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Balmer DF, Rosenblatt SA, Blalock AE. Counternarratives that illuminate faculty agency: A five-year longitudinal qualitative study of physician educators in academic medicine. Med Teach 2024:1-8. [PMID: 38460500 DOI: 10.1080/0142159x.2024.2326096] [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: 08/03/2023] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE Physician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work. METHODS AND MATERIALS We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together. RESULTS In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program. CONCLUSIONS Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators.
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Affiliation(s)
- Dorene F Balmer
- Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samuel A Rosenblatt
- Department of Anaesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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2
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Anderson HL, Abdulla L, Balmer DF, Govaerts M, Busari JO. Inequity is woven into the fabric: a discourse analysis of assessment in pediatric residency training. Adv Health Sci Educ Theory Pract 2024; 29:199-216. [PMID: 37351698 DOI: 10.1007/s10459-023-10260-9] [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: 12/08/2022] [Accepted: 06/18/2023] [Indexed: 06/24/2023]
Abstract
Intrinsic inequity in assessment refers to sources of harmful discrimination inherent in the design of assessment tools and systems. This study seeks to understand intrinsic inequity in assessment systems by studying assessment policies and associated procedures in residency training, using general pediatrics as a discourse case study. Foucauldian discourse analysis (FDA) was conducted on assessment policy and procedure documents. Two authors independently prepared structured analytic notes using guiding questions. Documents and respective analytic notes were subsequently reviewed independently by all authors. Each author prepared further unstructured analytic notes on the documents' discourse. The authors then compared notes and constructed truth statements (i.e., interpretations of what the discourse establishes as true about the construct under study) and sub-strands (i.e., themes) that were repeated and legitimized across the documents via iterative discussion. Based on analysis, the authors constructed two truth statements. These truth statements, "good assessment is equitable assessment," and "everyone is responsible for inequity," conceptualized inequity in assessment as an isolated or individual-level aberration in an otherwise effective or neutral system. Closer examination of the truth statements and sub-strands in the discourse presented an alternative view, suggesting that inequity may in fact not be an aberration but rather an inherent feature of assessment systems.
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Affiliation(s)
- Hannah L Anderson
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Layla Abdulla
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dorene F Balmer
- Director of Research On Education, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Marjan Govaerts
- Department of Educational Development, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Jamiu O Busari
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Leep Hunderfund AN, Schumacher DJ, Fung CC, Sukhera J, Young ME, Balmer DF. Picking Up Where the Authors Left Off: Reading Research in Medical Education. Acad Med 2023; 98:S1-S5. [PMID: 37983388 DOI: 10.1097/acm.0000000000005373] [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: 08/02/2023]
Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is cochair, Research in Medical Education (RIME) Program Planning Committee, and associate professor of neurology and medical director, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Daniel J Schumacher
- D.J. Schumacher is cochair, RIME Program Planning Committee, and tenured professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cha-Chi Fung
- C.-C. Fung is incoming cochair, RIME Program Planning Committee, and associate professor of clinical medical education and vice chair for medical education, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - Javeed Sukhera
- J. Sukhera is incoming cochair, RIME Program Planning Committee, chair of psychiatry, Institute of Living, chief, Department of Psychiatry, Hartford Hospital, and associate clinical professor of psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Meredith E Young
- M.E. Young is immediate past cochair, RIME Program Planning Committee, and associate professor, Institute of Health Science Education, McGill University, Montreal, Quebec, Canada; ORCID: http://orcid.org/0000-0002-2036-2119
| | - Dorene F Balmer
- D.F. Balmer is immediate past cochair, RIME Program Planning Committee, and professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Blalock AE, Balmer DF. Thinking organizationally and longitudinally to understand gender disparities in academic medicine. Med Educ 2023; 57:892-895. [PMID: 37528609 DOI: 10.1111/medu.15171] [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] [Received: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Affiliation(s)
- A Emiko Blalock
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Abstract
PROBLEM Program evaluation approaches that center the achievement of specific, measurable, achievable, realistic, and time-bound goals are common in health professions education (HPE) but can be challenging to articulate when evaluating emergent programs. Principles-focused evaluation is an alternative approach to program evaluation that centers on adherence to guiding principles, not achievement of goals. The authors describe their innovative application of principles-focused evaluation to an emergent HPE program. APPROACH The authors applied principles-focused evaluation to the Children's Hospital of Philadelphia Medical Education Collaboratory, a works-in-progress program for HPE scholarship. In September 2019, the authors drafted 3 guiding principles. In May 2021, they used feedback from Collaboratory attendees to revise the guiding principles: Advance Excellence , Build Bridges , and Cultivate Learning . OUTCOMES In July 2021, the authors queried participants about the extent to which their experience with the Collaboratory adhered to the revised guiding principles. Twenty of the 38 Collaboratory participants (53%) responded to the survey. Regarding the guiding principle Advance Excellence , 9 respondents (45%) reported that the Collaboratory facilitated engagement in scholarly conversation only by a small extent, and 8 (40%) reported it facilitated professional growth only by a small extent. Although some respondents expressed positive regard for the high degree of rigor promoted by the Collaboratory, others felt discouraged because this degree of rigor seemed unachievable. Regarding the guiding principle Build Bridges , 19 (95%) reported the Collaboratory welcomed perspectives within the group. Regarding the guiding principle Cultivate Learning , 19 (95%) indicated the Collaboratory welcomed perspectives within the group and across disciplines, and garnered collaboration. NEXT STEPS Next steps include improving adherence to the principle of Advancing Excellence , fostering a shared mental model of the Collaboratory's guiding principles, and applying a principles-focused approach to the evaluation of multi-site HPE programs.
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Affiliation(s)
- Dorene F. Balmer
- D.F. Balmer is professor, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, and director of research on education, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Hannah Anderson
- H. Anderson is research associate, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel C. West
- D.C. West is professor and associate chair for education, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, and senior director of medical education, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-0909-4213
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Balmer DF, Rhim HJH, Sandhu G. Why, When, How, and Where to Find an Experienced Qualitative Researcher. J Grad Med Educ 2023; 15:6-8. [PMID: 36817534 PMCID: PMC9934819 DOI: 10.4300/jgme-d-22-00916.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- Dorene F. Balmer
- Dorene F. Balmer, PhD, is a Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Co-Director of Research on Education, Children's Hospital of Philadelphia, and Associate Editor, Journal of Graduate Medical Education (JGME)
| | - Hai Jung Helen Rhim
- Hai Jung Helen Rhim, MD, MPH, MHPE, is an Associate Professor of Pediatrics and Director of Educational Innovations, Pediatric Hospitalist, and Program Director, Pediatric Hospital Medicine Fellowship Program, Children's Hospital at Montefiore
| | - Gurjit Sandhu
- Gurjit Sandhu, PhD, is an Associate Professor of Surgery and Learning Health Sciences, Vice Chair for Resident Professional Development, Department of Surgery, University of Michigan Health System, and Associate Editor, JGME
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Obsekov V, Teng C, Balmer DF. EKG Acquisition Curriculum for Pediatric Trainees. J Med Educ Curric Dev 2023; 10:23821205231204758. [PMID: 37822779 PMCID: PMC10563494 DOI: 10.1177/23821205231204758] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Pediatric residency trainees interface with electrocardiograms (EKG) as part of routine clinical care. Depending on workflow and availability of support staff, trainees may be required to obtain EKGs on patients, though training on this skill varies. Our intervention seeks to train incoming pediatric residents on obtaining EKGs from pediatric patients and identifying common problems that may result in acquisition of low-fidelity EKGs. METHODS A team of physicians, EKG technicians, and simulation educators designed a 30-min didactic and experiential learning opportunity for incoming pediatric trainees held prior to their start of clinical responsibilities. During the session, trainees were introduced to the basics of EKG acquisition and common quality issues that arise. Afterwards, they practiced placing EKG leads on a mannequin and a live model. A pre- and post-session survey was utilized to assess the session's utility and participant's learning. RESULTS The intervention was perceived as a valuable experience by participants over the course of 2 years. We found increased participant comfort with performing and troubleshooting EKGs (P<.001). There was a 33% improvement in quality assessment of EKG rhythm strips after the session (P<.001). CONCLUSION Given the importance of EKGs to the care of pediatric patients, it is essential that pediatricians receive adequate training in acquiring and assessing EKG quality. This intervention was deemed to be highly useful with a demonstrated improvement in EKG troubleshooting skills among first year pediatric residents. This session improves learner comfort with essential clinical responsibilities and identification of low-quality EKGs that often warrant repeat testing.
