Medical Education最新文献

{"title":"The pitfalls and perils of anonymous learner feedback","authors":"Katherine M. Wisener","doi":"10.1111/medu.15487","DOIUrl":"10.1111/medu.15487","url":null,"abstract":"<p>‘<i>Dr. [A] was late one minute, one time. But to be fair, it didn't negatively impact my learning</i>’. This is a comment from a learner on my colleague's anonymised student evaluation of teaching form. The consideration of whether this might be a ‘fair’ comment is reflective of a larger conversation about the utility and value of online, anonymised feedback forms. As such tensions garner a heightened focus in health professions education (HPE) specifically,<span><sup>1</sup></span> the article by Jenq et al.<span><sup>2</sup></span> is particularly timely.</p><p>Their study offers an important contribution to this area of scholarly work as it compares both givers and receivers of feedback, offering a useful juxtaposition of challenges while most studies focus on one group or the other. Viewing both sides of the same coin in one context helps to illuminate the perspectives of multiple players in the clinical learning environment on the topic of upward feedback. Another distinctive aspect of their work is that the authors examine upward feedback in a Taiwanese culture, with speculation that learners and faculty in Asian cultures are more sensitive to power dynamics than those in Westernised cultures, thereby making in-person feedback conversations more difficult to hold successfully.</p><p>The authors found that the influence of medical hierarchy was prevalent and posed a barrier to giving and receiving feedback across all participant groups which included medical students, residents, nurses and clinical educators. For example, nurses were often prevented by their departments from giving feedback to clinical educators and felt as though their feedback would be ignored by clinicians. Learners were reluctant to provide constructive feedback for fear of retribution and concern that their feedback would also be dismissed due to their low status. Educators were more likely to accept feedback from more senior clinicians than from their learners or peers. Further, clinicians took constructive feedback particularly hard because they felt reputational consequences in front of others. Because of these strong and persistent power and social dynamics, the authors leave us with three implications for their work, each of which are deserving of their own respective ‘unpacking’.</p><p>The authors first recommend a shift to anonymous upward feedback processes with the hope that learners can give, and teachers can receive, constructive feedback without the threat of hierarchical issues that come with face to face conversations. It is important to keep in mind, however, that anonymous feedback comes with its own challenges. For example, feedback should be timely,<span><sup>3</sup></span> but to maintain learner anonymity, feedback has to be held until long after the teaching encounter. Anonymous feedback mechanisms violate other foundational feedback tenets as well, by not being situated in an educational alliance, and with no opportunities for discussion and re","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1436-1438"},"PeriodicalIF":4.9,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897770","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":"When I say … improvisation.","authors":"Christiaan Alexander Rhodius, Marco Antonio de Carvalho Filho","doi":"10.1111/medu.15480","DOIUrl":"https://doi.org/10.1111/medu.15480","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897771","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":"Using theoretical engagement to understand workplace learning across contexts-Bringing worlds apart together.","authors":"Francisco M Olmos-Vega, Renée E Stalmeijer","doi":"10.1111/medu.15481","DOIUrl":"https://doi.org/10.1111/medu.15481","url":null,"abstract":"<p><p>The pivotal importance of workplace learning (WPL) within health professions education has elevated its understanding and improvement to a major research priority. From a sociocultural learning theory perspective, WPL is inherently situated and context-specific. This means that the health care settings in which (future) health care professionals are trained will impact how and what is learned. However, to what extent is the research performed thus far transferable across professional contexts, cultures and borders? To what extent has WPL research sufficiently addressed the contextual characteristics of WPL to enable the evaluation of its transferability? To what extent have methodological and theoretical approaches enabled the building of understanding across contexts? We propose that heightening the transferability of WPL research as well as opening up the conversation to more diverse WPL contexts, settings and cultures will require mapping context and theoretical engagement. To explore what theoretical engagement may afford to our understanding of the influence of context on WPL, we use two theories: Landscapes of Practice and Figured Worlds. These theories with sociocultural groundings provide concrete lenses to understand the interplay between the individual and the context. We conclude with implications for research and practice and advocate for more attention to research practices that may deepen our understanding and heighten the transferability of workplace learning research.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893800","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":"Fixing disconnects: Exploring the emergence of principled adaptations in a competency-based curriculum.","authors":"Mary C Ott, Lori Dengler, Kathryn Hibbert, Michael Ott","doi":"10.1111/medu.15475","DOIUrl":"https://doi.org/10.1111/medu.15475","url":null,"abstract":"<p><strong>Purpose: </strong>Competency-based medical education (CBME) promises to improve medical education through curricular reforms to support learner development. This intention may be at risk in the case of a Canadian approach to CBME called Competence by Design (CBD), since there have been negative impacts on residents. According to Joseph Schwab, teachers, learners and milieu must be included in the process of curriculum-making to prevent misalignments between intended values and practice. This study considered what can be learned from the process of designing, enacting and adapting CBD to better support learners.