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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC Med Educ 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Sheakley ML, Bauler LD, Tanager CL, Newby D. Student Perceptions of a Novel Approach to Promote Professionalism Using Peer Evaluation in a Team-Based Learning™ Setting: a Quality Improvement Project. Med Sci Educ 2019; 29:1229-1232. [PMID: 34457607 PMCID: PMC8368677 DOI: 10.1007/s40670-019-00830-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Development of professional behaviors, including communication and interprofessional collaboration, is an important competency during medical school that is difficult to teach in the classroom. We developed an approach to peer evaluation for use in Team-Based Learning that has two novel components: inclusion of a non-numeric sliding scale ranging from "apprentice" to "expert" to assess professional development on a continuum, and incorporation of a structured face-to-face feedback session. Students liked the format of the face-to-face feedback session, felt it gave them an opportunity to better understand their peers' comments, and thought it was more effective than the anonymous written evaluation tool.
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Affiliation(s)
- Maria L. Sheakley
- Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI 49008 USA
| | - Laura D. Bauler
- Department of Biomedical Sciences, Division of Epidemiology and Biostatistics, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Dr., Kalamazoo, MI 49008 USA
| | - Claire L. Tanager
- Western Michigan University Homer Stryker M.D. School of Medicine, Student, 1000 Oakland Dr., Kalamazoo, MI 49008 USA
| | - Dart Newby
- Western Michigan University Homer Stryker M.D. School of Medicine, Student, 1000 Oakland Dr., Kalamazoo, MI 49008 USA
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Oertel M, Schmitz M, Becker JC, Eich HT, Schober A. Successful integration of radiation oncology in preclinical medical education : Experiences with an interdisciplinary training project. Strahlenther Onkol 2019; 195:1104-9. [PMID: 31309265 DOI: 10.1007/s00066-019-01492-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Modern impartation of both anatomic and radiation oncology (RO) knowledge in medical education enables a transfer of preclinical knowledge to clinical practice, which may be addressed by multidisciplinary concepts. The faculty's "Anatomy and imaging" course attempts to integrate RO, radiology and nuclear medicine into the preclinical curriculum. The present analysis focuses on the description of the course concept and discusses the potential didactic impact of the implementation of RO. METHODS In total 5 semester cohorts have undertaken the course since the introduction of RO in the winter semester of 2015/2016 with 682 students participating. It is designed as a small group circuit training with a teaching content of 8 h daily. Course evaluation was performed on a 100-item Likert scale. RESULTS General evaluation showed an average of 9.3-12.7 on a Likert scale (0 being the best, 100 being the worst grade). Use of media, relevance for medical training, gain of interest in medicine in general and overall satisfaction with the course received excellent mean values. For RO, there was a high degree of consent with the following statements: "the course was well organized", "subjects and presentation were well-structured", "topics were well chosen", "the time for exercises was sufficient" and "teaching by student tutors and physicians was adequate". CONCLUSION The present evaluation demonstrates the feasibility of introducing RO in the preclinical part of medical education. The course concept shows excellent results in evaluation and may help in broadening RO knowledge and in recruiting new doctoral candidates and residents.