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Affiliation(s)
- Vladislav Obsekov
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Teng
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Dorene F Balmer
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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8
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is cochair, Research in Medical Education (RIME) Program Planning Committee, and professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-406
| | - Meredith E Young
- M.E. Young is cochair, Research in Medical Education (RIME) Program Planning Committee, and associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Andrea N Leep Hunderfund
- A.N.L. Hunderfund is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of neurology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Schumacher
- D. Schumacher is incoming cochair, Research in Medical Education (RIME) Program Planning Committee, and tenured professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zareen Zaidi
- Z. Zaidi is immediate past chair, Research in Medical Education (RIME) Program Planning Committee, and professor, George Washington School of Medicine and Health Sciences, Washington, DC; ORCID: https://orcid.org/0000-0003-4328-5766
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9
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Young M, McOwen K, Balmer DF. RIME Review Process: Unique Challenges and Opportunities. Acad Med 2022; 97:S187. [PMID: 35767357 DOI: 10.1097/acm.0000000000004795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Meredith Young
- associate professor, Institute of Health Sciences Education, McGill University
| | - Katherine McOwen
- senior director of educational affairs, association of American Medical Colleges
| | - Dorene F Balmer
- professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania
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Young ME, Balmer DF, Teal CR, Borges NJ. Coordinating Flight Paths to Facilitate Interorganizational Cooperation, Interdependence, and Autonomy: Considerations for Organizations Supporting Medical Education Research and Scholarship. Acad Med 2022; 97:S8-S10. [PMID: 35947470 DOI: 10.1097/acm.0000000000004915] [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: 06/15/2023]
Affiliation(s)
- Meredith E Young
- M.E. Young is cochair, Research in Medical Education (RIME) Program Planning Committee, and associate professor, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Dorene F Balmer
- D.F. Balmer is cochair, Research in Medical Education (RIME) Program Planning Committee, and professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-406
| | - Cayla R Teal
- C.R. Teal is chair, Medical Education Scholarship, Research Evaluation (MESRE), associate dean for assessment and evaluation, and associate professor, Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-2138-4926
| | - Nicole J Borges
- N.J. Borges is chair-elect, Medical Education Scholarship, Research Evaluation (MESRE), and chair and professor, Department of Medical Education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0003-0167-2725
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11
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Zaidi Z, Sewell JL, Schumacher D, Sukhera J, Hunderfund ANL, Balmer DF, Park YS, Kulasegaram K, Young ME, Fung CC, LaDonna KA. Can I Ask a Question About URiM Awards That I Don't Know the Answer to? Designing an Award for Underrepresented Medical Education Researchers. Acad Med 2022; 97:S4-S7. [PMID: 35947477 DOI: 10.1097/acm.0000000000004902] [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
Meaningful Equity, Diversity, and Inclusion (EDI) efforts may be stymied by concerns about whether proposed initiatives are performative or tokenistic. The purpose of this project was to analyze discussions by the Research in Medical Education (RIME) Program Planning committee about how best to recognize and support underrepresented in medicine (URiM) researchers in medical education to generate lessons learned that might inform local, national, and international actions to implement meaningful EDI initiatives. Ten RIME Program Planning Committee members and administrative staff participated in a focus group held virtually in August 2021. Focus group questions elicited opinions about "if and how" to establish a URiM research award. The focus group was recorded, transcribed, and thematically analyzed. Recognition of privilege, including who has it and who doesn't, underpinned the focus group discussion, which revolved around 2 themes: (1) tensions between optics and semantics, and (2) potential unintended consequences of trying to level the medical education playing field. The overarching storyline threaded throughout the focus group discussion was intentionality. Focus group participants sought to avoid performativity by creating an award that would be meaningful to recipients and to career gatekeepers such as department chairs and promotion and tenure committees. Ultimately, participants decided to create an award that focused on exemplary Equity, Diversity, and Inclusion (EDI) scholarship, which was eventually named the "RIME URiM Research Award." Difficult but productive conversations about EDI initiatives are necessary to advance underrepresented in medicine (URiM) scholarship. This transparent commentary may trigger further critical conversations.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is professor, George Washington School of Medicine and Health Sciences, Washington, DC; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Justin L Sewell
- J.L. Sewell is professor of medicine, University of California San Francisco, San Francisco, California
| | - Daniel Schumacher
- D. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Javeed Sukhera
- J. Sukhera is chair/chief of psychiatry, Institute of Living/Hartford Hospital, and associate clinical professor, Yale University School of Medicine, New Haven, Connecticut
| | | | - Dorene F Balmer
- D.F. Balmer is professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yoon Soo Park
- Y.S. Park is associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts
| | - Kulamakan Kulasegaram
- K. Kulasegaram is a scientist and associate professor, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Meredith E Young
- M.E. Young is associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cha-Chi Fung
- C.-C. Fung is associate professor, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kori A LaDonna
- K.A. LaDonna is assistant professor, Department of Innovation in Medical Education & Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Balmer DF, Klein MD, Li STT, Gusic ME. Program Evaluation's "Next of Kin". Acad Med 2022; 97:1573-1574. [PMID: 36198164 DOI: 10.1097/acm.0000000000004690] [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: 06/16/2023]
Affiliation(s)
| | - Melissa D Klein
- professor of pediatrics, Cincinnati Children's Hospital and University of Cincinnati College of Medicine
| | - Su-Ting T Li
- professor of pediatrics, University of California Davis School of Medicine
| | - Maryellen E Gusic
- professor of medical education and pediatrics, University of Virginia School of Medicine
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Balmer DF, Rama JA, Simpson D. A Standards-Based Checklist for Program Evaluation as Scholarly Activity. J Grad Med Educ 2022; 14:617-618. [PMID: 36274759 PMCID: PMC9580308 DOI: 10.4300/jgme-d-22-00603.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dorene F. Balmer
- Dorene F. Balmer, PhD, is Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Associate Editor, Journal of Graduate Medical Education (JGME)
| | - Jennifer A. Rama
- Jennifer A. Rama, MD, MEd, is Associate Professor of Pediatrics, Baylor College of Medicine
| | - Deborah Simpson
- Deborah Simpson, PhD, is Director of Education–Academic Affairs, Advocate Aurora Health, Adjunct Clinical Professor of Family Medicine, University of Wisconsin School of Medicine and Public Health and Medical College of Wisconsin, and Deputy Editor, JGME
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Congdon M, Clancy CB, Balmer DF, Anderson H, Muthu N, Bonafide CP, Rasooly IR. Diagnostic Reasoning of Resident Physicians in the Age of Clinical Pathways. J Grad Med Educ 2022; 14:466-474. [PMID: 35991115 PMCID: PMC9380621 DOI: 10.4300/jgme-d-21-01032.1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Development of skills in diagnostic reasoning is paramount to the transition from novice to expert clinicians. Efforts to standardize approaches to diagnosis and treatment using clinical pathways are increasingly common. The effects of implementing pathways into systems of care during diagnostic education and practice among pediatric residents are not well described. OBJECTIVE To characterize pediatric residents' perceptions of the tradeoffs between clinical pathway use and diagnostic reasoning. METHODS We conducted a qualitative study from May to December 2019. Senior pediatric residents from a high-volume general pediatric inpatient service at an academic hospital participated in semi-structured interviews. We utilized a basic interpretive qualitative approach informed by a dual process diagnostic reasoning framework. RESULTS Nine residents recruited via email were interviewed. Residents reported using pathways when admitting patients and during teaching rounds. All residents described using pathways primarily as management tools for patients with a predetermined diagnosis, rather than as aids in formulating a diagnosis. As such, pathways primed residents to circumvent crucial steps of deliberate diagnostic reasoning. However, residents relied on bedside assessment to identify when patients are "not quite fitting the mold" of the current pathway diagnosis, facilitating recalibration of the diagnostic process. CONCLUSIONS This study identifies important educational implications at the intersection of residents' cognitive diagnostic processes and use of clinical pathways. We highlight potential challenges clinical pathways pose for skill development in diagnostic reasoning by pediatric residents. We suggest opportunities for educators to leverage clinical pathways as a framework for development of these skills.
