Showing papers in "Medical Teacher in 2019"

Twelve tips for conducting qualitative research interviews

Abstract: The qualitative research interview is an important data collection tool for a variety of methods used within the broad spectrum of medical education research. However, many medical teachers and life science researchers undergo a steep learning curve when they first encounter qualitative interviews, both in terms of new theory but also regarding new methods of inquiry and data collection. This article introduces the concept of qualitative research interviews for novice researchers within medical education, providing 12 tips for conducting qualitative research interviews.

Supporting the development of a professional identity: General principles

Abstract: While teaching medical professionalism has been an important aspect of medical education over the past two decades, the recent emergence of professional identity formation as an important concept has led to a reexamination of how best to ensure that medical graduates come to "think, act, and feel like a physician." If the recommendation that professional identity formation as an educational objective becomes a reality, curricular change to support this objective is required and the principles that guided programs designed to teach professionalism must be reexamined. It is proposed that the social learning theory communities of practice serve as the theoretical basis of the curricular revision as the theory is strongly linked to identity formation. Curricular changes that support professional identity formation include: the necessity to establish identity formation as an educational objective, include a cognitive base on the subject in the formal curriculum, to engage students in the development of their own identities, provide a welcoming community that facilitates their entry, and offer faculty development to ensure that all understand the educational objective and the means chosen to achieve it. Finally, there is a need to assist students as they chart progress towards becoming a professional.

Professional burnout among medical students: Systematic literature review and meta-analysis.

Abstract: Background: This systematic review and meta-analysis aim to summarize the available evidence on the prevalence of professional burnout among medical students.Methods: The review was performed accor...

Narrative medicine as a medical education tool: A systematic review.

Abstract: Aim: Narrative medicine has been promoted as an innovative and effective means of stimulating medical students' professional development by teaching them to approach their patients' experiences of illness with more understanding and compassion. This systematic literature review aims to answer the following question: what evidence of effect is available in the literature about models for teaching narrative medicine? Methods: We conducted a narrative review of 36 articles and used the Best Evidence in Medical Education (BEME) Global Scale and Kirkpatrick Scale for strength and importance of evidence to categorize reported assessment strategies and to evaluate the effectiveness of their narrative medicine programs. Results: We found evidence that narrative medicine is an effective pedagogic tool with a clear and replicable structure and methodology. We also determined that a positive impact could be measured when pertaining to participation and modification of attitudes, knowledge, and skills. However, unequivocal evidence of the effect of narrative medicine on students' behavior or ongoing interaction with colleagues and patients is still lacking. Conclusion: While many recent publications describe the goals and virtues of a narrative-based approach, more research is needed to determine whether or not there is an ideological consensus undergirding this approach. In addition, it is still unclear whether the long-term impact of narrative medicine classroom interventions are felt by patients, or whether such interventions positively impact patient care.

Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships

Abstract: Feedback in medical education has traditionally showcased techniques and skills of giving feedback, and models used in staff development have focused on feedback providers (teachers) not receivers (learners). More recent definitions have questioned this approach, arguing that the impact of feedback lies in learner acceptance and assimilation of feedback with improvement in practice and professional growth. Over the last decade, research findings have emphasized that feedback conversations are complex interpersonal interactions influenced by a multitude of sociocultural factors. However, feedback culture is a concept that is challenging to define, thus strategies to enhance culture are difficult to pin down. In this twelve tips paper, we have attempted to define elements that constitute a feedback culture from four different perspectives and describe distinct strategies that can be used to foster a learning culture with a growth mind-set.

The clinical learning environment

Abstract: Learning in a clinical context is foundational in the training of health professionals; there is simply no alternative. The subject of the clinical learning environment (CLE) is at the forefront of discussions. In this introduction to a themed issue on the CLE, we present an expanded conceptual model that approaches the CLE through six different lenses, termed "avenues:" architectural, digital, diversity and inclusion, education, psychological, and sociocultural, with each avenue represented by a paper. The aim is to facilitate dialog around the contributions of different academic disciplines to research on the CLE. Collectively the papers highlight the overlap between the various "avenues" in how they influence each other, and how they collectively have shaped the work to understand and improve the CLE. The expectation is that the various avenues can add to existing knowledge and create new ideas for interventions to improve the clinical learning environment across nations for learners and teachers with the ultimate aim of improving patient care. Research and efforts to improve the CLE are critical to learning, professional socialization and well-being for trainees as they learn and participate in patient care, and to the quality of care they will deliver over decades of practice after graduation.

