Medical Education最新文献

{"title":"(Mis)Alignment in resident and advisor co-regulated learning in competency-based training.","authors":"Leora Branfield Day, Deborah Butler, Ayelet Kuper, Rupal Shah, Lynfa Stroud, Shiphra Ginsburg, Walter Tavares, Ryan Brydges","doi":"10.1111/medu.15549","DOIUrl":"https://doi.org/10.1111/medu.15549","url":null,"abstract":"<p><strong>Background/objective: </strong>In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will \"monitor and advise\" residents. We sought to clarify how AA-resident dyads collaboratively interpret assessment data from multiple sources, co-create learning goals and action plans and attempt to enhance residents' SRL skills.</p><p><strong>Methods: </strong>Shortly after each of their six meetings during two years of Internal Medicine residency, we conducted individual, brief interviews with AAs (N = 10) and residents (N = 10). We analysed transcripts using an abductive framework with theory-based and evidence-based sensitizing concepts.</p><p><strong>Results: </strong>We collected 49 residents and 36 AA 'meeting debriefs', which produced rich data on how dyads variably engaged in SRL and Co-RL. Residents and AAs adopted \"learning stances\" that oriented their perceptions and approaches to Co-RL. Their stances did not always align within dyads. We found unique patterns in how stances evolved or devolved over time, and in how these changes impacted dyads' Co-RL processes. While some dyads evolved to engage in proactive co-regulation, most stayed consistent or oscillated reactively in their relationships, with little apparent Co-RL focused on helping residents to develop clinical competencies through SRL. We catalogued multiple influential sources of regulation of learning.</p><p><strong>Conclusion: </strong>The conceptually ideal form of Co-RL was not consistently achieved in this well-intended implementation of AA-resident dyads. To better translate 'coaching over time' from intention to practice, we recommend that residency programmes use Co-RL principles to refine CBME processes, including refining assessment tools, resident orientation sessions and faculty development practices.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469416","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":"Forward thinking with reverse mentoring: Prioritising well-being over professional development.","authors":"Ashley V Simpson, Andrew Toby Merriman, Valerie Rae","doi":"10.1111/medu.15551","DOIUrl":"https://doi.org/10.1111/medu.15551","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372260","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":"Inspiring young minds: Celebrating innovations in widening participation.","authors":"Ashley V Simpson","doi":"10.1111/medu.15558","DOIUrl":"https://doi.org/10.1111/medu.15558","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365786","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":"Professionalism lapses in health professions training: Navigating the 'Yellow Card' moments for transformative learning.","authors":"Matt Sibbald, Urmi Sheth, Nicole Last, Amy Keuhl, Isla McPherson, Sarah Wojkowski, Dorothy Bakker, Paula Rowland","doi":"10.1111/medu.15540","DOIUrl":"https://doi.org/10.1111/medu.15540","url":null,"abstract":"<p><strong>Introduction: </strong>Health professions training programmes face increasing reports of professionalism lapses, which can delay, or end, trainee progression. How programmes respond to professionalism lapses to facilitate professional identity development has not been clarified. The objective of this study is to identify factors that facilitate and impair transformations around professionalism lapses in health professions training programmes.</p><p><strong>Methods: </strong>We conducted a qualitative study interviewing 5 faculty and 20 trainees with firsthand or secondhand experience with professionalism lapses from a range of health professions training programmes at McMaster University. Using reflexive thematic analysis, we coded verbatim transcripts informed by the lenses of social and transformative learning theories. We constructed themes through iterative and comparative analysis, seeking meaningful variation across professions and triangulating faculty and trainee perspectives.</p><p><strong>Results: </strong>Four themes were constructed. First, lapses are in the eye of the beholder with personal definitions intersecting with institutional and situation norms. Difficulties exist in recognising and convincing trainees to respond to lapses that are perceived to be minor or subject to interpretation. Second, responses to professionalism lapses occurred within power hierarchies, which impacted how trainees reacted to the remediation process, risked superficial trainee responses to concerns and led to concerns around inequitable treatment in how standards were applied. Third, fostering transformation involves building trainee confidence, agency, trust and engagement. Focused support and advocacy for trainees can empower and promote agency in tackling disorienting lapses. Fourth, perspective shifts involve deep engagement over time, including but not limited to self-reflection, structured discussion and seeking support.