Showing papers in "Medical Education in 2022"
TL;DR: The scope of barriers and targeted interventions to maintaining health professional education during war are described and research is summarized to summarise the research.
Abstract: War negatively impacts health professional education when health care is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarise the research.
16 citations
TL;DR: A range of medical education interventions which report a positive impact on medical student UT are identified, which could support stakeholders such as policy makers and institutions to adapt the medical curriculum to better prepare their medical students for practice by enhancing their UT.
Abstract: Uncertainty is an inevitable part of medical practice. An ability to tolerate uncertainty is viewed as a key competency across many health‐care systems. Poor uncertainty tolerance (UT) has been linked to negative outcomes including reduced psychological well‐being in medical students. A variety of medical education interventions have been developed with the intention of increasing medical students' UT. However, there is no synthesis of these studies available to inform education and research practice. Our aim was to conduct a scoping review of medical education interventions that evaluate their impact on UT.
12 citations
TL;DR: The lived experience of being a male nursing student: Implications for student retention and success and Advancing consideration of gender within health profession education.
Abstract: der and gender nonbinary medical students and physicians. Transgender Health. 2019;4(1):209-216. 12. World Health Organization. State of the world's nursing 2020: Investing in education, jobs and leadership. 2020. https://www.who.int/publicationsdetail-redirect/9789240007017. Accessed September 30, 2021. 13. Carnevale T, Priode K. “The good ole'girls' nursing club”: The male student perspective. J Transcult Nurs. 2018;29(3):285-291. 14. Powers K, Herron EK, Sheeler C, Sain A. The lived experience of being a male nursing student: Implications for student retention and success. J Prof Nurs. 2018;34(6):475-482. How to cite this article: Lydon S, Madden C, Byrne D, O'Connor P. Advancing consideration of gender within health profession education: What is required? Med Educ. 2022; 56(3):250-252. doi:10.1111/medu.14685
12 citations
TL;DR: In this paper , a multicentre qualitative study was conducted to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.
Abstract: The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis.While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others.Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.
12 citations
TL;DR: Regulatory processes need to be built around clear definitions of the goals for each stage of professional development, the current movement toward competency-based education, and the variable durations of medical education.
Abstract: The aim of this paper is to provide an overview of the major quality assurance strategies, accreditation and licensure, in health professions education. It explores the nature of these regulatory processes using Brazil and the United States as examples because these large systems are at different ends of the developmental continuum. For each, it describes the tensions that arise, offers a critical synthesis of the evidence and maps out future directions.
12 citations
TL;DR: Competency‐based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice, but inclusion of patients in postgraduate medical learners' assessment is largely absent.
Abstract: Competency‐based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent.
11 citations
TL;DR: The research suggests that clinical education, and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties.
Abstract: There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work‐based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher–learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery.
10 citations
TL;DR: This study investigates author characteristics to provide an evidence-based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing.
Abstract: The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence‐based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing.
9 citations
TL;DR: ‘Fit’ refers to an applicants' perceived compatibility to a residency programme and a variety of structural, identity‐related and relational factors contribute to self‐assessments of fit.
Abstract: ‘Fit’ refers to an applicants' perceived compatibility to a residency programme. A variety of structural, identity‐related and relational factors contribute to self‐assessments of fit. The 2021 residency recruitment cycle in the USA was performed virtually due to the COVID‐19 pandemic. Little is known about how video‐interviewing may affect residency applicants' ability to gauge fit.
9 citations
TL;DR: As a first step to understanding students' UT development, this work asked ‘How do medical students, in their clinical years, experience uncertainty stimuli?'
Abstract: Uncertainty tolerance (UT) describes how individuals respond to stimuli of uncertainty, with low UT among medical doctors and students linked to negative outcomes such as burnout. UT research in medical education has focused on measuring the construct, with little research seeking to understand how medical students experience uncertainty. Hence, knowledge on how education may shape students' UT development is lacking. As a first step to understanding students' UT, we asked ‘How do medical students, in their clinical years, experience uncertainty stimuli?’
8 citations
TL;DR: In this paper , a scoping review aims to contribute to the understanding of measurements, drivers and outcomes of medical student engagement, defined as behavioural, cognitive and emotional aspects of students' academic experience in teaching, learning and research through interacting with other students, faculty and community.
Abstract: Student engagement is defined as behavioural, cognitive and emotional aspects of students' academic experience in teaching, learning and research through interacting with other students, faculty and community. Despite the growing interest in the field of student engagement, medical education research in this area is still fragmented. This scoping review aims to contribute to the understanding of measurements, drivers and outcomes of medical student engagement.