Fulfilling a new obligation: Teaching and learning of sustainable healthcare in the medical education curriculum

Abstract: Aims: Leading the growing international recognition of the need for sustainability in healthcare delivery, the UK medical regulator has mandated that newly qualified doctors must be able to apply the principles of sustainable healthcare to medical practice. This original research investigates how best to incorporate this new learning into the medical curriculum. Methods: Data from multiple sources were triangulated to generate themes through grounded theory. Meetings were held with representatives of key stakeholder organizations, relevant documents were reviewed and semi-structured interviews were conducted with diverse medical educators who teach sustainable healthcare. Results: There is continual pressure on space in the curriculum, and faculty lack the knowledge to teach this emerging subject, which is also difficult to examine. Students increasingly demand that sustainability be addressed in their education and future careers. Many sources of support and learning resources are available. Conclusions: Practical recommendations for implementation in any medical school include: teaching sustainability as a cross-cutting theme rather than a topic, clinicians and students learning from each other in this developing field, and embedding into assessment the wider determinants of disease. Sustainable healthcare emphasizes prevention rather than late intervention, with benefits to the environment on which health depends, healthcare systems and patients.

Artificial intelligence in medical education

Abstract: Artificial intelligence (AI) is a growing phenomenon, and will soon facilitate wide-scale changes in many professions, including medical education. In order for medical educators to be properly prepared for AI, they will need to have at least a fundamental knowledge of AI in relation to learning and teaching, and the extent to which it will impact on medical education. This Guide begins by introducing the broad concepts of AI by using fairly well-known examples to illustrate AI's implications within the context of education. It then considers the impact of AI on medicine and the implications of this impact for educators trying to educate future doctors. Drawing on these strands, it then identifies AI's direct impact on the methodology and content of medical education, in an attempt to prepare medical educators for the changing demands and opportunities that are about to face them because of AI.

Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology.

Abstract: Purpose: Case-based learning (CBL) is now used as a teaching strategy to promote clinical problem-solving ability. The purpose of this study was to determine whether CBL is superior to the traditio...

Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner

Abstract: Microaggressions and expressions of overt discrimination negatively affect the experience of medical trainees at all levels. Mistreatment of trainees, including abusive and discriminatory behavior by patients and families, occurs commonly and is receiving increased attention in both the medical literature and popular press. Heightened awareness of the problem has sparked a call to engage in substantive conversations about bias in health professions education. The emphasis on direct observation in medical education makes the bedside a common setting for educators to witness these behaviors firsthand. Many educators are committed to developing a positive climate for learners but lack the training and skills to facilitate discussions about discrimination. As a result, these difficult but important conversations may not occur. The authors present a three-phase approach to responding to microaggressions and discrimination toward trainees from patients, and offer a communication toolkit that frontline medical educators can use in their daily practice.

Experience based learning (ExBL): Clinical teaching for the twenty-first century

Abstract: The problem: Clinical practice commonly presents new doctors with situations that they are incapable of managing safely. This harms patients and stresses the new doctors and other clinicians. Unpreparedness for practice remains a problem despite changes in curricula from apprenticeship to outcome-based designs. This is unsurprising because capability depends on learning from practical experience in supportive learning environments. To assure the care of patients and well-being of residents, the pedagogy of medical students' practice-based education is in urgent need of an overhaul. This Guide: Experience based learning (ExBL) is a 21st century pedagogy of practice-based learning, derived from best current theory and evidence. ExBL specifies capabilities that medical students need to acquire from practical experience. It exemplifies how clinicians' behavior can help students gain experience. It explains how reflection converts real patient learning into capability and identity. It identifies desirable features of learning environments. This Guide advises clinicians, students, placement leads, faculty developers, and other stakeholders how to make new doctors as capable as possible. ExBL is a comprehensive model of medical students' practice-based learning, which complements competency-based education to prepare new doctors to deliver safe, effective, and compassionate care.