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Affiliation(s)
- Morgan Congdon
- Morgan Congdon, MD, MPH, MSEd, is Assistant Professor of Clinical Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Caitlin B. Clancy
- Caitlin B. Clancy, MD, is Assistant Professor of Clinical Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Dorene F. Balmer
- Dorene F. Balmer, PhD, is Professor of Pediatrics and Director of Research on Pediatric Education, Division of General Pediatrics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Hannah Anderson
- Hannah Anderson, MBA, is Clinical Research Associate in Medical Education, Division of General Pediatrics, Children's Hospital of Philadelphia
| | - Naveen Muthu
- Naveen Muthu, MD, MSCE, is Instructor of Clinical Informatics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Christopher P. Bonafide
- Christopher P. Bonafide, MD, MSCE, is Associate Professor of Pediatrics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Irit R. Rasooly
- Irit R. Rasooly, MD, MSCE, is Clinical Instructor of Pediatrics and Clinical Informatics, Division of General Pediatrics, and Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
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Balmer DF, Richards BF. Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research? Adv Health Sci Educ Theory Pract 2022; 27:277-288. [PMID: 34460054 DOI: 10.1007/s10459-021-10068-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA, 19104, USA.
| | - Boyd F Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Anderson HL, Kurtz J, West DC, Balmer DF. Replace, amplify, transform: a qualitative study of how postgraduate trainees and supervisors experience and use telehealth for instruction in ambulatory patient care. BMC Med Educ 2022; 22:118. [PMID: 35193579 PMCID: PMC8861601 DOI: 10.1186/s12909-022-03175-3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Little is known about using telehealth patient visits as an educational mode. Therefore, rapid implementation of telehealth during the COVID-19 pandemic had to be done without understanding how to optimize telehealth for education. With the likely sustained/post-pandemic use of telehealth in ambulatory patient care, filling gaps in our understanding of how telehealth can be used for instruction in this context is critical. This study sought to understand perceptions of pediatric postgraduate trainees and supervisors on the use of telehealth for instruction in ambulatory settings with the goal of identifying effective ways to enhance learning during telehealth visits. METHODS In May-June of 2020, the authors purposefully sampled first- and third-year postgraduate trainees and supervising attendings from pediatric fellowship programs at one institution that implemented telehealth for instructional activities. They conducted semi-structured interviews; interviews lasted a median of 51 min (trainees) and 41 min (supervisors). They conducted interviews and data analysis iteratively until reaching saturation. Using thematic analysis, they created codes and constructed themes from coded data. They organized themes using the Replace-Amplify-Transform (RAT) model, which proposes that technology can replace in-person learning and/or amplify and transform learning. RESULTS First-year trainees (n = 6), third-year trainees (n = 5) and supervisors (n = 6) initially used telehealth to replace in-person learning. However, skills that could be practiced in telehealth visits differed from in-person visits and instructional activities felt rushed or awkward. Trainees and supervisors adapted and used telehealth to amplify learning by enhancing observation and autonomy. They also transformed learning, using telehealth to develop novel skills. CONCLUSIONS To harness telehealth for instructional activities, our findings indicated that trainees and supervisors should shift from using it as a direct replacement for in-person education to taking advantage of novel opportunities to amplify and transform education in PGME. The authors provide data-driven recommendations to help PGME trainees, supervisors and educators capitalize on the educational advantages of telehealth.
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Affiliation(s)
- Hannah L Anderson
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA.
| | - Joshua Kurtz
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
| | - Daniel C West
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Dorene F Balmer
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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17
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is chair, Research in Medical Education (RIME) Program Planning Committee, and professor, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Meredith Young
- M. Young is incoming co-chair, RIME Program Planning Committee, and associate professor in the Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dorene F Balmer
- D.F. Balmer is incoming co-chair, RIME Program Planning Committee, and associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Yoon Soo Park
- Y.S. Park is immediate past chair, RIME Program Planning Committee, associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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Zaidi Z, McOwen KS, Balmer DF, Schumacher DJ, Sukhera J, Young M, Park YS. RIME 60 Years: Celebration and Future Horizons. Acad Med 2021; 96:S13-S16. [PMID: 34348380 DOI: 10.1097/acm.0000000000004296] [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: 06/13/2023]
Abstract
This year marks the 60th anniversary (1961-2021) of Research in Medical Education (RIME). Over the past 6 decades, RIME has selected medical education research to be presented each year at the Association of American Medical Colleges Annual Meeting: Learn Serve Lead and published in a supplement of Academic Medicine. In this article, the authors surveyed RIME chairs from the past 20 years to identify ways that RIME has advanced medical education research and to generate ideas for future directions. RIME chairs described advancements in the rigor and impact of RIME research and the timeliness of the topics, often serving as a driver for cutting-edge research. They highlighted RIME's role in promoting qualitative research, introducing new epistemologies, and encouraging networking as a means of career advancement. Going forward, RIME chairs suggested (1) strengthening collaborations with formal advanced MEd and PhD degree programs, (2) creating formal mentorship channels for junior and minority faculty, and (3) promoting research related to knowledge translation.
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Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is chair, Research in Medical Education (RIME) Program Planning Committee, and professor, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Katherine S McOwen
- K.S. McOwen is senior director of educational affairs, Association of American Medical Colleges, Washington, DC; ORCID: https://orcid.org/0000-0002-1577-0206
| | - Dorene F Balmer
- D.F. Balmer is incoming co-chair, RIME Program Planning Committee, and associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor of pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics, and scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8146-4947
| | - Meredith Young
- M. Young is incoming co-chair, RIME Program Planning Committee, and associate professor, Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada; ORCID: https://orcid.org/0000-0002-2036-2119
| | - Yoon Soo Park
- Y.S. Park is immediate past chair, RIME Program Planning Committee, associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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19
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Balmer DF, Varpio L, Bennett D, Teunissen PW. Longitudinal qualitative research in medical education: Time to conceptualise time. Med Educ 2021; 55:1253-1260. [PMID: 33847408 PMCID: PMC8596518 DOI: 10.1111/medu.14542] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Longitudinal qualitative research is an approach to research that entails generating qualitative data with the same participants over extended periods of time to understand their lived experiences as those experiences unfold. Knowing about dynamic lived experiences in medical education, that is, learning journeys with stops and starts, detours, transitions and reversals, enriches understanding of events and accomplishments along the way. The purpose of this paper is to create access points to longitudinal qualitative research in support of increasing its use in medical education. METHODS The authors explore and argue for different conceptualisations of time: analysing lived experiences through time versus analysing lived experiences cross-sectional or via 2-point follow-up studies and considering time as subjective and fluid as well as objective and fixed. They introduce applications of longitudinal qualitative research from several academic domains: investigating development and formal education; building longitudinal research relationship; and exploring interconnections between individual journeys and social structures. They provide an illustrative overview of longitudinal qualitative research in medical education, and end with practical advice, or pearls, for medical education investigators interested in using this research approach: collecting data recursively; analysing longitudinal data in three strands; addressing mutual reflexivity; using theory to illuminate time; and making a long-term commitment to longitudinal qualitative research. CONCLUSIONS Longitudinal qualitative research stretches investigators to think differently about time and undertake more complex analyses to understand dynamic lived experiences. Research in medical education will likely be impoverished if the focus remains on time as fixed. Seeing things qualitatively through time, where time is fluid and the past, present and future interpenetrate, produces a rich understanding that can move the field forward.
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Affiliation(s)
- Dorene F. Balmer
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lara Varpio
- Department of MedicineCenter for Health Professions EducationUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Deirdre Bennett
- Medical Education UnitSchool of MedicineUniversity College CorkCorkIreland
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
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Affiliation(s)
- Kori A. LaDonna
- Kori A. LaDonna, PhD, is Assistant Professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony R. Artino
- Anthony R. Artino Jr, PhD, is Professor and Associate Dean for Evaluation and Educational Research, The George Washington University School of Medicine and Health Sciences, and Deputy Editor, Journal of Graduate Medical Education
| | - Dorene F. Balmer
- Dorene F. Balmer, PhD, is Associate Professor, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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21
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Balmer DF, Rosenblatt S, Boyer D. Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education. Med Educ 2021; 55:1205-1213. [PMID: 34060657 DOI: 10.1111/medu.14572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 05/28/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice. METHODS 11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2 years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant. RESULTS All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them. DISCUSSION Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Rosenblatt
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donald Boyer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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22
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Thompson PY, Bynum WE, Schumacher DJ, Park YS, Alexandraki I, Balmer DF. Mutual Rewards: Engaging the Field and Creating a Path Toward Academic Journal Editorship. Acad Med 2021; 96:1377-1378. [PMID: 34261862 DOI: 10.1097/acm.0000000000004241] [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
In this commentary, the inaugural cohort of Academic Medicine assistant editors shares their experiences in this role and the value of creating a path toward academic journal editorship for early- and mid-career scholars. They are a group with diverse backgrounds and a common commitment to advance scholarship in medical education. They collectively describe how they have contributed to the journal in multiple ways, reflect on how they navigated onboarding challenges in the midst of a pandemic, and, most important, share why this role matters for the medical education scholarship community. They express how the assistant editor role has been mutually rewarding, allowing the assistant editors to gain entry to academic journal editorship while also serving the journal and its community.