</p><p><strong>Discussion: </strong>Identifying and addressing professionalism lapses is complex and requires nuanced and contextual exploration of personal, institutional and situational dynamics at play. By fostering environments that promote genuine reflection and dialogue and focus on building trainee confidence, agency, trust and engagement, health professions training programmes can better support trainees in navigating these complex situations and contribute to the broader goal of socialising to a professional culture and practice.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365787","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":"Residents' perceptions of what makes feedback valuable in workplace-based learning: A discrete choice experiment.","authors":"Renée M van der Leeuw, Noor H Bouwmeester, Kevin W Eva, Mickaël Hiligsmann, Pim W Teunissen","doi":"10.1111/medu.15541","DOIUrl":"https://doi.org/10.1111/medu.15541","url":null,"abstract":"<p><strong>Introduction: </strong>Research on feedback has shifted emphasis away from its 'delivery' to consideration of the interaction between individual learners and their 'feedback provider'. The complexity inherent in determining whether feedback is perceived as valuable by learners, however, can quickly overwhelm educators if every interaction must be considered completely idiosyncratic. We, therefore, require a better understanding of variability in the ways in which feedback is perceived. To that end, we ran a discrete choice experiment aimed at determining residents' preferences and whether discernible patterns exist across learners regarding factors that influence perceptions of feedback's learning value.</p><p><strong>Methods: </strong>We performed a discrete choice experiment in which respondents were asked to read a clinical case and select repetitively between two feedback scenarios that differed according to six attributes identified from the literature as influencing feedback credibility: Dialogue, Focus, Relationship, Situation, Source and Valence. By systematically varying the levels of each attribute contained in the scenarios and asking residents to choose which from each pair they deemed more valuable for learning, a mixed logit model and latent class analysis could be applied to determine learners' feedback preferences and whether clusters of preference exist.</p><p><strong>Results: </strong>Ninety-five elderly care medicine residents in the Netherlands completed the questionnaire. Their responses indicated that Valence, Dialogue, Relationship and Focus each accounted for about 20% of their preferences regarding the type of feedback perceived to offer the most learning value. Source and Situation were less influential, each accounting for 11% of the choices made. A latent class model with three clusters of respondents best accounted for the heterogeneity in feedback preferences. A total of 62% of respondents could be assigned to one of the three profiles with at least 80% probability. None of the respondents' characteristics (seniority, residency programme nor sex) were related to the feedback preference profile.</p><p><strong>Discussion: </strong>Our findings suggest that 'how' feedback is provided has a greater influence on perceived learning value than who provides it. That said, variability exists in resident perceptions with no evidence (as yet) of factors that predict individual preferences. As such, tailoring to the needs and reactions of individual learners is likely to require open and ongoing conversations, and we recommend using the learner profiles generated through this study as a starting point because they provide classifications that could facilitate effective connections for the majority of residents.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365788","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":"Going to work sick: A scoping review of illness presenteeism among physicians and medical trainees.","authors":"Lorenzo Madrazo, Jade Choo-Foo, Wenhui Yu, Kori A LaDonna, Marie-Cécile Domecq, Susan Humphrey-Murto","doi":"10.1111/medu.15538","DOIUrl":"https://doi.org/10.1111/medu.15538","url":null,"abstract":"<p><strong>Background: </strong>Illness presenteeism (IP)-characterized by individuals working despite being sick-is a prevalent and complex phenomenon among physicians and trainees amidst competing priorities within medicine. The COVID-19 pandemic and growing attention to physician and trainee well-being have sparked renewed interest in IP. We conducted a scoping review to explore what is known about IP: more specifically, how IP is perceived, what approaches have been used to study the phenomenon and how it might have changed through the COVID-19 pandemic.</p><p><strong>Method: </strong>The Arksey and O'Malley scoping review framework was used to systematically select and summarize the literature. Searches were conducted across four databases: Medline, Embase, PsycInfo and Web of Science. Quantitative and thematic analyses were conducted.