TL;DR: The concept of professionalism is dominant within health care education and the lives of practising clinicians globally, and yet there is no single agreed definition nor framework applied universally across the health care professions as mentioned in this paper .
Abstract: The concept of professionalism is dominant within health care education and the lives of practising clinicians globally, and yet there is no single agreed definition nor framework applied universally across the health care professions. This article questions how much attention is paid to where definitions of the concept of professionalism came from and whether the accepted norms within the dominant discourses are still truly applicable to a 21st century workforce.
TL;DR: In this article , a meta-ethnography based on a large amount of diverse qualitative studies is presented to provide a comprehensive picture of the experiences and challenges that international medical graduates face before and after migration.
Abstract: International medical graduates (IMGs) represent a large portion of practising doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK's General Medical Council (GMC) recently set targets to 'eliminate disproportionate complaints' and 'eradicate disadvantage and discrimination in medical education'. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs to identify factors affecting IMGs' professional practice (either directly or indirectly).In September 2019, we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors' themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts.Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practising in all six continents in a range of settings, including primary and secondary care. We developed five key concepts: migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the four main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented.This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
TL;DR: A vision of systems-based disability-inclusive, accessible, and equitable Medical education is proposed using 9 of Deming's 14 points as applicable to Medical education.
Abstract: The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to ‘overcome’ disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community.
TL;DR: In this paper , the authors explore how the medical education community adapts and reconceptualizes their personal and professional roles to the COVID-19 crisis, and find that the collective struggle sparked by the pandemic could generate critical reflection necessary for transforming professional values and practices for the better.
Abstract: The COVID‐19 pandemic has caused unprecedented stress to the medical education community, potentially worsening problems like burnout and work‐life imbalance that its members have long been grappling with. However, the collective struggle sparked by the pandemic could generate the critical reflection necessary for transforming professional values and practices for the better. In this hermeneutic phenomenological study, we explore how the community is adapting—and even reconceptualising—their personal and professional roles amidst the COVID‐19 crisis.
TL;DR: The DBND online presentations were a successful alternative to in-person sessions, suggesting that important public health lessons can be taught online to elementary students, without compromising the quality as mentioned in this paper .
Abstract: the greatest challenges of online delivery was the equipment: a computer, camera, speaker, microphone, projector/screen and stable internet connection. The survey demonstrated that not all classrooms were adequately equipped: 43% of the teachers and 35% of the medical students reported technical difficulties, such as internet connectivity and audio issues. To circumvent this, we recommend adopting a town hall meeting setup, where one elementary student walks up to the computer at a time to talk, to allow presenters to communicate. Alternatively, the teacher can circulate with a laptop to the student who would like to speak. A trial run prior to the session to rectify technical challenges is also recommended. The DBND online presentations were a successful alternative to in-person sessions, suggesting that important public health lessons can be taught online to elementary students, without compromising the quality. With some technical improvements, the virtual DBND programme is a successful model for virtual elementary education and medical student community engagement, beyond the confines of geographic area.
TL;DR: The present essay aims to help clarify the role of deliberate reflection in diagnostic reasoning by examining variations in instructions on how to reflect upon a case, the value of further guidance while learning from deliberate reflection, and its benefits in real practice.
Abstract: The idea that reflection improves reasoning and learning, since long present in other fields, emerged in the 90s in the medical education literature. Since then, the number of publications on reflection as a means to improve diagnostic learning and clinical problem‐solving has increased steeply. Recently, concerns with diagnostic errors have raised further interest in reflection. Several approaches based on reflection have been proposed to reduce clinicians' errors during diagnostic reasoning. What reflection entails varies substantially, and most approaches still require empirical examination.
TL;DR: In this article , the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored. But they are increasingly being recognised as necessary for effective feedback conversations.
Abstract: Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored.
TL;DR: Most programs used a combination of logics when trying to capture the essential tasks of a profession in EPAs, including disease or patient groups and service provision, which may potentially inform best practice guidelines for EPA development.
Abstract: INTRODUCTION
Entrustable professional activities (EPAs), discrete profession-specific tasks requiring integration of multiple competencies, are increasingly used to help define and inform curricula of specialty training programs. Although guidelines exist to help guide the developmental process, deciding what logic to use to draft a preliminary EPA-framework poses a crucial but often difficult first step. The logic of an EPA-framework can be defined as the perspective used by its developers to break down the practice of a profession into units of professional work. This study aimed to map dominant logics and their rationales across postgraduate medical education and fellowship programs.