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Affiliation(s)
- Paula Y Thompson
- P.Y. Thompson is administrative director, Research. Innovation. Scholarship. Education. (RISE), Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - William E Bynum
- W.E. Bynum IV is associate professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Yoon Soo Park
- Y.S. Park is associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8583-4335
| | - Irene Alexandraki
- I. Alexandraki is professor and associate dean for medical education, Office of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Dorene F Balmer
- D.F. Balmer is associate professor, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
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23
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Gottlieb-Smith R, Gelb DJ, Becker B, Dymm B, Gutgsell O, Patel N, Balmer DF. Longitudinal Qualitative Study of Career Decision-making of First-Year Medical Students: Why Neurology (or Not)? Neurol Clin Pract 2021; 11:e387-e396. [PMID: 34484935 DOI: 10.1212/cpj.0000000000001071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/19/2021] [Indexed: 11/15/2022]
Abstract
Objective The growing shortage of neurologists is in part due to suboptimal recruitment. Little is known about students' decision making regarding a career in neurology, particularly early in training. Using a longitudinal qualitative approach, we aimed to understand factors that influence first-year medical students' decisions about neurology. Methods We conducted 1-on-1 semistructured interviews with 15 first-year medical students at 1 institution before and after the preclinical neurology course (2018-2019). In the first interview, we asked about career intentions, factors likely to influence specialty choice, and perceptions of neurology. In the second interview, we asked about changes in students' views over the year. Using thematic analysis, we generated codes and clustered coded data into themes. Results The 2 most prominent factors influencing career choice in general were lifestyle and personal interest. No students expressed concerns about lifestyle in neurology. Most students were neutral about neurology or had a positive personal interest, which typically increased after the neurology course. Students frequently worried about content difficulty and the curative potential of neurology. Conclusions Interventions should include early education about the factors important to students in determining specialty choice, including lifestyle, and address potentially negative perceptions of neurology. Increasing time allotment to the preclinical neurology course may combat perception of the content as difficult.
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Affiliation(s)
- Rachel Gottlieb-Smith
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Douglas J Gelb
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Benjamin Becker
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Braydon Dymm
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Olivia Gutgsell
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Namrata Patel
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dorene F Balmer
- Department of Pediatrics (RG-S, NP), and Department of Neurology, University of Michigan (DJG, BB, BD, OG), Ann Arbor; and Department of Pediatrics (DFB), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Cunningham H, Taylor DS, Desai UA, Ender KL, Glickstein J, Krishnan US, Richards BF, Charon R, Balmer DF. Reading the Self: Medical Students' Experience of Reflecting on Their Writing Over Time. Acad Med 2021; 96:1168-1174. [PMID: 33149084 DOI: 10.1097/acm.0000000000003814] [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: 06/11/2023]
Abstract
PURPOSE To investigate students' experience (over time) with meta-reflection writing exercises, called Signature Reflections. These exercises were used to strengthen reflective capacity, as part of a 4-year reflective writing portfolio curriculum that builds on a recognized strategy for reflection (narrative medicine) and employs longitudinal faculty-mentors. METHOD In 2018, the authors conducted 5 focus groups with 18 third-year students from the Columbia University Vagelos College of Physicians and Surgeons class of 2019 to examine students' experience with Signature Reflections. Using an iterative, thematic approach, they developed codes to reflect common patterns in the transcripts, distilled conceptually similar codes, and assembled the code categories into themes. RESULTS Three core themes (safe space, narrative experience, mirror of self) and 1 overarching theme (moving through time) were identified. Students frequently experienced relief at having a safe reflective space that promoted grappling with their fears or vulnerabilities and highlighted contextual factors (e.g., trusted faculty-mentors, protected time) that fostered a safe space for reflection and exploration. They often emphasized the value of tangible documentation of their medical school journey (narrative experience) and reported using Signature Reflections to examine their emerging identity (mirror of self). Overlapping with the core themes was a deep appreciation for the temporal perspective facilitated by the Signature Reflections (moving through time). CONCLUSIONS A longitudinal narrative medicine-based portfolio curriculum with pauses for meta-reflection allowed students, with faculty support, to observe their trajectory through medical school, explore fears and vulnerabilities, and narrate their own growth. Findings suggest that narrative medicine curricula should be required and sufficiently longitudinal to facilitate opportunities to practice the skill of writing for insight, foster relationships with faculty, and strengthen students' temporal perspectives of their development.
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Affiliation(s)
- Hetty Cunningham
- H. Cunningham is associate professor of pediatrics, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0003-1686-0497
| | - Delphine S Taylor
- D.S. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388
| | - Urmi A Desai
- U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Katherine L Ender
- K.L. Ender is assistant professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Julie Glickstein
- J. Glickstein is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Usha S Krishnan
- U.S. Krishnan is professor of pediatrics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0002-5733-6096
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-1864-7238
| | - Rita Charon
- R. Charon is professor of medicine, Department of Medicine, and professor of medical humanities & ethics, Department of Medical Humanities & Ethics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-6003-5219
| | - Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0001-6805-4062
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Caro Monroig AM, Chen HC, Carraccio C, Richards BF, Ten Cate O, Balmer DF. Medical Students' Perspectives on Entrustment Decision Making in an Entrustable Professional Activity Assessment Framework: A Secondary Data Analysis. Acad Med 2021; 96:1175-1181. [PMID: 33239536 DOI: 10.1097/acm.0000000000003858] [Citation(s) in RCA: 3] [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] [Indexed: 06/11/2023]
Abstract
PURPOSE Research on how entrustment decisions are made identifies 5 influential factors (supervisor, trainee, supervisor-trainee relationship, context, task). However, this literature primarily represents the perspective of supervisors in graduate medical education and is conducted outside of an assessment framework where entrustment decisions have consequences for trainees and for patients. To complement the literature, the authors explored how medical students in a pilot program that used an entrustable professional activity (EPA) assessment framework perceived factors influencing entrustment decisions. METHOD The authors conducted a secondary analysis of qualitative data from program evaluation of a pilot project using an EPA assessment framework to advance students through their curriculum and into residency. Data were derived from 8 focus groups conducted over 4 years (2015-2018) with 27 students who shared their experience of learning and supervision in the project. Sensitized by the entrustment literature, the authors coded and analyzed focus group transcripts according to principles of thematic analysis. RESULTS Components of the trainee and supervisor-trainee relationship factors predominated students' perceptions of entrustment decisions. Students directed their own learning by asking for feedback, seeking opportunities to engage in learning, sharing limitations of their knowledge with supervisors, and pushing supervisors to recalibrate assessments when appropriate. Students' agentic actions were facilitated by longitudinal supervisor-trainee relationships wherein they felt comfortable asking for help and built confidence in patient care. Students mentioned components of other factors that influenced entrustment decisions (supervisor, clinical task, clinical context), but did so less frequently and from a nonagentic vantage point. CONCLUSIONS Students' perspectives on entrustment decisions can be derived from their views on learning and supervision in an EPA assessment framework. Their perspectives complement the literature by highlighting students' agentic actions to influence entrustment decisions and promotion of agentic action through practices incorporating longitudinal supervisor-trainee relationships.
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Affiliation(s)
- Angeliz M Caro Monroig
- A.M. Caro Monroig is a pediatric resident, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania. At the time of the study, she was an MD and MPH candidate; ORCID: https://orcid.org/0000-0001-6869-473X
| | - H Carrie Chen
- H.C. Chen is professor of pediatrics and associate dean of assessment and educational scholarship, Georgetown University School of Medicine, Washington, DC; ORCID: https://orcid.org/0000-0003-1663-1598
| | - Carol Carraccio
- C. Carraccio is vice president of competency-based assessment, American Board of Pediatrics, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-5473-8914
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics and director of educational research and scholarship, University of Utah School of Medicine, Salt Lake City, Utah
| | - Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Dorene F Balmer
- D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
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Ten Cate O, Balmer DF, Caretta-Weyer H, Hatala R, Hennus MP, West DC. Entrustable Professional Activities and Entrustment Decision Making: A Development and Research Agenda for the Next Decade. Acad Med 2021; 96:S96-S104. [PMID: 34183610 DOI: 10.1097/acm.0000000000004106] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.
