Medical Education最新文献_第9页

Tolerance for uncertainty and medical students' specialty choices: A myth revisited.

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-23 DOI: 10.1111/medu.15610

Odette Wegwarth, Moritz Pfoch, Claudia Spies, Martin Möckel, Stefan J Schaller, Markus Wehler, Helge Giese

{"title":"Tolerance for uncertainty and medical students' specialty choices: A myth revisited.","authors":"Odette Wegwarth, Moritz Pfoch, Claudia Spies, Martin Möckel, Stefan J Schaller, Markus Wehler, Helge Giese","doi":"10.1111/medu.15610","DOIUrl":"https://doi.org/10.1111/medu.15610","url":null,"abstract":"Background: In 1962, the idea emerged that medical students' tolerance of uncertainty could determine their specialty choice. While some studies supported this claim, others refuted it, often using independently developed instruments. We explored whether the reported link between specialty choice and uncertainty tolerance is more myth than evidence by employing established instruments to investigate whether specialty choice could be explained by variance in uncertainty tolerance.Method: We conducted a cross-sectional online survey at two periods of time. From February to June 2023, we queried 563 final-year medical students from 34 German medical universities (1) on their uncertainty tolerance using three validated tools (the modified tolerance for ambiguity scale, the physicians' reaction to uncertainty scale and the uncertainty intolerance scenario method) and (2) on their intended specialty choice. In a follow-up 1 year later (May to June 2024), 263 of those medical students responded to our query on their final specialty choice and again on their uncertainty tolerance.Results: Participants' (N = 563) median age was 26.0 years (mean: 27.2; SD = 3.8), and 70% (n = 396) were female. Originally reported differences and rank orders in uncertainty tolerance among medical students with different intended specialty choices could not be replicated for any of the three scales. Instead, our results suggest different rank orders of uncertainty tolerance by different tools, as well as nonsignificant differences between intended medical specialties. Intercorrelation coefficient analyses demonstrated that, depending on the scale, only 0.3% to 1.5% of the variance in uncertainty tolerance could be attributed to specialty choice. Follow-up data using actual instead of intended medical choices left findings unchanged.Discussion: Our findings suggest that the presumed link between uncertainty tolerance and specialty choice is more myth than evidence. Instead of teaching this link or using it as an admissions criterion, medical schools should equip students with the skills needed to navigate uncertainty across their careers.","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033439","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}

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Exploring how structural forms of power shape the training of intraprofessional collaboration between family physicians and specialty physicians in outpatient workplace settings. 探索权力的结构形式如何影响家庭医生和专科医生在门诊工作场所的专业内合作培训。

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-15 DOI: 10.1111/medu.15607

René Wong, Cynthia R Whitehead

{"title":"Exploring how structural forms of power shape the training of intraprofessional collaboration between family physicians and specialty physicians in outpatient workplace settings.","authors":"René Wong, Cynthia R Whitehead","doi":"10.1111/medu.15607","DOIUrl":"https://doi.org/10.1111/medu.15607","url":null,"abstract":"Introduction: Intraprofessional collaboration between family physicians (FPs) and specialist physicians (SPs) is posited to improve patient outcomes but is hindered by power dynamics. Research informing intraprofessional training on hospital wards often conceptualizes power at an interactional level. However, less is known about how social structures make these power dynamics possible. This study explores how structural forms of power shape how FP and SP supervisors engage with and teach intraprofessional collaboration in outpatient settings and to what effect.Methods: Using diabetes as a case study of intraprofessional collaboration, we conducted a discourse analysis of formal documents (written to guide how collaboration should be practiced) and interview transcripts with 15 FP and SP supervisors. Informed by governmentality and the sociology of professions, we analysed how discourses governing diabetes care shape FPs' and SPs' clinical and teaching behaviours, implications for jurisdictional boundaries and the nature of their collaborative relationships.Results: Discourses of evidence-based medicine construct a hierarchical social structure in medicine that permeates how physicians engage with and teach intraprofessional collaboration. FPs and SPs enact and teach these hierarchical roles when collaborating in the referral-consultation process in ways that establish and reinforce jurisdictional boundaries. The interactions at the intersection of these boundaries foster a form of collaboration characterized by SPs surveilling and regulating FPs' practices.Discussion: As currently constructed, intraprofessional collaboration in outpatient settings may be practiced and taught in ways that reinforce asymmetric power dynamics between FPs and SPs. Without awareness of this unintentional effect, educational attempts to advance this constructed notion of collaboration may ironically impede the achievement of collaborative ideals. Outlining the processes by which structural power permeates FPs' and SPs' collaborative behaviours opens space for educators to acknowledge and mitigate the effects of social structures on intraprofessional training in other clinical and educational contexts.","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008201","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}

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Can we be too gritty? 我们能不能太狡猾了？

