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Venktaramana V, Loh EKY, Wong CJW, Yeo JW, Teo AYT, Chiam CSY, Foo DJM, Teo F, Liang J, Raveendran V, Chng LCL, Xiao S, Chong K, Quek SL, Chiang CLL, Toh RQE, Ng CWH, Lim EG, Leong S, Tay KT, Chan A, Chia EWY, Tan LHS, Ong YT, Sheri K, Ng JX, Chin AMC, Zhou JX, Chiam M, Lee ASI, Mason S, Krishna LKR. A systematic scoping review of communication skills training in medical schools between 2000 and 2020. Med Teach 2022; 44:997-1006. [PMID: 35653622 DOI: 10.1080/0142159x.2022.2054693] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Communication skills training (CST) remains poorly represented and prioritised in medical schools despite its importance. A systematic scoping review (SSR) of CST is proposed to better appreciate current variability in their structure, content, and assessment. This is to guide their future design in medical school curricula. METHODS The Systematic Evidence-Based Approach (SEBA) was used to guide concurrent SSRs of teaching and assessment in CST. After independent database searches, concurrent thematic and content analysis of included articles were conducted separately. Resultant themes/categories were combined via the jigsaw perspective to provide a more holistic view of the data. These were then compared to tabulated summaries of the included articles to create funnelled domains. RESULTS 52,300 papers were identified, 150 full-text articles included, and four funnelled domains were identified: Indications, Design, Assessment, and Barriers and Enablers of CST. CSTs confer numerous benefits to physicians and patients. It saw increased confidence, improved diagnostic capabilities and better clinical management, as well as greater patient satisfaction and treatment compliance. Skills may be divided into core, prerequisite competencies, and advanced skills pertinent to more challenging and nuanced scenarios - such as population or setting-specific situations. CST teaching and assessment modalities were found to align with Miller's Pyramid, with didactic teaching gradually infused with experiential approaches to enhance their understanding and integration. A plethora of CST frameworks, teaching and assessment methods were identified and are presented together. CONCLUSION While variable in approach, content and assessment, CST in medical schools often employ stage-based curricula to instil competency-based topics of increasing complexity throughout medical school education. This process builds on the application of prior knowledge and skills, influencing practice and, potentially, the students' professional identity formation. In addition, the institution plays a critical role in overseeing training, ensuring longitudinal guidance and holistic assessments of the students' progress.
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Affiliation(s)
- Vaishnavi Venktaramana
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Eleanor Kei Ying Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Clarissa Jing Wen Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Andrea York Tiang Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Celest Sin Yu Chiam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Dillon Jie Ming Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Faith Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jonathan Liang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Luke Cheng Lin Chng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Shiwei Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Kevin Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Seng Leong Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Shariel Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Amos Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Elisha Wan Ying Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Krish Sheri
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Jun Xuan Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Unit Liverpool, University of Liverpool, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Palliative Care Unit Liverpool, University of Liverpool, Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education Singapore, Dover Park Hospice, Singapore, Singapore
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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC Med Educ 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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3
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Wong MK, Hong DZH, Wu J, Ting JJQ, Goh JL, Ong ZY, Toh RQE, Chiang CLL, Ng CWH, Ng JCK, Cheong CWS, Tay KT, Tan LHS, Ong YT, Chiam M, Chin AMC, Mason S, Radha Krishna LK. A systematic scoping review of undergraduate medical ethics education programs from 1990 to 2020. Med Teach 2022; 44:167-186. [PMID: 34534043 DOI: 10.1080/0142159x.2021.1970729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Ensuring medical students are equipped with essential knowledge and portable skills to face complex ethical issues underlines the need for ethics education in medical school. Yet such training remains variable amidst evolving contextual, sociocultural, legal and financial considerations that inform training across different healthcare systems. This review aims to map how undergraduate medical schools teach and assess ethics. METHODS Guided by the Systematic Evidence-Based Approach (SEBA), two concurrent systematic scoping reviews were carried out, one on ethics teaching and another on their assessment. Searches were conducted on PubMed, Embase, PsycINFO and ERIC between 1 January 1990 and 31 December 2020. Data was independently analysed using thematic and content analysis. RESULTS Upon scrutinising the two sets of full-text articles, we identified 141 articles on ethics teaching and 102 articles on their assessments. 