Medical Education最新文献

{"title":"Factors influencing the inclusion of diverse volunteer patients within medical student primary care placements.","authors":"Mohammad Malik, Leanne Tyson, Pauline Bryant, Payal Patel, Richard Young, Joanna Semlyen","doi":"10.1111/medu.15562","DOIUrl":"https://doi.org/10.1111/medu.15562","url":null,"abstract":"<p><strong>Introduction: </strong>Research shows that medical students are graduating with inadequate teaching on diverse patients and insufficient experience of working with diverse patient groups. The inclusion of patients from diverse groups is necessary in healthcare teaching to ensure medical students are adequately prepared for practice. In this study, we explored the perspectives of General Practitioner (GP) tutors on the recruitment of diverse volunteer patients for medical student primary clinical care placements. In particular, we focused on the current representation of diverse volunteer patients, barriers affecting their inclusion and recommendations to help with this.</p><p><strong>Methods: </strong>Focus groups were carried out with GP tutors involved in the recruitment of volunteer patients from one region in the United Kingdom. Transcripts were analysed using Thematic Analysis.</p><p><strong>Results: </strong>Participants acknowledged the importance of ensuring that medical students have clinical experience in assessing and managing patients from diverse populations, but most did not actively think about the diversity of the patients they were recruiting. Instead, recruitment was driven by the need to cover the curriculum and teaching requirements. To ensure that students' learning was not diminished and recognising time was a significant factor, participants automatically discounted certain patients from being a volunteer patient. They acknowledged that they did not feel comfortable identifying patients based on their demographics and were more likely to invite patients who had been volunteer patients before.</p><p><strong>Discussion: </strong>Suggested solutions to overcome the factors affecting the recruitment of diverse patients are presented. Patient populations will continue to become more diverse, and therefore, medical schools must prepare their students for this and encourage GP tutors to make a conscious effort to recruit diverse patient volunteers for teaching.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating cross-language qualitative data in health professions education research: Is there an iceberg below the waterline?","authors":"Marwa Schumann, Ashley Dennis, Jean-Michel Leduc, Harm Peters","doi":"10.1111/medu.15563","DOIUrl":"https://doi.org/10.1111/medu.15563","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs and economic impact of student-led clinics-A systematic review.","authors":"Debra Mitchell, Stephen Maloney, Luke Robinson, Terry Haines, Jonathan Foo","doi":"10.1111/medu.15550","DOIUrl":"https://doi.org/10.1111/medu.15550","url":null,"abstract":"<p><strong>Purpose: </strong>Student-led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student-led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student-led clinics and report the methods that have been used to measure these costs and benefits.</p><p><strong>Method: </strong>We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student-led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student-led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies.</p><p><strong>Results: </strong>Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description-monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits.</p><p><strong>Conclusions: </strong>Student-led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student-led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student-led clinics in comparison to alternatives. Without the full picture, decision-makers may make decisions that are ill-informed and lead to a loss of benefit for society.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trainee resistors: Have our students become our teachers?","authors":"Erin R. Peebles,&nbsp;Rabia Khan","doi":"10.1111/medu.15569","DOIUrl":"10.1111/medu.15569","url":null,"abstract":"&lt;p&gt;The physician as advocate is not a new concept; in fact, many licensing bodies require advocacy as a competency.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Advocacy encourages working within and around the health care system in order to support patients. However, in order to meaningfully change the system, and begin to address social inequities, physicians need to challenge the health system itself. Physicians that focus on addressing social inequities, or fight against oppression, have been conceptualised as engaging in resistance.&lt;/p&gt;&lt;p&gt;Physician resistance is defined as ‘…individual and collective expressions of condemnation of social harms and injustices, with the intent of stopping them, preventing them from recurring, and/or holding those responsible for them to account’.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Physicians and trainees who work with patients who are marginalised or oppressed are more likely to engage in resistance.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, in order to engage in resistance, physicians must stand up to a system that expects obedience and deference.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In this edition, Wyatt et al. paint a compelling picture of acts of trainee resistance over time using the metaphor of a wildfire, whether burning hot, or smouldering under the ground, waiting to re-ignite. The evolution of the wildfire of resistance is examined through an interplay of contexts, subjectivities and interactions. Trainees who transitioned into positions of power and/or recognition, whether formal or informal, were able to continue active resistance. When the trainee context or subjectivity changed in such a way that the trainee felt unsafe, or somewhat surprisingly, safer, they described engaging in quieter, less explosive acts of resistance. And finally, for one trainee, their resistance effort had succeeded in effecting change and their resistance ‘fizzled’ out.