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Affiliation(s)
- Olle Ten Cate
- O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780
| | - Dorene F Balmer
- D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Holly Caretta-Weyer
- H. Caretta-Weyer is assistant professor, Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9783-5797
| | - Rose Hatala
- R. Hatala is professor, Department of Medicine, University of British Columbia, Vancouver, Canada; ORCID: https://orcid.org/0000-0003-0521-2590
| | - Marije P Hennus
- M.P. Hennus is a pediatric intensivist and program director, pediatric intensive care fellowship, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0003-1508-0456
| | - Daniel C West
- D.C. West is professor and senior director of medical education, Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0909-4213
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Balmer DF, Teunissen PW, Devlin MJ, Richards BF. Stability and Change in the Journeys of Medical Trainees: A 9-Year, Longitudinal Qualitative Study. Acad Med 2021; 96:906-912. [PMID: 32852322 DOI: 10.1097/acm.0000000000003708] [Citation(s) in RCA: 3] [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] [Indexed: 05/27/2023]
Abstract
PURPOSE It takes many years for trainees to become physicians-so long that their individual journeys through medical school and residency are seldom systematically studied and thus not well understood. Lack of understanding hinders effective support of future physicians' development across traditional time-bound phases of medical education. The authors initiated a longitudinal qualitative study, tracing a cohort of 6 trainees through the same medical school and 6 different residencies. They asked, how do stability and change characterize the lived experience of trainees through time? METHOD From 2010 to 2019, the authors conducted in-depth interviews every 6 to 12 months with 6 trainees, using reflective prompts about formative events and prior interviews. Data were inductively coded and analyzed in an iterative fashion. By scrutinizing data via time-ordered displays of codes, the authors identified 3 patterns of stability and change, particularly related to constructing careers in medicine. The study originated at a private medical school in New York, New York. RESULTS Patterns in the balance between stability and change were shaped by trainees' career interests. Trainees motivated by stable clinical interests perceived their journey as a "series of stepping-stones." Trainees motivated by evolving clinical interests described disruptive change or "upsets"; however, they were still accommodated by medical education. In contrast, trainees motivated by stable nonclinical (i.e., social science) interests perceived their journey as a "struggle" in residency because of the clinically heavy nature of that phase of training. CONCLUSIONS Based on this descriptive, 9-year study of a small number of trainees, medical education seems to accommodate trainees whose journeys are motivated by clinical interests, even if those clinical interests change through time. Medical education could consider alternatives to time-bound frames of reference and focus on the right time for trainees to integrate clinical and social sciences in medical training.
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Pim W Teunissen
- P.W. Teunissen is professor of workplace learning in healthcare, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, and gynecologist, Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michael J Devlin
- M.J. Devlin is professor of clinical psychiatry, Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Schumacher DJ, Martini A, Kinnear B, Kelleher M, Balmer DF, Wurster-Ovalle V, Carraccio C. Facilitators and Inhibitors to Assessing Entrustable Professional Activities in Pediatric Residency. Acad Pediatr 2021; 21:735-741. [PMID: 33221495 DOI: 10.1016/j.acap.2020.11.013] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Research on entrustable professional activities (EPAs) has focused on EPA development with little attention paid to implementation experiences. This constructivist grounded theory study sought to begin filling this gap by exploring the experiences of pediatric residency programs with implementing EPA-based assessment. METHODS Interviews with 19 program leader and clinical competency committee participants from 13 sites were held between January and July 2019. Participants were asked about their experiences with implementing EPA-based assessment. Data collection and analysis were iterative. RESULTS Participants described a range of facilitators and inhibitors that influenced their efforts to implement EPA-based assessment. These fell into 4 thematic areas: 1) alignment of EPA construct with local views of performance and assessment, 2) assessing EPAs illuminates holes in the residency curriculum, 3) clinical competency committee structure and process impacts EPA-based assessment, and 4) faculty engagement and development drives ability to assess EPAs. Areas described as facilitators by some participants were noted to be inhibitors for others. The sum of a program's facilitators and inhibitors led to more or less ability to assess EPAs on the whole. Finally, the first area functions differently from the others; it can shift the entire balance toward or away from the ability to assess EPAs overall. CONCLUSION This study helps fill a void in implementation evidence for EPA-based assessment through better understanding of facilitators and inhibitors to such efforts.
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Affiliation(s)
- Daniel J Schumacher
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio.
| | - Abigail Martini
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio
| | - Benjamin Kinnear
- Departments of Pediatrics and Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (B Kinnear and M Kelleher), Cincinnati, Ohio
| | - Matthew Kelleher
- Departments of Pediatrics and Medicine, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (B Kinnear and M Kelleher), Cincinnati, Ohio
| | - Dorene F Balmer
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (DF Balmer), Philadelphia, Pa
| | - Victoria Wurster-Ovalle
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine (DJ Schumacher, A Martini, and V Wurster-Ovalle), Cincinnati, Ohio
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Riddle JM, Balmer DF, Simpson D. Effective Presentation of Your Evaluation Results: What, So What, Now What. J Grad Med Educ 2021; 13:281-282. [PMID: 33897963 PMCID: PMC8054579 DOI: 10.4300/jgme-d-21-00161.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Janet M. Riddle
- Janet M. Riddle, MD, is Research Assistant and Professor of Medical Education, University of Illinois Chicago College of Medicine, and Associate Editor, Journal of Graduate Medical Education (JGME)
| | - Dorene F. Balmer
- Dorene F. Balmer, PhD, is Associate Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Deborah Simpson
- Deborah Simpson, PhD, is Director of Education, Academic Affairs Advocate Aurora Health, Adjunct Clinical Professor of Family Medicine, University of Wisconsin School of Medicine and Public Health and Medical College of Wisconsin, and Deputy Editor, JGME
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Balmer DF, Rama JA, Simpson D. Implementing the Evaluation Plan and Analysis: Who, What, When, and How. J Grad Med Educ 2021; 13:129-130. [PMID: 33680313 PMCID: PMC7901627 DOI: 10.4300/jgme-d-20-01523.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
OBJECTIVES To explore interrupters' and interruptees' experiences of interruptions occurring during morning rounds in a PICU in an attempt to understand better how to limit interruptions that threaten patient safety. DESIGN Qualitative ethnographic study including observations, field interviews, and in-depth interviews. SETTING A 55-bed PICU in a free-standing, quaternary-care children's hospital. SUBJECTS PARTICIPANTS Attending physicians, fellow physicians, frontline clinicians (resident physicians and nurse practitioners), and nurses working in the PICU. INTERVENTIONS Data collection occurred in two parts: 1) field observations during morning rounds with brief field interviews conducted with participants involved in an observed interruption and 2) in-depth interviews conducted with selected participants from prior field observations. MEASUREMENTS AND MAIN RESULTS Data were coded using a constant comparative method with thematic analysis, clustering codes into groups, and subsequently into themes. We observed 11 rounding encounters (17 hr of observation and 48 patient encounters), conducting 25 field interviews and eight in-depth interviews. Themes included culture of interruption triage, interruption triage criteria, and barriers to interruption triage. Interruptees desired forming a culture of triage, whereby less-urgent interruptions were deferred until later or addressed through an asynchronous method; this desire was misaligned with interrupters who described ongoing interruption triage based on clinical changes, time-sensitivity, and interrupter comfort, despite not having a formal triage algorithm. Barriers to interruption triage included a lack of situational awareness and experience among interrupters and interruptees. CONCLUSIONS Interrupters and interruptees did not have a shared understanding of the culture of triage within the PICU. Although interrupters attempted to triage interruptions, no formal triage algorithm existed and interruptees did not perceive a triaging culture. Using data from this study, we created a triage algorithm that could inform future studies, potentially decrease unnecessary interruptions, and optimize information sharing for essential interruptions.
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Affiliation(s)
- Samuel A Rosenblatt
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Donald L Boyer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Turner TL, Zenni EA, Balmer DF, Lane JL. How Full Is Your Tank? A Qualitative Exploration of Faculty Volunteerism in a National Professional Development Program. Acad Pediatr 2021; 21:170-177. [PMID: 32619544 DOI: 10.1016/j.acap.2020.06.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Professional development programs (PDPs) within academic professional organizations rely on faculty volunteers, but little is known about the volunteering process and experience. Our aim was to gain insights into the initial decision to volunteer, the experience of volunteering and the decision to re-volunteer or not (ie, remain or leave as a volunteer). The study setting was a PDP of the Academic Pediatric Association, the Educational Scholars Program. METHODS In 2014, 13 Educational Scholars Program faculty members participated in semistructured phone interviews. The authors performed a general inductive analysis of the data, inductively created codes, and analyzed coded data for emergent themes that led to the creation of a model for recruiting and sustaining volunteers. RESULTS Four themes related to the initial volunteer decision and the decision to re-volunteer or not (self-interest and altruism, reputation of the program, relevant skill set, and doability), and 4 themes related to the experience of volunteering (emotional impact, career advancement and professional recognition, professional growth, and doability) emerged. The relationship among the themes led to the creation of a model of volunteering, involving a metaphorical volunteerism "tank" that is full when faculty initially volunteer and subsequently fills or empties as a result of dynamic interplay between the themes for each individual. CONCLUSIONS Leaders of PDPs may find our model of volunteering beneficial for enhancing the emotional and tangible benefits and minimizing the logistical issues of volunteering. This information should contribute to success in recruiting and retaining the volunteers who are essential for developing and sustaining PDPs.