</p><p><strong>Results: </strong>Of 4277 articles screened, 45 were included. Of these, four were published after the onset of the COVID-19 pandemic. All studies framed IP as problematic for physicians, patients and health care systems. Dominant sociocultural drivers of IP included obligations towards patients and colleagues and avoiding the stigma of appearing vulnerable or even temporarily weak. Structural factors included heavy workload, poor access to health services and lack of sick leave policies for physicians. The pandemic does not appear to have affected IP-related causes or behaviours. Proposed solutions included both educational interventions and policy-driven changes.</p><p><strong>Conclusions: </strong>Despite being viewed in the literature as largely negative, IP remains highly prevalent among physicians and trainees. Our review highlights that IP among physicians is fraught with tensions: while IP seemingly contradicts certain priorities such as physician wellbeing, IP may be justified by fulfilling obligations to patients and colleagues. Future work should examine IP through diverse theoretical lenses to further elucidate its complexities and inform nuanced individual and systems-level interventions to minimize the negative consequences of IP.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365785","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 … multiculturalism.","authors":"Themrise Khan","doi":"10.1111/medu.15559","DOIUrl":"https://doi.org/10.1111/medu.15559","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365789","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":"International medical graduates' social connections: A qualitative study.","authors":"Mo Al-Haddad, Susan Jamieson, Evi Germeni","doi":"10.1111/medu.15542","DOIUrl":"https://doi.org/10.1111/medu.15542","url":null,"abstract":"<p><strong>Introduction: </strong>Social connections in the host country improve International Medical Graduates' (IMGs') well-being, intercultural competence and performance at work but is an issue that has been largely overlooked in the academic literature and policy discussions. The aim of this study was to better understand the social connections that IMGs form by exploring this phenomenon in a UK context.</p><p><strong>Methods: </strong>IMGs and UK Medical Graduates (UKMGs) practising in Scotland were invited to participate. This was a qualitative study using online semi-structured interviews for data collection and reflexive thematic analysis.</p><p><strong>Results: </strong>Forty-one participants were recruited (24 IMGs and 17 UKMGs), selected with maximum variation in terms of gender, ethnicity, speciality, grade and country of primary medical qualification. Twenty-one (58%) of the participants had experience working in other parts of the UK. Five themes were identified: (i) overcoming early isolation, IMGs strove to overcome their initial social isolation which harmed their mental well-being; (ii) where connections are made, IMGs form social connections mainly at work and within their religious communities; (iii) seeds of segregation, some IMGs found themselves outside tight UK native friendship groups. Alcohol was a socially exclusive activity for some IMGs, as were other host country cultural norms. Exclusion led IMGs to form social connections with other IMGs or other 'outsider' groups; (iv) degrees of Discrimination, discrimination and racism were experienced by some IMGs. Discrimination was individual, structural and institutional, and (v) \"Open (ing) the door\", participants described interventions at organisational, departmental, and individual levels to improve IMGs' ability to form social connections.</p><p><strong>Discussion: </strong>This study highlighted the challenges that IMGs face when trying to form social connections. More emphasis needs to be placed on promoting an environment where social connections, in particular between IMGs and host country natives, can flourish.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349668","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 improvisation to enhance communication skills in 4th year medical students","authors":"Lisa Erdman,&nbsp;Cheryl Dellasega","doi":"10.1111/medu.15503","DOIUrl":"10.1111/medu.15503","url":null,"abstract":"<p>In healthcare settings, effective communication between clinicians and patients is a critical skill that promotes optimal care and health outcomes. However, in medical education, there has been relatively little emphasis on developing students' skills to deal with a variety of communication scenarios they may experience in their practice. These early encounters in medical education are critical, as they shape behaviour patterns that can continue into residency and beyond. As a result, there is a need to develop innovative pedagogical approaches that help students gain self-confidence in their communication skills and cultivate empathy in their interactions with patients, families and colleagues. Medical improvisation offers promise as an adaptation of improvisational theatre principles and role play to improve communication and teamwork in medical practice.