Medical Education最新文献

{"title":"Selective processing of clinical information related to correct and incorrect diagnoses: An eye-tracking experiment.","authors":"Justine Staal, Jelmer Alsma, Jos Van der Geest, Sílvia Mamede, Els Jansen, Maarten A Frens, Walter W Van den Broek, Laura Zwaan","doi":"10.1111/medu.15544","DOIUrl":"https://doi.org/10.1111/medu.15544","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic errors are often attributed to erroneous selection and interpretation of patients' clinical information, due to either cognitive biases or knowledge deficits. However, whether the selection or processing of clinical information differs between correct and incorrect diagnoses in written clinical cases remains unclear. We hypothesised that residents would spend more time processing clinical information that was relevant to their final diagnosis, regardless of whether their diagnosis was correct.</p><p><strong>Methods: </strong>In this within-subjects eye-tracking experiment, 19 internal or emergency medicine residents diagnosed 12 written cases. Half the cases contained a correct diagnostic suggestion and the others an incorrect suggestion. We measured how often (i.e. number of fixations) and how long (i.e. dwell time) residents attended to clinical information relevant for either suggestion. Additionally, we measured confidence and time to diagnose in each case.</p><p><strong>Results: </strong>Residents looked longer and more often at clinical information relevant for the correct diagnostic suggestion if they received an incorrect suggestion and were able to revise this suggestion to the correct diagnosis (dwell time: M: 6.3 seconds, SD: 5.1 seconds; compared to an average of 4 seconds in other conditions; number of fixations: M: 25 fixations, SD: 20; compared to an average of 16-17 fixations). Accordingly, time to diagnose was longer in cases with an incorrect diagnostic suggestion (M: 86 seconds, SD: 47 seconds; compared to an average of 70 seconds in other conditions). Confidence (range: 64%-67%) did not differ depending on residents' accuracy or the diagnostic suggestion.</p><p><strong>Discussion: </strong>Selectivity in information processing was not directly associated with an increase in diagnostic errors but rather seemed related to recognising and revising a biased suggestion in favour of the correct diagnosis. This could indicate an important role for case-specific knowledge in avoiding biases and diagnostic errors. Future research should examine information processing for other types of clinical information.</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":"142349669","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":"Upholding our PROMISE: Increased representation is not enough to foster belonging in graduate medical education.","authors":"Patricia Poitevien, Oriaku Kas-Osoka, Audrea Burns, Laura Kester Prakash, Jyothi Marbin, Alan Schwartz, Candice Taylor Lucas, Lahia Yemane, Rebecca Blankenburg","doi":"10.1111/medu.15546","DOIUrl":"https://doi.org/10.1111/medu.15546","url":null,"abstract":"<p><strong>Purpose: </strong>Sense of belonging supports academic achievement and encourages career endurance. The purpose of this study was to characterize what individual and institutional factors influence one's sense of belonging by describing the experiences of underrepresented in medicine (UIM) paediatric and internal medicine-paediatric residents in the United States.</p><p><strong>Method: </strong>The authors conducted a national survey of paediatric and internal medicine-paediatric residents. The 23-item anonymous web-based survey was distributed between October 2020 and January 2021 and included questions on socio-demographic characteristics and individual perceptions on sense of belonging, value, common mission or values at a program or institution and respect. The authors used linear mixed models and fitted regression models to examine individual factors and environmental factors that impact sense of belonging, value and respect.</p><p><strong>Results: </strong>Across 29 residency programs, 938 (53%) of 1748 residents completed the survey. One hundred sixty-seven (18%) self-identified as UIM. UIM residents had a lower sense of belonging than non-UIM residents [mean (SD) 3.6 (0.87) vs. 4.0 (0.57)]. Black/AA and Hispanic/Latinx residents had the lowest sense of belonging [3.5 (0.82) and 2.8 (0.93), respectively]. UIM residents demonstrated decreased sense of belonging in programs that lacked bias training and where peers discriminated against them. Sense of belonging was increased in programs where they perceived a sense of support, respect or values alignment. Surprisingly, individual UIM resident sense of belonging was not improved by having more UIM residents in a program.</p><p><strong>Conclusion: </strong>UIM paediatric residents experience a decreased sense of belonging during training. Programs can support sense of belonging for UIM residents by demonstrating respect and support for them and by offering systems for bias training and reporting bias and discrimination. Recruiting a greater number of UIM trainees remains important; however, compositional diversity alone does not improve a sense of belonging for UIM residents. There is continued need for structural/institutional change, including addressing institutional culture and structural racism.