83 overlapped resulting in 160 distinct articles. Similar themes and categories were identified, these include teaching modalities, curriculum content, enablers and barriers to teaching, assessment methods, and their pros and cons. CONCLUSION This review reveals the importance of adopting an interactive, multimodal and interdisciplinary team-teaching approach to ethics education, involving community resource partners and faculty trained in ethics, law, communication, professionalism, and other intertwining healthcare professions. Conscientious effort should also be put into vertically and horizontally integrating ethics into formal medical curricula to ensure contextualisation and application of ethics knowledge, skills and attitudes, as well as protected time and adequate resources. A stage-based multimodal assessment approach should be used to appropriately evaluate knowledge acquisition, application and reflection across various practice settings. To scaffold personalised development plans and remediation efforts, multisource evaluations may be stored in a centralised portfolio. Whilst standardisation of curricula content ensures cross-speciality ethical proficiency, deliberative curriculum inquiry performed by faculty members using a Delphi approach may help to facilitate the narrowing of relevant topics.
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Affiliation(s)
- Mun Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Daniel Zhi Hao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Zhi Yang Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Jared Chuan Kai Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Palliative Medicine, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, United Kingdom
- Cancer Research Centre, University of Liverpool, Liverpool, United Kingdom
- Duke-NUS Medical School, Singapore, Singapore
- Centre of Biomedical Ethics, National University of Singapore, Singapore, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
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Chiam M, Ho CY, Quah E, Chua KZY, Ng CWH, Lim EG, Tan JRM, Wong RSM, Ong YT, Soong YL, Kwek JW, Yong WS, Loh KWJ, Lim C, Mason S, Krishna LKR. Changing self-concept in the time of COVID-19: a close look at physician reflections on social media. Philos Ethics Humanit Med 2022; 17:1. [PMID: 35078488 PMCID: PMC8789479 DOI: 10.1186/s13010-021-00113-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/17/2021] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may have profound effects on their mental and physical health, personal relationships and professional efficacy. METHODS With mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria. RESULTS A total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms. CONCLUSION It is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19's impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as 'compensatory' to one another, with coping mechanisms buffering and fortifying the physician's overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures.
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Affiliation(s)
- Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Chong Yao Ho
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Elaine Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Ruth Si Man Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yoke Lim Soong
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Jin Wei Kwek
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Wei Sean Yong
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Kiley Wei Jen Loh
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Hong DZ, Goh JL, Ong ZY, Ting JJQ, Wong MK, Wu J, Tan XH, Toh RQE, Chiang CLL, Ng CWH, Ng JCK, Ong YT, Cheong CWS, Tay KT, Tan LHS, Phua GLG, Fong W, Wijaya L, Neo SHS, Lee ASI, Chiam M, Chin AMC, Krishna LKR. Postgraduate ethics training programs: a systematic scoping review. BMC Med Educ 2021; 21:338. [PMID: 34107935 PMCID: PMC8188952 DOI: 10.1186/s12909-021-02644-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/21/2020] [Accepted: 03/30/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Molding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure. A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum. METHODS With a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review. RESULTS The first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF). CONCLUSIONS Our systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.
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Affiliation(s)
- Daniel Zhihao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jia Ling Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Zhi Yang Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Mun Kit Wong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Xiu Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Jared Chuan Kai Ng
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Laura Hui Shuen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore General Hospital, Singapore, 169854 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Shirlyn Hui Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228 Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Cr, Singapore, 169610 Singapore
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, L3 9TA Liverpool, UK
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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