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Waliany S, Caceres W, Merrell SB, Thadaney S, Johnstone N, Osterberg L. Preclinical curriculum of prospective case-based teaching with faculty- and student-blinded approach. BMC Med Educ 2019; 19:31. [PMID: 30674302 PMCID: PMC6343267 DOI: 10.1186/s12909-019-1453-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 01/04/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Case-based teaching with real patient cases provides benefit of simulating real-world cognition. However, while clinical practice involves a prospective approach to cases, preclinical instruction typically involves full disclosure of case content to faculty, introducing hindsight bias into faculty teaching in medical curricula. METHODS During 2015-2018, we piloted an optional medical school curriculum involving 6-7 one-hour sessions over a 3-month period each year. New groups enrolled each year from first- and second-year classes. A facilitator provided a blinded physician discussant and blinded students with case information during and not in advance of each session, allowing prospective case-based discussions. Cases were based on real patients treated in the Department of Medicine. Clinical material was presented in the chronologic sequence encountered by treating physicians. Content covered a median of 5 patient visits/case (range: 2-10) spanning over months. A 14-item survey addressing components of the reporter-interpreter-manager-educator (RIME) scheme was developed and used to compare self-reported clinical skills between course participants and non-participant controls during the 2016 course iteration. RESULTS This elective curriculum at Stanford School of Medicine involved 170 preclinical students (22.7% of 750 eligible). During the 2016 course iteration, a quasi-experimental study compared self-reported clinical skills between 29 course participants (response rate: 29/49 [59.2%]) and 35 non-participant controls (response rate: 35/132 [26.5%]); students self-assessed clinical skills via the RIME-based survey developed for the course. Two-sample t-tests compared the change in pre- and post-course skills between course participants and non-participants. Of 15 Department of Medicine faculty members invited as discussants, 12 (80%) consented to participate. Compared with controls, first-year participants self-assessed significantly greater improvement in understanding how clinicians reason through cases step-by-step to arrive at diagnoses (P = 0.049), work through cases in longitudinal settings (P = 0.049), and share information with patients (P = 0.047). Compared with controls, second-year participants self-assessed significantly greater improvement (P = 0.040) in understanding how clinicians reason through cases step-by-step to arrive at diagnoses. CONCLUSIONS Prospective case-based discussions with blinding of faculty and students to clinical content circumvents hindsight bias and may impart real-world cognitive skills as determined by student self-report.
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Affiliation(s)
- Sarah Waliany
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
| | - Wendy Caceres
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
| | | | - Sonoo Thadaney
- Program for Bedside Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Noelle Johnstone
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Lars Osterberg
- Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, MSOB x152, Stanford, CA 94305 USA
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Chae SJ, Kim M, Chang KH, Chung YS. Potential bias factors that affect the course evaluation of students in preclinical courses. Korean J Med Educ 2017; 29:73-80. [PMID: 28597870 PMCID: PMC5465435 DOI: 10.3946/kjme.2017.54] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/24/2017] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE We aim to identify what potential bias factors affected students' overall course evaluation, and to observe what factors should be considered in the curriculum evaluation system of medical schools. METHODS This study analyzed students' ratings of preclinical instructions at the Ajou University School of Medicine. The ratings of instructions involved 41 first-year and 45 second-year medical students. RESULTS There was a statistically significant difference between years of study and ratings' scoring. Learning difficulty, learning amount, student assessment, and teacher preparation from second-year students were significantly higher than first-year students (p<0.05). The analysis results revealed that student assessment was the predictor of ratings from first-year students, while teacher preparation was the predictor of ratings from second-year students. CONCLUSION We found significant interactions between year of study and the students' rating results. We were able to confirm that satisfaction of instructions factors perceived by medical students were different for the characteristics of courses. Our results may be an important resource for evaluating preclinical curriculums.
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Affiliation(s)
- Su Jin Chae
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
| | - Miran Kim
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
- Department of Obstetrics & Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Ki Hong Chang
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Sok Chung
- Office of Medical Education, Ajou University School of Medicine, Suwon, Korea
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
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Rdesinski RE, Chappelle KG, Elliot DL, Litzelman DK, Palmer R, Biagioli FE. Development and use of an instrument adapted to assess the clinical skills learning environment in the pre-clinical years. Med Sci Educ 2015; 25:285-291. [PMID: 26509103 PMCID: PMC4617779 DOI: 10.1007/s40670-015-0141-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools. METHODS The ten-item Pre-Clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach's alphas were calculated for emerging dimensions. RESULTS The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: "Patients as Objects", "Talking Respectfully of Colleagues", and "Patient-Centered Behaviors". Reliability measures (Cronbach's alpha) for the Pre-Clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions. CONCLUSIONS The Pre-Clinical C3 instrument's performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-Clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions.
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Affiliation(s)
- Rebecca E. Rdesinski
- Research Associate, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathryn G. Chappelle
- Graduate student in Clinical Psychology, Pacifica Graduate Institute, Carpinteria, California (retired, June 2013, as Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon)
| | - Diane L. Elliot
- Professor, Division of Health Promotion and Sports Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Debra K. Litzelman
- D. Craig Brater Chair of Global Health Education, Professor of Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ryan Palmer
- Assistant Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Frances E. Biagioli
- Professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
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