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Affiliation(s)
- Teri L Turner
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza and Texas Children's Hospital (TL Turner), Houston, Tex; Center for Research, Innovation, and Scholarship in Medical Education, Texas Children's Hospital (TL Turner), Houston, Tex.
| | - Elisa A Zenni
- Department of Pediatrics, University of Florida College of Medicine - Jacksonville (EA Zenni)
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and the Children's Hospital of Philadelphia (DF Balmer)
| | - J Lindsey Lane
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado (JL Lane), Aurora, Colo
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Riddle JM, Balmer DF, Simpson D. Blueprinting Evaluation Evidence: Data Sources and Methods. J Grad Med Educ 2020; 12:783-784. [PMID: 33391606 PMCID: PMC7771587 DOI: 10.4300/jgme-d-20-01274.1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Janet M Riddle
- Research Assistant Professor of Medical Education, University of Illinois Chicago College of Medicine
| | - Dorene F Balmer
- Associate Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Deborah Simpson
- Medical Education Program Director, Advocate Aurora Health, Adjunct Clinical Professor of Family Medicine, University of Wisconsin School of Medicine and Public Health and Medical College of Wisconsin
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Li STT, Klein MD, Balmer DF, Gusic ME. Scholarly Evaluation of Curricula and Educational Programs: Using a Systematic Approach to Produce Publishable Scholarship. Acad Pediatr 2020; 20:1083-1093. [PMID: 32653690 DOI: 10.1016/j.acap.2020.07.005] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 07/05/2020] [Indexed: 12/15/2022]
Abstract
The goal of designing innovative curricula and programs in medical education is to create interventions that will change the attitudes, knowledge, skills, and behaviors of learners in order to prepare them to contribute to the health of patients and communities they serve. Systematic evaluation allows curriculum/program developers to optimize their curriculum/program and ensure that the goals of the curriculum/program are met. While curriculum/program evaluation is distinct from educational research, when approached in a rigorous manner, curriculum/program evaluation can be published as educational scholarship. The goal of our paper is to equip readers with tools to apply a scholarly approach to curriculum/program evaluation to produce findings that will advance the field. We start by defining curricula, educational programs, learner assessment, and evaluation. We then briefly describe examples of best practice models for curriculum/program development that incorporate the critical step of planning for evaluation. Building on published work, we distinguish the use of best practice models and conceptual frameworks to inform curriculum/program development and evaluation. More specifically, we outline steps to plan an evaluation that demonstrates WHAT was effective, describes HOW the curriculum/program contributed to the outcomes achieved, and points to WHY the curriculum/program led to the outcomes observed. We conclude with key considerations for publishing findings of an evaluation, including what to include in each section of a manuscript.
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Affiliation(s)
- Su-Ting T Li
- Divsion of Pediatric Hospital Medicine, Department of Pediatrics, University of California Davis (S-TT Li), Sacramento, Calif.
| | - Melissa D Klein
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine (MD Klein), Cincinnati, Ohio
| | - Dorene F Balmer
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania (DF Balmer), Philadelphia, Pa
| | - Maryellen E Gusic
- Departments of Medical Education and Pediatrics, University of Virginia School of Medicine (ME Gusic), Charlottesville, Va
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Schwartz A, Balmer DF, Borman-Shoap E, Chin A, Henry D, Herman BE, Hobday P, Lee JH, Multerer S, Myers RE, Ponitz K, Rosenberg A, Soep JB, West DC, Englander R. Shared Mental Models Among Clinical Competency Committees in the Context of Time-Variable, Competency-Based Advancement to Residency. Acad Med 2020; 95:S95-S102. [PMID: 32769469 DOI: 10.1097/acm.0000000000003638] [Citation(s) in RCA: 4] [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] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate response process validity evidence for clinical competency committee (CCC) assessments of first-year residents on a subset of General Pediatrics Entrustable Professional Activities (EPAs) and milestones in the context of a national pilot of competency-based, time-variable (CBTV) advancement from undergraduate to graduate medical education. METHOD Assessments of 2 EPAs and 8 milestones made by the trainees' actual CCCs and 2 different blinded "virtual" CCCs for 48 first-year pediatrics residents at 4 residency programs between 2016 and 2018 were compared. Residents had 3 different training paths from medical school to residency: time-variable graduation at the same institution as their residency, time-fixed graduation at the same institution, or time-fixed graduation from a different institution. Assessments were compared using ordinal mixed-effects models. RESULTS Actual CCCs assigned residents higher scores than virtual CCCs on milestones and one EPA's supervision levels. Residents who graduated from a different institution than their residency received lower milestone ratings than either group from the same institution; CBTV residents received higher ratings on one milestone (ICS4) and similar ratings on all others compared with non-CBTV residents who completed medical school at the same institution. CONCLUSIONS First-year residents who graduated from CBTV medical school programs were assessed as having the same level of competence as residents who graduated from traditional medical school programs, but response process evidence suggests that members of CCCs may also draw on undocumented personal knowledge of the learner to draw conclusions about resident competence.
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Affiliation(s)
- Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education and research professor, pediatrics, University of Illinois College of Medicine, and network director, Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), Chicago, Illinois
| | - Dorene F Balmer
- D.F. Balmer is associate professor, pediatrics, The Children's Hospital of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Borman-Shoap
- E. Borman-Shoap is vice chair of education, pediatric residency program director, and assistant professor, pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Alan Chin
- A. Chin is assistant clinical professor, pediatrics, University of California, Los Angeles, Mattel Children's Hospital, Los Angeles, California
| | - Duncan Henry
- D. Henry is associate program director for assessment, and clinical competency committee chair, pediatric residency, University of California, San Francisco, San Francisco, California
| | - Bruce E Herman
- B.E. Herman is professor and vice chair of education and residency programs, pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Patricia Hobday
- P. Hobday is assistant professor, pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - James H Lee
- J.H. Lee is associate director, pediatrics residency program, and assistant professor, pediatrics, the David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Sara Multerer
- S. Multerer is director, pediatric residency program, and associate professor, pediatric hospital medicine, University of Louisville Department of Pediatrics and Norton Children's Hospital, Louisville, Kentucky
| | - Ross E Myers
- R.E. Myers is associate director, pediatric residency program, and associate professor, pediatrics, Rainbow Babies and Children's Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Keith Ponitz
- K. Ponitz is director, pediatric residency training program, pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Adam Rosenberg
- A. Rosenberg is professor of pediatrics and program director, pediatric residency, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Jennifer B Soep
- J.B. Soep is associate professor, pediatrics, University of Colorado, Aurora, Colorado
| | - Daniel C West
- D.C. West is professor and associate chair for education, pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Englander
- R. Englander is associate dean, undergraduate medical education, and professor, pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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Balmer DF, Courts KA, Dougherty B, Tuton LW, Abbuhl S, Hirshfield LE. Applying the Theory of Gendered Organizations to the Lived Experience of Women with Established Careers in Academic Medicine. Teach Learn Med 2020; 32:466-475. [PMID: 32458706 DOI: 10.1080/10401334.2020.1767106] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: The number of women who enter medical school has been on par with the number of men for almost 20 years, but parity in training has not translated to equity in professional life. To capitalize on the perspective of women faculty with established careers in academic medicine and to bring theory to the largely descriptive research on gender inequity in academic medicine, the authors used the Theory of Gendered Organizations to demonstrate how academic medical centers function as inherently gendered organizations. Approach: The authors recruited women faculty with established careers at one academic medical center based on purposeful and snowball sampling and interviewed 30 participants in Summer/Fall 2018. They coded and analyzed data inductively. In later stages of analysis they used sensitizing concepts from the Theory of Gendered Organizations to guide our focus on formal expectations of, and informal interactions in, the academic medical center. Findings: The disjuncture, i.e., "lip service", between formal expectations intended to be gender-neutral and informal interactions that advantaged men demonstrated how the academic medical center functioned as a gendered organization. Participants experienced these interactions as being treated differently than men and/or being stereotyped. As their careers progressed, participants recognized gender inequity as embedded in the organization, or as they said, "the way things were stacked". Subsequent to this recognition, they navigated this gendered organization by advocating for themselves and younger women faculty. Insights: Women with established careers in academic medicine experienced gender inequity as embedded in the organization but navigate gendered interactions by advocating for themselves and for younger women. Using the Theory of Gendered Organizations as an analytic lens demonstrates how academic medical centers function as gendered organizations; these findings can inform both theory-based research and pragmatic change strategies.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly A Courts
- St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Bridget Dougherty
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lucy Wolf Tuton
- Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Abbuhl
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura E Hirshfield
- Departments of Medical Education and Sociology, University of Illinois-Chicago, Chicago, USA
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Mink RB, Wininger DA, Turner A, Leslie LK, Balmer DF, Hofkosh D, McGuinness GA, Muchmore EA. Reducing Trainee Stress by Delaying the Pediatric Fellowship Start Date. Pediatrics 2020; 146:peds.2019-3500. [PMID: 32848027 DOI: 10.1542/peds.2019-3500] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Richard B Mink
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles Medical Center, Torrance, California;
| | | | - Adam Turner
- American Board of Pediatrics, Chapel Hill, North Carolina
| | | | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dena Hofkosh
- Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | - Elaine A Muchmore
- Department of Medicine, University of California, San Diego and US Department of Veterans Affairs San Diego Healthcare System, San Diego, California
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Young M, LaDonna K, Varpio L, Balmer DF. Focal Length Fluidity: Research Questions in Medical Education Research and Scholarship. Acad Med 2019; 94:S1-S4. [PMID: 31365400 DOI: 10.1097/acm.0000000000002913] [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: 06/10/2023]
Abstract
Research and scholarship in health professions education has been shaped by intended audience (i.e., producers vs users) and the purpose of research questions (i.e., curiosity driven or service oriented), but these archetypal dichotomies do not represent the breadth of scholarship in the field. Akin to an array of lenses required by scientists to capture images of a black hole, the authors propose the analogy of lenses with different focal lengths to consider how different kinds of research questions can offer insight into health professions research-a microscope, a magnifying glass, binoculars, and telescopes allow us to ask and answer different kinds of research questions. They argue for the relevance of all of the different kinds of research questions (or focal lengths); each provides important insight into a particular phenomenon and contributes to understanding that phenomenon in a different way. The authors propose that research questions can move fluidly across focal lengths. For example, a theoretical question can be made more pragmatic through asking "how" questions ("How can we observe and measure a phenomenon?"), whereas a pragmatic question can be made more theoretic by asking a series of "why" questions ("Why are these findings relevant to larger issues?"). In summary, only through the combination of lenses with different focal lengths, brought to bear through interdisciplinary work, can we fully comprehend important phenomena in health professions education and scholarship-the same way scientists managed to image a black hole.