A Best Evidence in Medical Education systematic review to determine the most effective teaching methods that develop reflection in medical students: BEME Guide No. 51.

Abstract: Introduction: Reflection is thought to be an essential skill for physicians. Although much has been written about it, there is little concurrence about how to best teach reflection in medical educa...

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan

Abstract: Background: Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care.Aim: This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect?Methods: Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations.Results: Students’ total scores on the JSE and its two factors (Perspective Taking and Compassionate...

Medical humanities in medical education and practice

Abstract: Wherever the art of Medicine is loved, there is also a love of Humanity (Hippocrates 2018)What is Medical Humanities (MH) and why is it important for medical education today? In this Commentary, we...

Grappling with complexity: Medical students' reflective writings about challenging patient encounters as a window into professional identity formation.

Abstract: Aim: Clerkship-specific interactive reflective writing (IRW)-enhanced reflection may enhance professional identity formation (PIF), a fundamental goal of medical education. PIF process as revealed ...

Twelve tips for enhancing student engagement.

Abstract: Student engagement refers to a broad range of activities where students participate in management, education, research, and community activities within their institutions. It is a mutually beneficial collaborative approach between students and their institutions. This article provides practical advice for the implementation or further development of student engagement at medical, dental, and veterinary schools. The tips provided are based on the experiences of a group of universities recently recognized for best practice in student engagement, and are supported by evidence from the literature. The tips cover overarching themes which include the creation of an institutional culture and formal framework for student engagement, and maximize communication routes between students with peers and faculty. Tips are for specific areas of active student engagement, covering curriculum design and development, peer teaching, governance processes, research activities, peer support programs, and interaction with the local community.

Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53

Abstract: Aim: Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear.Method: To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks.Result: Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found dis...

Addressing the hidden curriculum in the clinical workplace: A practical tool for trainees and faculty.

Abstract: Introduction: The hidden curriculum, commonly described in negative terms, is considered highly influential in medical education, especially in the clinical workplace. Structured approaches to addr...

Continuing professional development to foster behaviour change: From principles to practice in health professions education.

Abstract: Healthcare professionals need to continuously improve their knowledge, skills and performance to effectively function in an ever-changing healthcare environment. They depend on continuing professional development programs (CPD), either within or outside their institutions, to reflect on and update their clinical practice. Professional growth requires more than knowledge transfer; it requires curiosity, humility, self-awareness and a motivation for mastery. Educators can build on these factors and create effective learning experiences to develop complex skills including communication, interprofessional collaboration, teamwork, leadership and reflective practice. CPD program leaders should adopt an evolved approach to program design that leverages adult learning principles, active learning and longitudinal curricula, while identifying and overcoming system barriers to change, and targeting meaningful behaviour and health outcomes. In this article, we describe principles and strategies that CPD leaders can apply to their own programs, categorized under three steps: (1) Program design, (2) Program implementation and (3) Program evaluation. Under each step, we provide theoretical principles as well as practical tips, focusing on strategies that can motivate and facilitate change.

A review of interprofessional training wards: Enhancing student learning and patient outcomes

Abstract: Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes. Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990-June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data. Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2-12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ. Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students' long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.

The terminology of clinical reasoning in health professions education: Implications and considerations

Abstract: Introduction: Clinical reasoning is considered to be at the core of health practice Here, we report on the diversity and inferred meanings of the terms used to refer to clinical reasoning and consider implications for teaching and assessment Methods: In the context of a Best Evidence Medical Education (BEME) review of 625 papers drawn from 18 health professions, we identified 110 terms for clinical reasoning We focus on iterative categorization of these terms across three phases of coding and considerations for how terminology influences educational practices Results: Following iterative coding with 5 team members, consensus was possible for 74, majority coding was possible for 16, and full team disagreement existed for 20 terms Categories of terms included: purpose/goal of reasoning, outcome of reasoning, reasoning performance, reasoning processes, reasoning skills, and context of reasoning Discussion: Findings suggest that terms used in reference to clinical reasoning are non-synonymous, not uniformly understood, and the level of agreement differed across terms If the language we use to describe, to teach, or to assess clinical reasoning is not similarly understood across clinical teachers, program directors, and learners, this could lead to confusion regarding what the educational or assessment targets are for "clinical reasoning"

Online interprofessional education facilitation: A scoping review.