</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":"142349670","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":"How do medical students' expectations shape their experiences of well-being programmes?","authors":"Emmanuel Tan, Erik Driessen, Janneke Frambach, Jennifer Cleland, Grainne P Kearney","doi":"10.1111/medu.15543","DOIUrl":"https://doi.org/10.1111/medu.15543","url":null,"abstract":"<p><strong>Introduction: </strong>Medical schools have a duty of care to support their students' health and well-being. Student support studies have tended to focus on outcomes in respect of effectiveness and satisfaction. In contrast, little is known about how student expectations of support may shape their experiences and engagement with support mechanisms, as well as the relationships students have with those offering support (including the institution itself). To address this gap in knowledge, we explore how medical students' expectations of student support systems shape, and are shaped by, institutional rules and processes.</p><p><strong>Methods: </strong>We employed a qualitative case study approach using an institutional ethnography informed methodology. Our context was a medical school that provides a well-advertised, formal institutional support system where students are assigned a personal tutor. Data collection included interviews with medical students (n = 13) plus document analysis (public facing artefacts and internal policies/guidelines related to the support system). We applied the lens of psychological contract theory to guide abductive analysis of interview and text data.</p><p><strong>Results: </strong>Students expected a strong support system to be provided by the medical school and the personal tutors. However, their experiences did not always align with their expectations. Some felt excluded by the system while others regarded the relationship with their personal tutor as more transactional than relational. Where their expectations were unmet, students responded by reducing their engagement with the formal support system and creating their own peer-support network that supplemented existing formal support.</p><p><strong>Discussion: </strong>Student expectations matter in shaping their experiences of support systems. Where expectations are unmet, students may disengage and/or find alternatives. This may be easier for some students compared with others. More understanding of the relationship between expectations and engagement with support can inform the development of institutional support structures that meet the needs of all students across time.</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":"142349667","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":"Exploring institutional stratification: Minority-serving institutional pathways to medical school acceptance in the United States.","authors":"Amanda K Burbage, Eushekia Y Hewitt","doi":"10.1111/medu.15539","DOIUrl":"https://doi.org/10.1111/medu.15539","url":null,"abstract":"<p><strong>Introduction: </strong>Recruiting and training a diverse pool of physicians from historically excluded groups is vital to solving complex scientific problems and increasing access to patient care. Disparate educational and health outcomes of COVID-19 amplified this need. In stratified higher education systems, underfunded institutions that serve greater numbers of underrepresented in medicine (URM) students face unique barriers to entering physician training. However, pathways from historically underfunded minority-serving institutions (MSIs) in the United States to medical school (MD) are not well understood.</p><p><strong>Method: </strong>A hierarchical logistic regression analysis of 328 488 de-identified applicants to US MD-granting medical schools for academic years 2017-2018 through 2022-2023 was used to determine predictors of acceptance based on MSI attendance compared to predominantly White institutions (PWI) and other literature-informed predictors. An interrupted time series analysis determined the significance in changes in observed differences in application acceptance before and after the COVID-19 pandemic.</p><p><strong>Results: </strong>In model 1, MSI attendance was associated with significantly lower odds of acceptance, with a 42% to 52% chance of acceptance compared to PWI applicants. Adding MCAT and GPA significantly increased odds of acceptance for most MSI applicants in model 2. MSI attendance, MCAT, GPA and socio-economic status indicators were useful predictors, improving the acceptance model by 39% better than the null model. Although some predictors showed a change in odds over time, none changed significantly when comparing before and after COVID-19.</p><p><strong>Discussion: </strong>MSI attending students were less likely to be admitted to MD programmes, highlighting systemic stratification until other academic factors were introduced to the model that alleviated lower odds, and the COVID-19 pandemic did not substantially change these trends. Improved pathways and strengthened institutional relationships between institutions that have greater proportions of underrepresented students and medical schools may help improve MSI applicant odds furthering diversity within the physician-trained workforce.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290784","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":"Medical students experience science communication via moderating podcasts","authors":"Doreen Pretze,&nbsp;Stephan Wiegand","doi":"10.1111/medu.15505","DOIUrl":"10.1111/medu.15505","url":null,"abstract":"&lt;p&gt;In an era where misinformation proliferates and public trust in science is crucial, medical professionals must possess the ability to communicate complex medical information accurately and empathetically to patients, colleagues and the broader community in an understandable manner. Therefore, it is essential for medical students to gain competencies in science communication.