METHODS
A scoping review using systematic searches within five electronic databases (Medline, Embase, Google Scholar, Scopus and Web of Science) was performed. Dominant logics of included papers were identified using inductive coding and iterative analysis.
RESULTS
In total, 42 studies were included. Most studies were conducted in the USA (n = 22; 52%), Canada (n = 6; 14%) and the Netherlands (n = 4; 10%). Across the reported range of specialties, family medicine (n = 4; 10%), internal medicine (n = 4; 10%), pediatrics (n = 3; 7%) and psychiatry (n = 3; 7%) were the most common. Three dominant logics could be identified namely "service provision", "procedures" and/or "disease or patient categories". The majority of papers (n = 37; 88%) used two or more logics when developing EPA-frameworks (median = 3, range = 1-4). Disease or patient groups and service provision were the most common logics used (39% and 37% respectively).
CONCLUSIONS
Most programs used a combination of logics when trying to capture the essential tasks of a profession in EPAs. For each of the three dominant logics, the authors arrived at a definition and identified benefits, limitations and examples. These findings may potentially inform best practice guidelines for EPA development.
TL;DR: This paper applied critical realist perspectives to unpack the underlying causes (mechanisms) that explained student experiences of programmatic assessment, to optimise assessment practice for future iterations, in order to improve student experience.
Abstract: Fundamental challenges exist in researching complex changes of assessment practice from traditional objective‐focused ‘assessments of learning’ towards programmatic ‘assessment for learning’. The latter emphasise both the subjective and social in collective judgements of student progress. Our context was a purposively designed programmatic assessment system implemented in the first year of a new graduate entry curriculum. We applied critical realist perspectives to unpack the underlying causes (mechanisms) that explained student experiences of programmatic assessment, to optimise assessment practice for future iterations.
TL;DR: In this paper , the authors explored EM and IM physicians' experiences with negotiating hospital admissions to better understand the social dynamics that contribute to interphysician conflict and provide foundational guidance for communication best practices.
Abstract: Despite the implementation of professionalism curricula and standardised communication tools, inter-physician conflict persists. In particular, the interface between emergency medicine (EM) and internal medicine (IM) has long been recognised as a source of conflict. The social nuances of this conflict remain underexplored, limiting educators' ability to comprehensively address these issues in the clinical learning environment. Thus, the authors explored EM and IM physicians' experiences with negotiating hospital admissions to better understand the social dynamics that contribute to inter-physician conflict and provide foundational guidance for communication best practices.Using a constructivist grounded theory (CGT) approach, the authors conducted 18 semi-structured interviews between June and October 2020 with EM and IM physicians involved in conversations regarding admissions (CRAs). They asked participants to describe the social exchanges that influenced these conversations and to reflect on their experiences with inter-physician conflict. Data collection and analysis occurred iteratively. The relationships between the codes were discussed by the research team with the goal of developing conceptual connections between the emergent themes.Participants described how their approaches to CRAs were shaped by their specialty identity, and how allegiance to members of their group contributed to interpersonal conflict. This conflict was further promoted by a mutual sense of disempowerment within the organisation, misaligned expectations, and a desire to promote their group's prerogatives. Conflict was mitigated when patient care experiences fostered cross-specialty team formation and collaboration that dissolved traditional group boundaries.Conflict between EM and IM physicians during CRAs was primed by participants' specialty identities, their power struggles within the broader organisation, and their sense of duty to their own specialty. However, formation of collaborative inter-specialty physician teams and expansion of identity to include colleagues from other specialties can mitigate inter-physician conflict.
TL;DR: This work investigated BMAT's predictive and incremental validity for performance in two undergraduate medical schools, Imperial College School of Medicine (ICSM) and Lee Kong Chian School of medicine (LKCMedicine), Singapore, to compare the evidence collected with published evidence relating to comparable tools.
Abstract: Although used widely, there is limited evidence of the BioMedical Admissions Test's (BMAT) predictive validity and incremental validity over prior educational attainment (PEA). We investigated BMAT's predictive and incremental validity for performance in two undergraduate medical schools, Imperial College School of Medicine (ICSM), UK, and Lee Kong Chian School of Medicine (LKCMedicine), Singapore. Our secondary goal was to compare the evidence collected with published evidence relating to comparable tools.
TL;DR: This research considered the influence of socio‐demographic background on preparation for medical school selection and on the successful offer of a place.
Abstract: There is a growing drive to improve the heterogeneity of medical school cohorts. However, those from lower socio‐economic groups remain under‐represented. Understanding the methods used by applicants to prepare for medical school selection, and the challenges they face with respect to opportunities and access, may provide important insights to this lack of diversity. This research considered the influence of socio‐demographic background on preparation for medical school selection and on the successful offer of a place.