Abstract: Introduction: The use of online media to deliver interprofessional education (IPE) is becoming more prevalent across health professions education settings. Facilitation of IPE activities is known t...

Patient-centered medical education: A proposed definition.

Abstract: Multiple papers have been presented to define patient-centered care, with regulatory bodies such as the General Medical Council mapping this in their professional standards. Educational institutions clearly value instilling appreciation of patient-centredness in medical training, and attempts have been made to make medical education more patient-centered in practice. Such attempts are often limited to expert patients sharing personal stories, and public involvement in teaching. Despite the drive towards patient-centered care and medical education, there has been no attempt to formally define what patient-centered medical education is and what it means to medical educators globally. This paper proposes a definition of patient-centered medical education that is about the patients, with the patients, and for the patients, to ensure current and future doctors remain sensitive to all of the needs of the people they care for. This should be considered at both the micro and macro community levels.

Student engagement in medical education: A mixed-method study on medical students as module co-directors in curriculum development.

Abstract: Introduction: Beyond participation in evaluation of teaching, there is sparse research available on more active roles of medical students in curriculum development. We report on a model of student engagement where medical students function as module co-directors, and how this is experienced by faculty and student module directors. Methods: Student engage in co-development of their curriculum with a high level of autonomy in organizing their activities. We conducted a mixed-methods, convergent design study based on surveys with faculty and student module co-directors and a student co-director focus group. Quantitative data were analyzed descriptively. Qualitative analysis was performed inductively. Results: Quantitatively, the majority of both faculty and student module directors report that the curriculum benefits from the students' work (95 and 94%). Both groups see each other as equal partners (80 and 87%). Qualitatively, this is related to students' competencies such as "bringing in broad and unique knowledge of the curriculum", "giving the students' perspective a voice," and "contributing ideas for improvement". Key strategies and challenges of the student co-module directors are illuminated. Conclusions: Student module co-directors represent a well-accepted practice model for curriculum development. This report may stimulate other faculties to engage their students more actively in medical education.

The relationship between burnout, personality traits, and medical specialty. A national study among Dutch residents

Abstract: Purpose: To examine the associations between residents' personality traits, type of specialty, and symptoms of burnout. Method: A cross-sectional online survey among Dutch residents was conducted (see Supplementary Material ). The 20-item Dutch translation of the Maslach Burnout Inventory was used to ascertain burnout. Personality traits were assessed with the 44-item Dutch Big Five Inventory. Logistic regression analyses, including all five personality traits, were used to assess associations with burnout. Analyses were stratified by specialties. Results: One thousand two hundred thirty one residents participated, 185 (15.0%) of whom met the criteria for burnout. Neuroticism was significantly associated with resident burnout in all specialties, more strongly in supportive (odds ratio (OR) 6.19, 95% CI 2.12-18.12) and surgical (OR 4.37, 95% CI 1.76-10.86) than in medical residents (OR 1.99, 95% CI 1.22-3.24). Extraversion was significantly associated with less burnout in surgical residents (OR 0.26, 95% CI 0.13-0.58). These findings remained highly significant after controlling for gender, overtime, autonomy at work, satisfaction between work and private life, and the perceived quality of the learning environment. Conclusions: Burnout risk was associated with personality traits in residents. Consistently, residents scoring high on neuroticism reported more burnout. Extraverted surgical residents were less susceptible to burnout. Residents scoring high on neuroticism may require more intense monitoring during their training years.