&lt;/p&gt;&lt;p&gt;What is striking in this account of trainee resistors, and other stories of physicians encountering challenging social situations,&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; is that trainees and physicians seem to feel an individual responsibility to create systemic change. Given the undisputable adverse health outcomes from social injustice, most medical schools now include curricula around the social determinants of health,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; and some are beginning to include courses on structural racism.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; However, many of these curricula are designed with the assumption that knowing about social determinants will allow physicians to act on social determinants. Trainees enter the workforce with an expectation that they will be able to address the SDH and encounter a system that is focused on efficiency and maintaining the status quo. There is evidence in physician narratives that physicians are educated to feel morally obligated to address the social status of patients, but they are unable to do so.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; If left to the individual alone, moral injury or distre","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 2","pages":"139-141"},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician development through interprofessional workplace interactions: A critical review.","authors":"Kelsey Ann Miller, Jonathan S Ilgen, Anique B H de Bruin, Martin V Pusic, Renée E Stalmeijer","doi":"10.1111/medu.15564","DOIUrl":"https://doi.org/10.1111/medu.15564","url":null,"abstract":"<p><strong>Introduction: </strong>Increasingly, medical training aims to develop physicians who are competent collaborators. Although interprofessional interactions are inevitable elements of medical trainees' workplace learning experiences, the existing literature lacks a cohesive model to conceptualise the learning potential residing in these interactions.</p><p><strong>Methods: </strong>We conducted a critical review of the health professions and related educational literatures to generate an empirically and theoretically informed description of medical trainees' workplace interactions with other health professionals, including learning mechanisms and outcomes. Informed by Teunissen's conceptualisation of workplace learning, we highlight the individual, social and situated dimensions of learning from interprofessional workplace interactions.</p><p><strong>Results: </strong>Workplace interactions between medical trainees and other health professionals tend to be brief, spontaneous, informal and often implicit without the predefined educational goals and roles that structure trainees' relationships with physician supervisors. Yet they hold potential for developing trainees' knowledge and skills germane to the work of a physician as well as building their capacity for collaboration. Our review identified a spectrum of learning theories helpful for examining what and how trainees learn from these interactions. Self-regulated learning theories focus attention on how learning depends on trainees interpreting and judging the cues offered by other health professionals. Sociocultural frameworks including the zone of proximal development and legitimate peripheral participation emphasise the ways other health professionals support trainees in performing tasks at the border of their abilities and facilitate trainees' participation in clinical work. Both the landscapes of practice theory and cultural historical activity theory highlight the influence of surrounding social, cultural and material environments. These theories are unified into cohesive model and demonstrated through an illustrative example.</p><p><strong>Conclusion: </strong>Interprofessional workplace interactions harbour a range of learning opportunities for medical trainees. Capitalising on their potential can contribute to training collaborative practice-ready physicians alongside traditional intra-professional interactions between physicians and merits future research.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformational learning and professional identity formation in postgraduate competency-based medical education.","authors":"Justin Chow, Lulwa Al-Duaij, Nicole Last, Urmi Sheth, Maham Rehman, Arden Azim, Faran Khalid, Sarah Blissett, Matthew Sibbald","doi":"10.1111/medu.15553","DOIUrl":"https://doi.org/10.1111/medu.15553","url":null,"abstract":"<p><strong>Introduction: </strong>Residency programmes are in transition to a framework for competency-based medical education (CBME). The intersection of CBME with transformational learning (TL) experiences and professional identity formation (PIF) - particularly within senior learners in transitional states - is unknown but important to understand in order to develop and implement strategies to support trainees' professional development.</p><p><strong>Methods: </strong>Through inductive qualitative methods, we conducted semi-structured interviews (n = 22) of current trainees and recent graduates from adult cardiology residency training programmes within Canada to explore the impact of TL experiences on residents' professional growth and identity formation. Interviews were analysed using thematic analysis informed by TL theory.</p><p><strong>Results: </strong>CBME did not appear to influence trainees' experiences of disorienting dilemmas and TL. Important clinical encounters and interpersonal relationships - in particular, those between mentor and mentee - shaped trainees' professional development as cardiologists ('enabling factors' for TL and PIF). 'Imposter phenomenon' was widely prevalent in our sample study population even among graduates who had already completed their training. Requisite elements for transformation (disorienting dilemmas, critical reflection, discourse and action) also contributed to PIF.</p><p><strong>Discussion: </strong>TL experiences influenced PIF in senior learners but infrequently intersected with CBME; these experiences were more commonly prompted by disorienting dilemmas relating to clinical outcomes or interpersonal interactions independent of CBME-specific architecture.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-based versus competency-based medical education: Opportunities and challenges","authors":"Holly R. Khachadoorian-Elia","doi":"10.1111/medu.15567","DOIUrl":"10.1111/medu.15567","url":null,"abstract":"<p>Commenting on Wyatt and Vidal's dialogue about the relationship between time and culture, @hollykhach outlines opportunities and challenges of adopting competency-based education.