TL;DR: In this paper , the authors investigated the causality, operation and interaction of differential rater function over time (DRIFT) and contrast effects (examiners' scores biased away from the standard of preceding performances).
Abstract: Differential rater function over time (DRIFT) and contrast effects (examiners' scores biased away from the standard of preceding performances) both challenge the fairness of scoring in objective structured clinical exams (OSCEs). This is important as, under some circumstances, these effects could alter whether some candidates pass or fail assessments. Benefitting from experimental control, this study investigated the causality, operation and interaction of both effects simultaneously for the first time in an OSCE setting.We used secondary analysis of data from an OSCE in which examiners scored embedded videos of student performances interspersed between live students. Embedded video position varied between examiners (early vs. late) whilst the standard of preceding performances naturally varied (previous high or low). We examined linear relationships suggestive of DRIFT and contrast effects in all within-OSCE data before comparing the influence and interaction of 'early' versus 'late' and 'previous high' versus 'previous low' conditions on embedded video scores.Linear relationships data did not support the presence of DRIFT or contrast effects. Embedded videos were scored higher early (19.9 [19.4-20.5]) versus late (18.6 [18.1-19.1], p < 0.001), but scores did not differ between previous high and previous low conditions. The interaction term was non-significant.In this instance, the small DRIFT effect we observed on embedded videos can be causally attributed to examiner behaviour. Contrast effects appear less ubiquitous than some prior research suggests. Possible mediators of these finding include the following: OSCE context, detail of task specification, examiners' cognitive load and the distribution of learners' ability. As the operation of these effects appears to vary across contexts, further research is needed to determine the prevalence and mechanisms of contrast and DRIFT effects, so that assessments may be designed in ways that are likely to avoid their occurrence. Quality assurance should monitor for these contextually variable effects in order to ensure OSCE equivalence.
TL;DR: In this article , the authors explored factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education(UME).
Abstract: Many studies focused on entrustment have not considered prospective entrustment decisions, where clinical competency and entrustment committees determine how much supervision trainees will require in the future for tasks occurring in not completely known contexts. The authors sought to explore factors that influence and determine prospective entrustment decisions made by members of such committees in graduate medical education (GME) and undergraduate medical education (UME).
TL;DR: Continuing professional development activities for healthcare professionals are central to the optimisation of patient safety and person‐centred care and very little is known about the costs and benefits of CPD.
Abstract: Continuing professional development (CPD) activities for healthcare professionals are central to the optimisation of patient safety and person‐centred care. Although there is some evidence on the economics of healthcare professionals training, very little is known about the costs and benefits of CPD.
TL;DR: On assessor as discussed by the authors , the assessor is an assessor for assessor-based taxonomy and taxonomy of assessor's taxonomy, and assessor taxonomy.
Abstract: on assessor
TL;DR: In this paper , the authors analyzed goal development dialogues within resident and faculty coaching relationships and found that the content of goals discussed in coaching meetings focused on how to be a resident with little discussion around challenges in direct patient care, and co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals.
Abstract: Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships.This was a qualitative study using interpretive description methodology. Eight internal medicine coach-resident dyads consented to audiotaping coaching meetings over a 1-year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co-construction as a sensitising concept.Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals.In analysing goal development in the coach-resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage-specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co-regulation and reflection on both clinical competencies and professional identity formation.
TL;DR: In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that from 2023, overseas doctors would only be eligible for certification to practise in the United States if they had graduated from a medical school that was accredited by a recognized agency as mentioned in this paper .
Abstract: Although medical school regulation is ubiquitous, the extent to which it should be based on global principles is unclear. In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG) announced that from 2023, overseas doctors would only be eligible for certification to practise in the United States if they had graduated from a medical school that was accredited by a ‘recognised’ agency. This policy empowered the World Federation for Medical Education (WFME) to create a recognition programme for regulatory agencies around the world, despite a lack of empirical evidence to support medical school regulation.
TL;DR: The aim of this study was to develop and substantiate a set of theory‐driven and context‐sensitive Design‐Principles for intraPC learning during hospital placements.
Abstract: To preserve quality and continuity of care, collaboration between primary‐care and secondary‐care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design‐Principles guide the design and development of educational activities when theory‐driven Design‐Principles are tailored into context‐sensitive Design‐Principles. The aim of this study was to develop and substantiate a set of theory‐driven and context‐sensitive Design‐Principles for intraPC learning during hospital placements.