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Affiliation(s)
- Meredith Young
- M. Young is associate professor, Department of Medicine and Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada. K. LaDonna is assistant professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. L. Varpio is professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania
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Pete Devon E, Tenney-Soeiro R, Ronan J, Balmer DF. A Pediatric Preintern Boot Camp: Program Development and Evaluation Informed by a Conceptual Framework. Acad Pediatr 2019; 19:165-169. [PMID: 30121317 DOI: 10.1016/j.acap.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/10/2018] [Revised: 08/05/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Boot camps are being developed and implemented by a growing number of medical schools to facilitate medical students' transition to internship. However, there is limited conceptual understanding of how this facilitation occurs. METHODS We developed and piloted a 1-week pediatric boot camp in 2015, then significantly revised and evaluated the program in 2016-2017 using a conceptual framework of self-efficacy. Consistent with this framework, the revised boot camp focuses on enhancing practical skills that can ease medical students' transition to internship. Observations and course evaluations informed process evaluation, whereas learner assessments immediately after and at 6 months after the boot camp informed outcomes evaluation in terms of both perceived self-efficacy and confidence. RESULTS Medical students valued sessions that were "hands on," and program improvements were made to include a variety of interactive curricular activities. Data from course evaluations provided evidence of increased perceived self-efficacy. Learner assessment showed a medium to large effect size for confidence in nearly all specific skills that were queried and a positive, albeit attenuated, effect on perceived self-efficacy at 6 months. CONCLUSIONS Program evaluation of a pediatric boot camp informed by a conceptual framework of self-efficacy shed light on how it might facilitate medical students' transition to internship. A similar conceptual framework may be useful for other trainee preparatory courses.
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Affiliation(s)
- Erin Pete Devon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Rebecca Tenney-Soeiro
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jeanine Ronan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pa
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Balmer DF, Darden A, Chandran L, D'Alessandro D, Gusic ME. How Mentor Identity Evolves: Findings From a 10-Year Follow-up Study of a National Professional Development Program. Acad Med 2018; 93:1085-1090. [PMID: 29465451 DOI: 10.1097/acm.0000000000002181] [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] [Indexed: 06/08/2023]
Abstract
PURPOSE Despite academic medicine's endorsement of professional development and mentoring, little is known about what junior faculty learn about mentoring in implicit curricula of professional development programs, and how their mentor identity evolves in this context. The authors explored what faculty-participants in the Educational Scholars Program implicitly learned about mentoring and how the implicit curriculum affected mentor identity transformation. METHOD Semistructured interviews with 19 of 36 former faculty-participants were conducted in 2016. Consistent with constructivist grounded theory, data collection and analysis overlapped. The authors created initial codes informed by Ibarra's model for identity transformation, iteratively revised codes based on incoming data patterns, and created visual representations of relationships amongst codes to gain a holistic, shared understanding of the data. RESULTS In the implicit curriculum, faculty-participants learned the importance of having multiple mentors, the value of peer mentors, and the incremental process of becoming a mentor. The authors used Ibarra's model to understand how the implicit curriculum worked to transform mentor identity: Faculty-participants reported observing mentors, experimenting with different ways to mentor and to be a mentor, and evaluating themselves as mentors. CONCLUSIONS The Educational Scholars Program's implicit curriculum facilitated faculty-participants taking on mentor identity via opportunities it afforded to watch mentors, experiment with mentoring, and evaluate self as mentor, key ingredients for identity construction. Leaders of professional development programs can develop faculty as mentors by capitalizing on what faculty-participants learn in the implicit curriculum and deliberately structuring postgraduation mentoring opportunities.
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062. A. Darden is director of faculty development, Department of Pediatrics, and director, Academy of Teaching Scholars, College of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma. L. Chandran is vice dean for academic and faculty affairs and Distinguished Teaching Professor, Stony Brook University School of Medicine, Stony Brook, New York. D. D'Alessandro is professor of pediatrics, Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa. M.E. Gusic is senior advisor for educational affairs and professor of medical education, University of Virginia School of Medicine, Charlottesville, Virginia
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Cunningham H, Taylor D, Desai UA, Quiah SC, Kaplan B, Fei L, Catallozzi M, Richards B, Balmer DF, Charon R. Looking Back to Move Forward: First-Year Medical Students' Meta-Reflections on Their Narrative Portfolio Writings. Acad Med 2018; 93:888-894. [PMID: 29261540 PMCID: PMC5976514 DOI: 10.1097/acm.0000000000002102] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The day-to-day rigors of medical education often preclude learners from gaining a longitudinal perspective on who they are becoming. Furthermore, the current focus on competencies, coupled with concerning rates of trainee burnout and a decline in empathy, have fueled the search for pedagogic tools to foster students' reflective capacity. In response, many scholars have looked to the tradition of narrative medicine to foster "reflective spaces" wherein holistic professional identity construction can be supported. This article focuses on the rationale, content, and early analysis of the reflective space created by the narrative medicine-centered portfolio at the Columbia University Vagelos College of Physicians and Surgeons. In January 2015, the authors investigated learning outcomes derived from students' "Signature Reflections," end-of-semester meta-reflections on their previous portfolio work. The authors analyzed the Signature Reflections of 97 (of 132) first-year medical students using a constant comparative process. This iterative approach allowed researchers to identify themes within students' writings and interpret the data. The authors identified two overarching interpretive themes-recognition and grappling-and six subthemes. Recognition included comments about self-awareness and empathy. Grappling encompassed the subthemes of internal change, dichotomies, wonder and questioning, and anxiety. Based on the authors' analyses, the Signature Reflection seems to provide a structured framework that encourages students' reflective capacity and the construction of holistic professional identity. Other medical educators may adopt meta-reflection, within the reflective space of a writing portfolio, to encourage students' acquisition of a longitudinal perspective on who they are becoming and how they are constructing their professional identity.
