 2017, 16 team retreats were attended by 232 interprofessional trainees and 77 unique staff (some attended multiple times). Thirty-seven faculty facilitated. Most participants strongly agreed that they knew their team members better personally and professionally after the retreat (M = 4.7 out of 5, n = 368); 78% of teams (n = 65) submitted SMART goals addressing high-functioning teams. Participants' comments consistently reflected the benefits of protected time for team building. Discussion This team retreat supports team development among trainees and staff on primary care teams by promoting relationship building, role clarity, communication, and team processes. It can be valuable for all interprofessional participants.
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Affiliation(s)
- Shalini Patel
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Chief of Primary Care, San Francisco VA
| | - Bridget C. O'Brien
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Director of Scholarship and Evaluation, Center of Excellence in Primary Care Education, San Francisco VA
| | - Maya Dulay
- Associate Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Director for Clinical Care and Education, San Francisco VA
| | - Gillian Earnest
- Research Data Analyst, University of California, San Francisco, School of Medicine; Research Data Analyst, San Francisco VA
| | - Rebecca L. Shunk
- Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Chief of Staff for Education, San Francisco VA; Co-Director, Center of Excellence for Primary Care Education, San Francisco VA
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Abstract
Transitions are both a blessing and a curse for learning and professional development. While transitions can afford valuable opportunities for growth, they can also burden learners in ways that stymie performance and development. In this Invited Commentary, the author focuses on the transition from medical school to residency-a transition that many believe has tipped too far toward burden. The commentary explores three ways of problematizing the transition to residency. The first is as a transaction problem involving a complex exchange of information among programs and people. The second is as a transfer problem in which learners must apply knowledge in new contexts. The third is a trajectory problem concerning each learner's progression through medical education. The author describes current efforts aligned with each framing of the problem and discusses potential gaps in these efforts that might be addressed through an overarching framing of transitions in medical education as transformative processes. This framing may help the medical educational community think more holistically about the problems and solutions with transitions.
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Affiliation(s)
- Bridget C O'Brien
- B.C. O'Brien is associate professor, Department of Medicine, and educational researcher, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
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Bowen JL, O'Brien BC, Ilgen JS, Irby DM, Ten Cate O. Chart stalking, list making, and physicians' efforts to track patients' outcomes after transitioning responsibility. Med Educ 2018; 52:404-413. [PMID: 29383741 DOI: 10.1111/medu.13509] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
CONTEXT Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients. METHODS Using a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up. RESULTS The authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems. CONCLUSION In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.
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Affiliation(s)
- Judith L Bowen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, and Associate Director, Center for Leadership and Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, California, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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O'Brien BC, Patel SR, Pearson M, Eastburn AP, Earnest GE, Strewler A, Gager K, Manuel JK, Dulay M, Bachhuber MR, Shunk R. Twelve tips for delivering successful interprofessional case conferences. Med Teach 2017; 39:1214-1220. [PMID: 28685632 DOI: 10.1080/0142159x.2017.1344353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Interprofessional case conferences (ICCs) offer an interactive, practical way to engage members of two or more health professions in discussions that involve learning and working together to improve patient care. Well-orchestrated ICCs provide opportunities to integrate interprofessional (IP) education into routine clinical practice. The authors provide 12 tips to support the conceptualization, planning, implementation, facilitation, evaluation, and sustainability of ICCs. They draw from extensive experience as IP educators and facilitators of ICCs and from literature on IP education, case-based learning, small-group facilitation, peer-assisted learning, and learner engagement - all of which offer insights into ICCs but have not been integrated and applied to this context.
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Affiliation(s)
- Bridget C O'Brien
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Shalini R Patel
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Meg Pearson
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Abigail P Eastburn
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Gillian E Earnest
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Anna Strewler
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- c Department of Community Health Systems , School of Nursing, University of California , San Francisco , CA , USA
| | - Krista Gager
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- c Department of Community Health Systems , School of Nursing, University of California , San Francisco , CA , USA
| | - Jennifer K Manuel
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- d Department of Psychiatry, School of Medicine , University of California , San Francisco , CA , USA
| | - Maya Dulay
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Melissa R Bachhuber
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
| | - Rebecca Shunk
- a San Francisco Veterans Affairs Medical Center , San Francisco , CA, USA
- b Department of Medicine, School of Medicine , University of California , San Francisco , CA , USA
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Bowen JL, Ilgen JS, Irby DM, Ten Cate O, O'Brien BC. "You Have to Know the End of the Story": Motivations to Follow Up After Transitions of Clinical Responsibility. Acad Med 2017; 92:S48-S54. [PMID: 29065023 DOI: 10.1097/acm.0000000000001919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Physicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians' motivations to follow up after transitioning responsibilities. METHOD Using a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center. Constant comparative methods guided the qualitative analysis, using motivation theories as sensitizing constructs. RESULTS The authors identified themes that characterized participants' motivations to follow up. Curiosity about patients' outcomes determined whether or not follow-up occurred. Insufficient curiosity about predictable clinical problems resulted in the choice to forgo follow-up. Sufficient curiosity due to clinical uncertainty, personal attachment to patients, and/or concern for patient vulnerability motivated follow-up to fulfill goals of knowledge building and professionalism. The authors interpret these findings through the lenses of expectancy-value (EVT) and self-determination (SDT) theories of motivation. CONCLUSIONS Participants' curiosity about what happened to their patients motivated them to follow up. EVT may explain how participants made choices in time-pressured work settings. SDT may help interpret how follow-up fulfills needs of relatedness. These findings add to a growing body of literature endorsing learning environments that consider task-value trade-offs and support basic psychological needs of autonomy, competency, and relatedness to motivate learning.
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Affiliation(s)
- Judith L Bowen
- J.L. Bowen is professor, Department of Medicine, Oregon Health & Science University, Portland, Oregon. J.S. Ilgen is associate professor, Division of Emergency Medicine, Department of Medicine, and associate director, Center for Leadership & Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington. D.M. Irby is professor, Department of Medicine, University of California, San Francisco, San Francisco, California. O. ten Cate is professor, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor, Department of Medicine, University of California, San Francisco, San Francisco, California. B.C. O'Brien is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
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