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, how could we enable students to engage in comprehensive dialogue with society? A promising approach could be a student-moderated live podcast.&lt;/p&gt;&lt;p&gt;In the project ‘YOU ASK we explain’, monthly live podcasts were produced in public locations within the heart of communities, fostering citizen discussions on sensitive medical topics. The recordings took place at locations related to the topics. If we talked about euthanasia, the podcast took place in a cemetery, if we talked about alcohol abuse, we went to a beer garden and if we talked about eating disorders, we went to a farm store. The medical students played a critical role as moderators and link between experts and community. Students developed a moderation guide and got communication training (2 times 2 hours) before the recording. Afterwards the students got oral feedback to their performance from the organisers. For each podcast, we invited an interprofessional discussion panel, consisted of a medical student as moderator, and three experts from different fields (i.e. physicians, pastors, computer scientists and social workers). The audience had the opportunity to ask questions anonymously by cards at any time. The technical support recorded and edited the podcasts and offered them at common podcast platforms. After podcast release, an evaluation of the student moderators showed the skills acquired. Topics of professional, science and rhetorical competencies as well as feedback were assessed on a 5-point Likert scale.&lt;/p&gt;&lt;p&gt;Since January 2023, we produced 15 episodes, which overall had about 550 visitors and 3000 listeners. Interestingly, more female (68% versus 51%) and older (13% versus 4% over 60 years) visitors attended the life events in relation to podcast listeners.&lt;/p&gt;&lt;p&gt;The moderating students were very engaged in the medical school and felt comfortable to give lectures in front of other people. However, the evaluation showed that they improved their skills for future presentations and moderations through the podcast and would like to see the format repeated. The students took about 3 hours for content preparation, to be able to answer any questions at any time, although they were only moderators. They assessed their skills in scientific work as strong, but encountered challenges in introducing controversies into discussions and supporting statements with scientific sources.&lt;/p&gt;&lt;p&gt;The podcast addressed various learning objectives such as medical-scientific skills, communication skills and health counselling. Students improved their scientific skills and, in addition, gained ","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1406-1407"},"PeriodicalIF":4.9,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290786","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":"Table of Contents November 2024 RGS","authors":"","doi":"10.1111/medu.15548","DOIUrl":"10.1111/medu.15548","url":null,"abstract":"<p>November brings the latest installment of invaluable lessons learned through innovative developments in health professional education in the form of the next installment of Really Good Stuff.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1369"},"PeriodicalIF":4.9,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290787","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":"Dispelling the magic of artificial intelligence in medical education.","authors":"Casey N McQuade, Thilan P Wijesekera, David Chartash","doi":"10.1111/medu.15536","DOIUrl":"https://doi.org/10.1111/medu.15536","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290783","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":"Community-based initiative: Engaging youth in medical education","authors":"Juan Medina-Echeverria,&nbsp;Daniel H. Sanchez","doi":"10.1111/medu.15507","DOIUrl":"10.1111/medu.15507","url":null,"abstract":"&lt;p&gt;In 2022, we launched a ground-breaking Mini Medical School Program tailored for fourth and fifth graders in North Chicago, Illinois. This initiative aimed to tackle the issue of underrepresentation of historically marginalised groups in medicine, particularly among Black and Latinx students, and address health disparities. Data from the AAMC website reveal alarming statistics, with only 6.3% of active physicians being Latino/Latina and a mere 5.2% being Black or African American.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The primary objective of our programme was to ignite interest and provide exposure to the medical field at a young age to underrepresented populations. We achieved this through an engaging and age-appropriate curriculum designed to introduce students to medicine in a fun and interactive manner, thus fostering a supportive learning environment. By offering initiatives like ours, we aspire to contribute to an increase in the representation of underrepresented groups in medicine.&lt;/p&gt;&lt;p&gt;To fulfil its primary objective, Mini-Medical School (MMS) adopted a community-based approach by partnering with the programme's MMS Student Executive Board, North Chicago Community Partners (NCCP), and received funding from the Creating Pathways and Access for Student Success (CPASS) Foundation. Through this collaboration, an age-appropriate curriculum was delivered virtually to 25 fourth- and fifth-grade students from AJ Katzenmaier Academy. The MMS Student Executive Board is composed of first- and second-year Underrepresented Minorities in Medicine students from Chicago Medical School.