Assessment of professionalism : From where have we come - to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism

Abstract: Background: In 2009, an International Working Group (IWG) on the Assessment of Professionalism began collaborating and published recommendations in 2011. Nearly a decade later the IWG recon...

A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity

Abstract: The relatively new term "Professional Identity Formation" (PIF) complements behavior-based and attitude-based perspectives on professionalism. Unprofessional behavior and its remediation should also be addressed from this perspective. However, a framework is needed to guide discussion and remediation of unprofessional behavior, which can encompass behavior-based, attitude-based, and identity-based perspectives on professionalism. To this end, the authors propose a multi-level professionalism framework which describes, apart from professional behavior, more levels which influence professional performance: environment, competencies, beliefs, values, identity, and mission. The different levels can provide tools for educators to address and discuss unprofessional behavior with their students in a comprehensive way. By reflecting on all the different levels of the framework, educators guard themselves against narrowing the discussion to either professional behavior or professional identity. The multi-level professionalism framework can help educators and students to gain a better understanding of the root of unprofessional behavior, and of remediation strategies that would be appropriate. For despite the recent emphasis on PIF, unprofessional behavior and its remediation will remain important issues in medical education.

The role of "improv" in health professional learning: A scoping review.

Abstract: Background: The use of improvizational theater ("improv") in health professional education ("medical improv") is an emerging field. However, optimal curricular design features and learning outcomes have not yet been systematically described. Objective: To synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education. Methods: A literature search with keywords "Improv" and "Improvisational Theatre" was undertaken in January 2016 in Ovid MEDLINE, CINHAL, EMBASE, SCOPUS, Web of Science, and ERIC, with an accompanying gray literature search. Four authors coded and achieved consensus on themes relating to curricular design elements and learning outcomes, which were mapped onto the CanMEDS framework. Results: Seven articles met inclusion criteria. Key curricular design features included (i) facilitators with dual clinical and theater expertise; (ii) creating a low-stakes environment; and (iii) engaging in debrief to highlight clinical relevance. Improv curricula were found to impact most CanMEDS roles, including: Medical Expert (comfort with uncertainty); Leader (team management); Scholar (feedback, self-reflection); Communicator (empathy, active listening, non-verbal communication); Collaborator (culture of trust); and Professional (resiliency and confidence). Mechanisms by which improv may promote acquisition of these professional competencies, and the utility of improv in areas such as interprofessional team development, leadership, and wellness and resiliency are discussed.

Student participation in the design of learning and teaching : Disentangling the terminology and approaches

Abstract: Background: Students are ever more involved in the design of educational practices, which is reflected in the growing body of literature about approaches to student participation. Similarities and differences between these approaches often remain vague since the terms are used interchangeably. This confusing and fragmented body of literature hampers our understanding the process and outcomes of student participation and choosing the most suitable approach for it. Method: We identified the three most frequently used terms related to the design of learning and teaching - design-based research (DBR), participatory design (PD), and co-creation - and disentangled the terminology by focusing on relevant definitions, aims, involvement of students, outcomes, and related terminology. Results: Differences between the approaches to student participation can be found in the degree to which students are the central actors and the degree to which the design is informed by educational theory. Conclusion: It is important to align the level of student participation with the purpose of the approach.

Twelve tips for the introduction of emotional intelligence in medical education

Abstract: Emotional intelligence (EI) is the ability to recognize, understand, and manage emotions in yourself and in others. EI has long been recognized as a critical component for individual and organizational success within the business realm, and there is emerging evidence that enhancing EI is equally important in the medical setting. EI can improve interpersonal communications, enable constructive conflict resolution, and promote a culture of professionalism. As healthcare becomes increasingly team-based, proficiency in EI will be required to build consensus among multidisciplinary stakeholders, and effect change in attitudes and behaviors that result in improved patient safety and clinical outcomes. Based on the existing literature and the authors' experiences, these 12 tips provide practical suggestions on how to introduce EI into a medical curriculum. These tips have broad applicability, and can be implemented in courses on topics such as professionalism, leadership development, empathy, patient safety, or wellness.