</p><p><strong>Methods: </strong>This qualitative study explored the making of CBD through the perspectives of implementation leads (N = 18) at national, institutional and programme levels. A sociomaterial orientation to agency in curriculum-making guided the inductive approach to interviewing and analysis in phase one. A deductive analysis in phase two applied Schwab's theory to further understand sources of misalignments and the purpose of adaptive responses.</p><p><strong>Results: </strong>Misalignments occurred when the needs of teachers, learners and milieu were initially underestimated in the process of curriculum-making, disconnecting assessment practices from experiences of teaching, learning and entrustment. While technical and structural issues posed significant constraints on agency, some implementation leads were able to make changes to the curriculum or context to fix the disconnects. We identified six purposes for principled adaptations to align with CBME values of responsive teaching, individualised learning and meaningful entrustment.</p><p><strong>Conclusion: </strong>Collectively, the adaptations we characterise demonstrate constructive alignment, a foundational principle of CBME in which assessment and teaching work together to support learning. This study proposes a model for making context-shaped, values-based adaptations to CBME to achieve its promise.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893796","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":"The social construction of time and its influence on medical education.","authors":"Tasha R Wyatt, Edison Iglesias de Oliveira Vidal","doi":"10.1111/medu.15472","DOIUrl":"https://doi.org/10.1111/medu.15472","url":null,"abstract":"<p><strong>Introduction: </strong>Few sociocultural constructs exist that are so deeply embedded in our daily lives and able to influence our thoughts, behaviours and interactions than time itself. Time spans all cultures, and yet many of us have not critically engaged with how time effects what we do, how we perceive and the ways in which we interact. As such, our relationship to time remains almost invisible running in the background nearly unnoticed until it is somehow brought into conscious awareness.</p><p><strong>Context: </strong>In this paper, we draw on Levine's concepts of clock time and event time as different perspectives on time, demonstrating how they play out in medical education and clinical practice within the United States and Brazil. Clock time treats time as something external to our lives, fixed by the natural world and measured by clocks. Event time is conceptualised more flexibly, where the duration of activities depends on internal cues related to the flow and progression of events rather than strict schedules.</p><p><strong>Discussion: </strong>By contrasting these differences, we hope to make visible the way that time influences our choices for educating physicians and provide a foundation for medical education to begin questioning how time is positioned, experienced and understood as a powerful force in the shaping of our profession. Additionally, we consider these perspectives within the concepts of Taylorism and Slow Medicine to better understand their links to medicine's formal and hidden curriculum in hopes of raising awareness and create new visions for medical education.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893799","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":"Reflecting on the Spectrum of Involvement: How do we involve patients as partners in education?","authors":"Amber Bennett-Weston, Simon Gay, Elizabeth S Anderson","doi":"10.1111/medu.15484","DOIUrl":"https://doi.org/10.1111/medu.15484","url":null,"abstract":"<p><strong>Background: </strong>The Spectrum of Involvement describes six levels of active patient involvement in healthcare education. Only at the highest levels are patients described as 'equal partners'. Although this framework was never intended to be hierarchical, healthcare educators continue to strive towards aspirations for involving patients as 'equal partners' in education. However, we do not know what these partnerships mean for all stakeholders and how they can be achieved in practice. This study explores key stakeholders' understandings and experiences of patient partnerships in healthcare education.</p><p><strong>Methods: </strong>A qualitative case study design was adopted, underpinned by a social constructivist philosophical stance. Semi-structured interviews were conducted with patients (n = 10) and educators (n = 10) from across a Medical School and a Healthcare School. Five focus groups were held with penultimate year students (n = 20) from across the two Schools. Data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Three themes were generated: (i) equal partnerships are neither feasible nor desirable; (ii) partnership is about being and feeling valued; and (iii) valuing patients as partners. Patients did not always desire the highest levels of involvement, as 'equal partners' in education. All stakeholders agreed that partnership need not be synonymous with equality. Instead, they contended that true partnerships were about valuing patients for their contributions at any level of involvement. Remuneration, student feedback, training and providing institutional access were viewed as important methods of valuing patients as partners.</p><p><strong>Conclusion: </strong>Patients, educators and students questioned the notion that patient partnerships are only achievable at the highest levels of involvement. Critical application of the Spectrum of Involvement in future research and education is encouraged. This study addresses a gap in the literature, providing tangible approaches to valuing patients as partners that are endorsed by all stakeholders. We propose a model for achieving valued patient partnerships in educational practice.