&lt;/p&gt;&lt;p&gt;Throughout the programme, students participated in an opening White Coat Ceremony and received instruction on topics including the cardiovascular system, gastrointestinal system, and neurology/mental health, culminating in a graduation ceremony. Additionally, monthly Zoom calls were organised between the Student Executive Board and students' parents to provide guidance on facilitating continued learning at home.&lt;/p&gt;&lt;p&gt;The 2 hour classes followed a structured format: a pretest to assess student baselines, a lecture and smaller breakout sessions led by medical student volunteers serving as teaching assistants (TAs). These interactive sessions reinforced lecture concepts. At the conclusion of each lesson, a post-test was administered, and students shared their favourite part of the day and discussed topics they found interesting.&lt;/p&gt;&lt;p&gt;Numerous valuable insights were gleaned from the MMS experience, informing our approach for future programme iterations. Notably, among the participating 4th-grade students, there was a preference for the Neurology/Mental Health component of the curriculum, as well as a strong affinity for cardiopulmonary resuscitation (CPR) as their favourite activity during the course.&lt;/p&gt;&lt;p&gt;Furthermore, as part of the feedback collection process, an end-of-year focus group study was conducted, in which the MMS students were interviewed regarding their pr","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1399-1400"},"PeriodicalIF":4.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266683","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":"Beyond inclusion politics: A critical discourse analysis of sex and gender in medical education","authors":"Navin Kariyawasam, Nanky Rai, Malika Sharma","doi":"10.1111/medu.15532","DOIUrl":"https://doi.org/10.1111/medu.15532","url":null,"abstract":"IntroductionMedical training refers frequently to sex and gender, yet these terms are often used vaguely and interchangeably with little critical engagement. We aimed to better understand the key discourses around sex and gender in medical training.MethodsAll verbal and written instances of gendered/sexed language, occurring in lectures, slides and provided written materials, within 1 year of preclerkship medical education at a single institution in Canada were recorded autoethnographically by a medical student. We analysed these instances using critical discourse analysis informed by anticolonial, feminist and queer theoretical perspectives, particularly contrasting the concepts of governmentality and ungovernability to better understand how sex and gender are deployed in medical training.ResultsDespite the proliferation of ostensibly queer‐ and trans‐positive content in medical curricula, sex and gender were frequently communicated inconsistently and imprecisely. In addition to, and perhaps as a result of, this inconsistent use, we uncovered three key discourses of (1) gender policing, (2) misogyny and (3) gender legibility. Collectively, these discourses can illustrate how medical education governs and reinforces gender norms.DiscussionThe repetitive and everyday use of ill‐defined and uncritical gendered and sexed language can be seen to discursively uphold systems of cisheteropatriarchy and transphobia within medicine. Trans and intersex bodies cannot be considered addendums to be tacked on to a foundation of cisnormative and inaccurate teaching in medical education. Institutional attempts to improve curricula must go beyond the addition of new modules, which can be undermined by otherwise cisheteropatriarchal understandings of sex and gender.","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"6 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266423","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":"Clarifying and expanding equity in assessment by considering three orientations: Fairness, inclusion and justice.","authors":"Hannah L Kakara Anderson, Marjan Govaerts, Layla Abdulla, Dorene F Balmer, Jamiu O Busari, Daniel C West","doi":"10.1111/medu.15534","DOIUrl":"https://doi.org/10.1111/medu.15534","url":null,"abstract":"<p><strong>Context: </strong>Despite increasing discussion and scholarship, equity in assessment is rarely defined and distinguished in a way that allows for shared understanding in medical education. This paper seeks to clarify and expand the conversation about equity in assessment by critically reviewing three distinct and evolving orientations toward equity in assessment. Orientations refers to the positions, attitudes, interests or priorities individuals can hold toward equity in assessment. The three orientations include fairness-oriented assessment, assessment for inclusion and justice-oriented assessment. While fairness-oriented assessment is a prevailing orientation in medical education, assessment for inclusion and justice-oriented assessment, originally developed in other fields of education, deserve careful consideration.</p><p><strong>Methods: </strong>In this paper, the authors explore unique underpinning assumptions of each orientation by critically examining the foundational literature of each orientation. They reflect on the unique perspectives each orientation provides, including the actions one might take and what advantages and disadvantages might result from looking at equity in assessment from any one orientation.</p><p><strong>Conclusions: </strong>Informed by this reflection, the authors propose that to more effectively advance equity in assessment in medical education, those working in the field should clearly identify their respective orientations, intentionally choose methods, tools and measures aligned with their orientations and expand their work by exploring alternative orientations.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290782","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}