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Affiliation(s)
- Hetty Cunningham
- H. Cunningham is assistant professor of pediatrics, Department of Pediatrics, Columbia University Medical Center, New York, New York; ORCID: http://orcid.org/0000-0003-1686-0497. D. Taylor is associate professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: https://orcid.org/0000-0002-1999-0388. U.A. Desai is assistant professor of medicine, Center for Family and Community Medicine, Columbia University Medical Center, New York, New York. S.C. Quiah is education, assessment, and evaluation specialist, Center for Education Research and Evaluation, Columbia University Medical Center, New York, New York. B. Kaplan is a second-year medical student, University of North Carolina School of Medicine, Chapel Hill, North Carolina. L. Fei is a second-year medical student, Tulane University School of School, New Orleans, Louisiana. M. Catallozzi is assistant professor of pediatrics and population and family health, Columbia University Medical Center, New York, New York. B. Richards is professor of pediatrics and director of education research and scholarship, University of Utah School of Medicine, Salt Lake City, Utah. D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. R. Charon is professor of medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0002-6003-5219
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Balmer DF, Tenney-Soeiro R, Mejia E, Rezet B. Positive Change in Feedback Perceptions and Behavior: A 10-Year Follow-up Study. Pediatrics 2018; 141:peds.2017-2950. [PMID: 29217671 DOI: 10.1542/peds.2017-2950] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Providing and learning from feedback are essential components of medical education, and typically described as resistant to change. But given a decade of change in the clinical context in which feedback occurs, the authors asked if, and how, perceptions of feedback and feedback behaviors might have changed in response to contextual affordances. METHODS In 2017, the authors conducted a follow-up, ethnographic study on 2 general pediatric floors at the same children's hospital where another ethnographic study on a general pediatric floor was conducted in 2007. Data sources included (1) 21 and 34 hours of observation in 2007 and 2017, respectively, (2) 35 and 25 interviews with general pediatric attending physicians and residents in 2007 and 2017, respectively, and (3) a review of 120 program documents spanning 2007 to 2017. Data were coded and organized around 3 recommendations for feedback that were derived from 2007 data and served as standards for assessing change in 2017. RESULTS Data revealed progress in achieving each recommendation. Compared with 2007, participants in 2017 more clearly distinguished between feedback and evaluation; residents were more aware of in-the-moment feedback, and they had shifted their orientation from evaluation and grades to feedback and learning. Explanations for progress in achieving recommendations, which were derived from the data, pointed to institutional and national influences, namely, the pediatric milestones. CONCLUSIONS On the basis of follow-up, ethnographic data, changes in the clinical context of pediatric education may afford positive change in perceptions of feedback and feedback behavior and point to influences within and beyond the institution.
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Affiliation(s)
- Dorene F Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and .,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca Tenney-Soeiro
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Erika Mejia
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Rezet
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Affiliation(s)
- Dorene F Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Boyd F Richards
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Tucker MB, Balmer DF, Gowda D. Impact of Explicit, Implicit, and Extra Curricula on Students’ Learning of the History and Physical Examination. MedEdPublish 2017. [DOI: 10.15694/mep.2017.000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. Purpose : History taking and physical examination (H&P) in a patient-centered manner is central to the practice of medicine. This qualitative case study explored the relative influences of explicit, implicit, and extra curricula on medical students' learning of the H&P. Methods : The authors conducted semi-structured interviews with 15 fourth-year medical students at Columbia University from September 2015 to January 2016. The authors coded interview transcripts in an iterative process, and clustered coded data into emerging themes to elucidate how curricula shaped students' learning of the H&P. Results : Students perceived misalignment between curricula, with two predominant patterns: lesser emphasis on patient-centered H&P and greater emphasis on hypothesis-driven H&P in implicit versus explicit curricula. Role models, patient interactions, and clinical context were important influences on students' learning of patient-centered H&P. Ward rounds, role models, and feedback were particularly impactful for students' learning of hypothesis-driven H&P. Students reported minimal learning from the extra curriculum. Conclusions : Medical students perceived a misalignment in learning the H&P between the explicit and implicit curricula, with the former being primarily where students developed patient-centeredness in conducting H&Ps and the latter being where students learned to conduct hypothesis-driven H&P. Efforts to align curricula could strengthen H&P training.
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Balmer DF, Devlin MJ, Richards BF. Understanding the relation between medical students' collective and individual trajectories: an application of habitus. Perspect Med Educ 2017; 6:36-43. [PMID: 27981436 PMCID: PMC5285281 DOI: 10.1007/s40037-016-0321-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION While medical educators typically attend to group trends, groups are made up of unique individuals. An exploration of Bourdieu's concept of habitus, defined as a system of dispositions, may help medical educators think relationally about the collective trajectory of the group and the individual trajectory of each student. METHODS We built on our 4‑year, longitudinal study which reported how field, capital, and habitus worked together to explain how medical students, as a group, navigated transitions in undergraduate medical education. In this secondary analysis, we reviewed serial collections of narratives about students' peak learning experiences in medical school (19 students, 5 narratives per student), concentrating on first-person representations of self. We then explored the relation between collective and individual trajectories in three illustrative cases. RESULTS The social space of undergraduate medical education harmonized students' experience and helped explain the collective trajectory, as evidenced by students' consistent reports of taking initiative and staying open-minded. But individuals were not totally harmonized. They had unique dispositions that influenced their ability to access valued resources and shaped their behaviour. For example, Emily consistently spoke of being driven by her own goals; Zach focused on meeting expectations of authorities; Hilary routinely oriented toward abstract medical knowledge. DISCUSSION Habitus provides a useful conceptual lens for thinking relationally about collective and individual trajectories of medical students. Our work may inform faculty as they seek to situate individualized learning within standardized curricula, and is a step toward researching transitions in medical training from a holistic perspective that includes, but is not limited to, individual trajectories.
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Affiliation(s)
- Dorene F Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | | | - Boyd F Richards
- Center for Education Research and Evaluation, Columbia University Medical Center, New York, NY, USA
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Abstract
The authors argue that Nel Noddings' philosophy, "an ethic of caring," may illuminate how students learn to be caring physicians from their experience of being in a caring, reciprocal relationship with teaching faculty. In her philosophy, Noddings acknowledges two important contextual continuities: duration and space, which the authors speculate exist within longitudinal integrated clerkships. In this Perspective, the authors highlight core features of Noddings' philosophy and explore its applicability to medical education. They apply Noddings' philosophy to a subset of data from a previously published longitudinal case study to explore its "goodness of fit" with the experience of eight students in the 2012 cohort of the Columbia-Bassett longitudinal integrated clerkship. In line with Noddings' philosophy, the authors' supplementary analysis suggests that students (1) recognized caring when they talked about "being known" by teaching faculty who "cared for" and "trusted" them; (2) responded to caring by demonstrating enthusiasm, action, and responsibility toward patients; and (3) acknowledged that duration and space facilitated caring relations with teaching faculty. The authors discuss how Noddings' philosophy provides a useful conceptual framework to apply to medical education design and to future research on caring-oriented clinical training, such as longitudinal integrated clerkships.
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is director of research on pediatric education, Children's Hospital of Philadelphia, and associate professor of pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. D.A. Hirsh is director, Harvard Medical School Academy Fellowship in Medical Education, director and cofounder, Harvard Medical School-Cambridge Integrated Clerkship, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts. D. Monie is director of research and evaluation, Columbia-Bassett Medical School Program, Cooperstown, New York. H. Weil is assistant dean for education, Bassett Healthcare, and director, Columbia-Bassett Medical School Program, Cooperstown, New York. B.F. Richards is assistant vice president, Columbia University College of Physicians and Surgeons, director, Center for Education Research and Evaluation, and professor of medical education in pediatrics, Columbia University Medical Center, New York, New York
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Affiliation(s)
- Dorene F. Balmer
- Corresponding author: Dorene F. Balmer, PhD, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA 19104, 267.426.1489,
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Abstract
As an early and important experience in medical education, dissection in the gross anatomy lab is a locus of professional formation. Because students often think of their professional development in evolving, narrative terms, the authors propose that close attention to these narratives might add to understanding of professional formation in progress. They solicited written reflections from students, to explore ways that both the content and form of written reflections might illuminate themes relevant to professional formation, and to describe some elements of professional formation in the context of one institution (Baylor College of Medicine, Houston, Texas). Seventeen students participated in writing sessions and wrote in response to an oral interview transcript and to a poem. Using a reading approach that grew out of the narrative medicine movement, the authors collaboratively engaged the content and form of these written reflections.Students' collection of written reflections was a rich source of information about their experiences in the anatomy lab. Through both content (e.g., expressions of gratitude, transitions, self-awareness) and form (e.g., from less detailed writing to literary playfulness), their writings gave a glimpse into the tensions, disappointments, and satisfactions of the practice of gross anatomy.This project models one way that educators can read and respond to the reflective writing that students generate. The authors go on to propose ways that interactions around reflective writing can be part of a broader goal of forming narrative-minded physicians, who become increasingly self- and other-aware as they progress in their education and practice.
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Affiliation(s)
- Mark J Kissler
- M.J. Kissler is a resident in combined internal medicine-pediatrics, University of Colorado School of Medicine, Aurora, Colorado. B. Saxton is adjunct professor of medical humanities, McGovern Center for Humanities and Ethics, McGovern Medical School at Houston, Houston, Texas. R. Nuila is assistant professor of internal medicine, medicine, medical ethics, and healthy policy, Baylor College of Medicine, and assistant professor in medical humanities, Honors College, University of Houston, Houston, Texas. D.F. Balmer is director of research on pediatric education, The Children's Hospital of Philadelphia, and associate professor of pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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