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 1","pages":"14-16"},"PeriodicalIF":4.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sculpting the good surgeon or excising the bad one: How clinical teachers could perpetuate attrition in surgical residency programmes","authors":"Arlen Astrid Rada-Estarita,&nbsp;María Camila Rincón-Ortiz,&nbsp;Oscar Geovanny Hernández-Rodríguez,&nbsp;Francisco Manuel Olmos-Vega","doi":"10.1111/medu.15557","DOIUrl":"10.1111/medu.15557","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Attrition in surgical residencies remains a significant issue, with traditional research focusing mainly on individual and programme factors. This study explores the role of clinical teachers (CTs) in influencing attrition rates. CTs are essential in moulding residents' training, serving both as enablers of workplace learning and guardians of their medical fields.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We employed a hermeneutic phenomenology framework to understand the sociocultural impacts on attrition. Data were collected through semi-structured interviews involving 19 CTs, 3 residents who left the programme and 2 who underwent remediation, following a six-step hermeneutic phenomenological analysis process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The entrenched ‘good surgeon’ narrative within the department demanded selflessness and total dedication, which CTs reinforced, thereby normalising a rigorous and challenging environment. This has led to attrition when residents fail to meet these challenges or choose to disengage from the system. We illustrated that CTs were pivotal in perpetuating these expectations, contributing significantly to resident attrition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CTs played a crucial role in resident attrition by enforcing a stringent cultural norm within surgical training programmes. Addressing this issue requires a visible change in CTs' role to foster a more supportive educational environment. Emphasising the beneficial aspects of the ‘good surgeon’ narrative and mitigating its adverse impacts is essential for reducing attrition rates and assisting all residents, including those facing challenges, in successfully completing their training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 3","pages":"328-337"},"PeriodicalIF":4.9,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15557","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards representation: Empowering youth and their community network with education.","authors":"Maggie Kerr Livingstone, Bethan Macdonald, Valerie Isobel Rae","doi":"10.1111/medu.15561","DOIUrl":"https://doi.org/10.1111/medu.15561","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When I say … social responsiveness","authors":"Anthea Hansen,&nbsp;Susan Camille van Schalkwyk,&nbsp;Cecilia Jacobs","doi":"10.1111/medu.15566","DOIUrl":"10.1111/medu.15566","url":null,"abstract":"&lt;p&gt;We live in a society that remains beset with substantial social inequalities that influence the quality of people's health and well-being.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The global health care system remains highly inequitable, skewed along lines such as race, culture and social class, with the most vulnerable in society still receiving largely inadequate health care. These challenging conditions necessitate that health professionals in training are prepared to be responsive to the complexities evident in health care. The focus of this special issue on ‘Constructive dialogue: Strengthening our knowledge by exploring cross-cultural differences’ provides an opportunity to consider social responsiveness in relation to an important construct such as culture, specifically in the context of health professions education (HPE).&lt;/p&gt;&lt;p&gt;The concept of social responsiveness is understood in a variety of ways across different fields. Within the context of HPE and in reference to medical schools, social responsiveness was conceptualised along a social obligation continuum with social responsibility on one end, social responsiveness in the middle and social accountability on the other end.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; At the time, social responsiveness was described by Boelen and Woollard&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; as ‘the engagement in a course of actions responding to social needs’ (p. 615). Although within the literature there have been efforts to further delineate these concepts, the breadth and connectedness of the social obligation continuum have resulted in many using the various terms interchangeably. Social responsiveness has been described as complementing social accountability, and while much of the work around social accountability has emphasised institutional roles in this regard, social &lt;i&gt;responsiveness&lt;/i&gt; has often been considered at the level of the individual.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In our own work, we have grappled with these terms from an HPE perspective, electing to focus on socially responsive curricula and their potential to produce socially responsive graduates who seek to ‘question the causes of health inequity and intervene in healthcare contexts and systems with a view to transforming them into more socially just spaces’&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; (p. 116). In this paper, we build on this understanding and highlight some fundamentals underpinning this important concept.&lt;/p&gt;&lt;p&gt;First, social responsiveness is underpinned by &lt;i&gt;conscientisation&lt;/i&gt;&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; for both students and educators. Freire's notion of conscientisation speaks to a critical consciousness, which requires a recognition of the oppressive systems in society and then taking action to transform these for the benefit of all.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Socially responsive health professionals, therefore, while needing to be clinically competent, also have to become deeply mindful of the context within which they practise as clinicians. This approach has implicat","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 1","pages":"22-24"},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}