¹</p><p>To address the challenge of effective clinical communications with patients, families and co-workers, our health humanities faculty implemented an innovative course entitled ‘Medical Improv’ as a selection for the required MS4 elective. The course offers medical students an introduction to the basic skills of improvisation and an understanding of how they can be used in a variety of clinical settings. This approach has been shown to help students respond to unexpected events, address patient concerns and communicate more confidently.<span>¹</span> Examples of course activities include: warm-up exercises involving teamwork, storytelling, body movement and mirroring; structured role playing to explore the non-verbal aspects of patient-clinician communication; and writing about how a challenging medical school situation could be addressed with improv techniques. The course includes eight 2.5-hour sessions within one semester.</p><p>Over the past year, the Medical Improv course has consistently resulted in nearly full enrollment (24 students). In both written course evaluations and oral feedback, students described how the use of improvisation in their class activities could improve their communication skills in their clinical practice. Students also developed insight into how medical improv training can enhance awareness of environmental factors such as the room set-up, which may influence the clinical encounter.</p><p>Students kept a reflective journal that indicated a progressive development of understanding the interrelations between communication skills, mindfulness, empathy, teamwork and patient care. The course helps students develop communication, listening and observational skills that can contribute to a more grounded and robust professional identity as well as more effective and empathic interactions with both patients and co-workers. Future studies will examine how this training might help to mitigate stress and burnout in the clinical setting.</p><p>This project has been approved by institutional review boards at Penn State College of Medicine.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1386"},"PeriodicalIF":4.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349671","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":"Connect or detach: A transformative experience for medical students in end-of-life care.","authors":"Diego Lima Ribeiro, Daniele Sacardo, Grazyna Drzazga, Marco Antonio de Carvalho-Filho","doi":"10.1111/medu.15545","DOIUrl":"https://doi.org/10.1111/medu.15545","url":null,"abstract":"<p><strong>Context: </strong>At the beginning of clinical practice, medical students face complex end-of-life (EoL) decisions, such as limiting life-sustaining therapies, which may precipitate emotionally charged moral dilemmas. Previous research shows these dilemmas may cause identity dissonance and impact students' personal and professional development. Despite the prevalence of such dilemmas, medical educators have limited insight into how students navigate these often emotional experiences. This study explores how medical students make sense of and deal with moral dilemmas lived during EoL's care.</p><p><strong>Methods: </strong>This cross-sectional qualitative study used thematic analysis (Braun and Clarke) to analyse interviews with 11 Brazilian final-year medical students. The interviews followed the drawing of a rich picture representing moral dilemmas experienced by medical students when engaging with EoL care. The reporting of this study follows the Standards for Reporting Qualitative Research (SRQR).</p><p><strong>Results: </strong>Participants highlighted four main themes when engaging with EoL care: 'experiencing death', 'making decisions at the end-of-life', 'connecting versus detaching: an upsetting dilemma' and 'being transformed'. They described the emotional overwhelm of experiencing death and the uncertainty in navigating EoL decisions. The central moral dilemma faced was whether to connect with or detach from patients. This dilemma was lived in the context of a hidden curriculum that preaches emotional distancing as a coping mechanism. Developing the moral courage to overcome this barrier and choosing to connect became a transformative experience, significantly impacting their personal and professional development and reinforcing their commitment to patient-centred care.</p><p><strong>Conclusion: </strong>Connecting with patients in EoL care involves breaking cultural norms to establish meaningful connections with patients aiming for compassionate care. This process may lead to identity dissonance and also represents an opportunity for transformative learning. Educators can support this transformative process by legitimating students' connections with patients, teaching emotional regulation strategies, and leveraging personal experiences to foster trust.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349666","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}