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893798","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":"Physicians' use of social media: Where cultural difference appears to overlap","authors":"Noha Atef","doi":"10.1111/medu.15490","DOIUrl":"10.1111/medu.15490","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 10","pages":"1257"},"PeriodicalIF":4.9,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893797","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":"Adopting a pedagogy of connection for medical education.","authors":"Marco Antonio de Carvalho Filho, Frederic William Hafferty","doi":"10.1111/medu.15486","DOIUrl":"https://doi.org/10.1111/medu.15486","url":null,"abstract":"<p><p>In this article, we propose developing a \"pedagogy of connection\" based on the history and evolution of medical education in Brazil. This pedagogy emerged from the intersection of the healthcare and higher educational systems, both dedicated to the principles of social justice and universal access, in response to the country's efforts to address the enduring impacts of slavery and social inequality. Following the \"Sanitary Reformation\" movement-a foundational moment for Brazil's healthcare and medical education systems-Brazil established the Unified Public Healthcare System (Sistema Único de Saúde - SUS). SUS is founded on principles of universality, integrality, equity, community participation, political and administrative decentralisation, hierarchisation and regionalisation. Aligned with these core principles and inspired by critical pedagogy, Brazilian medical education has evolved with a profound commitment to social justice, critical consciousness, professional presence and compassion. This evolution has given rise to a \"pedagogy of connection,\" which imbues medical education with a sense of purpose and joy, preparing future medical professionals to address the challenges of our ever-evolving society and healthcare systems. The connections fostered by this pedagogy occur in complementary dimensions: (a) healthcare system and society, (b) community, (c) profession, (d) patients, and (e) ourselves. This innovative pedagogy enhances medical education discourse and practice by emphasising the development of a professional identity grounded in social justice and patient-centred care, which remain challenges for current medical education systems. As the global medical education community embraces decolonisation, this pedagogy offers a framework that can be adapted and enriched in various contexts worldwide, fostering opportunities for mutual learning from diverse educational systems in a dialogical and democratic manner.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875276","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":"Impact of liminality and rituals on professional identity formation in physician training.","authors":"Jian-Hua Hong, Chun-Lin Chu, Daniel Fu-Chang Tsai, En-Chi Liao, Huei-Ming Yeh","doi":"10.1111/medu.15483","DOIUrl":"https://doi.org/10.1111/medu.15483","url":null,"abstract":"<p><strong>Purpose: </strong>The transition from medical student to practicing physician affects the complex processes of professional identity formation and professionalism, which have a lasting effect on the physician's career development. This study explored two different transitional processes of medical students in Taiwan, the associated rituals during this transitional period (the 'liminal phase') and their effect on the formation of professional identity.</p><p><strong>Method: </strong>Using snowball sampling, we recruited 13 medical students from two training systems: six from the traditional postgraduate year programme and seven from the accelerated postgraduate year (A-PGY) programme. Semi-structured interviews were thematically analysed to identify significant themes that encapsulated trainees' experiences. A consistent and mutually confirmed discussion ensured the identification of robust recurring themes.</p><p><strong>Results: </strong>A comparative analysis of the two training modalities provided critical insights into the relative impact of the training dynamics. The A-PGY cohort, subjected to an altered 'incorporation' ritual, encountered an influx of unexpected symbolic social power, complicating their transformation within the liminal phase. Without a defined internship like in the PGY system, A-PGY trainees exhibited confusion and inconsistencies in professional identity formation marked by conflicting internal and external perceptions. This ambiguity affected their clinical training, social integration and overall development of professionalism. The absence of a structured, sequential liminal phase increased conflict and diminished motivation, culminating in an incomplete self-crafting journey for A-PGY trainees.</p><p><strong>Conclusions: </strong>This study highlights the impact of the well-sequenced implementation of rituals in liminality on professional identity formation. A good transition training programme for medical students should compass sequential rituals in the liminal phase, including clear starting and ending points, supervision by seniors, guided reflection and plenty of opportunities for observation and imitation in context. Optimal training and pivotal elements in a medical training system warrant delicate design and further research when developing and changing the structure of the training programme.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875277","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":"Understanding cultural dynamics shaping clinical reasoning skills: A dialogical exploration.","authors":"Dilmini Karunaratne, Matthew Sibbald, Madawa Chandratilake","doi":"10.1111/medu.15479","DOIUrl":"https://doi.org/10.1111/medu.15479","url":null,"abstract":"<p><p>Our study examined the influence of national cultural predispositions on training medical professionals and doctor-patient dynamics using a dialogical approach, guided by Hofstede's framework. This framework provided valuable insights into how cultural tendencies shape the learning and application of clinical reasoning skills in different cultural contexts. We found that dimensions such as power distance and individualism versus collectivism significantly influenced clinical reasoning, while other dimensions had more nuanced effects. Junior doctors in Southern nations, despite initially lagging behind, developed advanced clinical reasoning skills with experience, eventually matching their Northern counterparts. The study highlighted the link between cultural norms and educational practices, variations in family involvement during reasoning, adherence to clinical guidelines and doctors' emotional engagement in clinical care between Southern and Northern contexts. Additionally, we recognised that effective clinical reasoning extends beyond technical knowledge, involving an understanding and integration of cultural dynamics into patient care. This highlights the pressing need to prioritise this topic.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875278","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}