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-15 DOI: 10.1111/medu.15594

Marlena Calo, Belinda Judd, Casey L. Peiris

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February in this issue 二月号。

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-08 DOI: 10.1111/medu.15600

Sarah Tatum George

{"title":"February in this issue","authors":"Sarah Tatum George","doi":"10.1111/medu.15600","DOIUrl":"10.1111/medu.15600","url":null,"abstract":"Patients are expected to be actively engaged as partners in education. However, little is known about what these partnerships mean and how they can be achieved in practice. This qualitative case study explored patients', educators' and students' perceptions of patient partnerships in health care education. Participants felt that true partnerships were about valuing patients for their contributions, irrespective of the extent of their involvement. This contrasts established conceptualisations of patient partnerships as requiring equality and as only being achievable at the highest levels of involvement. A model for achieving patient partnerships in educational practice is proposed.\u0000 Bennett-Weston, A, Gay, S, Anderson, E. Reflecting on the spectrum of involvement: how do we involve patients as partners in education? Med Educ 2025; 59(2): 198-209. 10.1111/medu.15484.Little is known about how primary care professionals cultivate a positive attitude to caring for patients in complex and challenging social situations. Qualitative analysis undertaken in this study of that issue identified two themes about their passion: (i) the joy derived from interacting with patients and (ii) the joy derived from professional growth or development. Despite the inherent challenges, professionals demonstrated vibrancy and pleasure in their interactions with patients and their professional development. Several factors about developing, maintaining and spreading a positive attitude were also identified. These findings may contribute to a reduction in the disparity of distribution of primary care by highlighting ways in which interest in primary care can be raised.\u0000 Mizumoto, J, Fujikawa, H, Mitsuyama, T, Izumiya, M, Eto, M. Positive perspectives of primary care professionals toward patients in complex and challenging social situations in Japan: an educational opportunity. Med Educ 2025; 59(2): 188-197. 10.1111/medu.15488.Effective medical training hinges on well-timed and structured rituals that transition students from academia to clinical practice. This study explores how these rituals shape professional identity in medical trainees. Key findings suggest that a successful training program includes sequential rituals in the transition period, with clear start and end points, senior supervision and opportunities for reflection and practice. The research emphasizes that such rituals are crucial for fostering consistent professional identities and advancing medical careers.\u0000 Hong, J-H, Chu, C-L, Tsai, D F-C, Liao, E-C, Yeh, H-M. Impact of limin","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 2","pages":"135"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15600","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951313","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}

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MEDU Annual Reviewer List

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-08 DOI: 10.1111/medu.15596

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RGS Annual Reviewer List

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-08 DOI: 10.1111/medu.15597

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For the sake of co-regulated learning, consider mindsets, culture and time 为了共同调节学习，考虑心态、文化和时间。

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-07 DOI: 10.1111/medu.15605

Jiaxi Tan, David A. Hirsh, Honghe Li

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The trope of ‘subjectivity’ versus ‘objectivity’ in summative assessment 总结性评估中的“主观性”与“客观性”的比喻。

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-07 DOI: 10.1111/medu.15606

John Norcini

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When language engenders discomfort 当语言让人不舒服时。

IF 4.9 1区教育学

Medical Education Pub Date : 2025-01-04 DOI: 10.1111/medu.15598

Justin P. Boyle, Justin L. Bullock

{"title":"When language engenders discomfort","authors":"Justin P. Boyle, Justin L. Bullock","doi":"10.1111/medu.15598","DOIUrl":"10.1111/medu.15598","url":null,"abstract":"We must be mindful of the language we use when caring for patients. This is regularly emphasized in medical education curricula, particularly when teaching trainees how to practice cultural humility and trauma-informed care for patients from marginalized communities. It is, therefore, simultaneously troubling and unsurprising to read ‘Beyond Inclusion Politics: A Critical Discourse Analysis of Sex and Gender in Medical Education’.1 In it, Kariyawasam et al. report, through an autoethnographic examination of a preclinical undergraduate medical school curriculum, that the everyday use of ill-defined gendered and sexed language was not only present but also found to uphold systems of transphobia and cisheteropatriarchy within medicine. Here, we explore our own reactions to the authors' use of language because these reactions emphasize important aspects of their conclusions.In the spirit of autoethnographic introspection, we felt a sense of discomfort when first reading this autoethnography because of the way in which the authors powerfully wielded language. Their words pierced our fragile academic skin: ‘Trans and intersex bodies cannot be considered addendums to be tacked on to a foundation of cisnormative and inaccurate teaching’.1 Reading the article, we found ourselves attempting to appease our discomfort by interrogating the piece's methodologic rigour, looking for tables that clearly documented exactly which words the autoethnographer had recorded. This level of seeking word-for-word proof was unfair: it is not a practice which we typically undertake or expect of other manuscripts. Unsettled by our own discomfort, we asked ourselves, ‘Where is this disconcertion coming from?’ As we share our journey to answer this question, we would be remiss not to acknowledge that we, two queer, cisgendered individuals are permitted to comment on a piece describing the repetitive harms of sexed and gendered language on trans and gender diverse individuals in medical education. Upon reflection, we realized that the discomfort we felt during our initial review of this autoethnography is likely rooted in the politics of our identities and the power that comes from the language we use. Written plainly, the authors did not write like we do. We never questioned the authors' core findings, but rather, we questioned whether this piece was appropriate for this academic setting.Because the authors so directly critiqued the cisheteropatriarchy in medical education, we defensively hid behind assessing methodology as a gatekeeping tool to determine whether this article was worthy of joining our academic dialogue. We were empowered as if we were the gatekeepers of this academic dialogue. In so doing, we committed an act of epistemic violence through our reflexive actions to judge the legitimacy of this work. Epistemic violence refers to the active oppression and displacement of non-dominant communities from ","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 3","pages":"261-263"},"PeriodicalIF":4.9,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927493","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}

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Beyond one-size-fits-all: Reimagining well-being programmes in medical education through student expectations and agency 超越一刀切：通过学生的期望和代理重新构想医学教育中的幸福方案。

IF 4.9 1区教育学

Medical Education Pub Date : 2024-12-24 DOI: 10.1111/medu.15604

Nabeela Kajee, Elize Archer

{"title":"Beyond one-size-fits-all: Reimagining well-being programmes in medical education through student expectations and agency","authors":"Nabeela Kajee, Elize Archer","doi":"10.1111/medu.15604","DOIUrl":"10.1111/medu.15604","url":null,"abstract":"In this issue of the journal, Tan et al.1 offer an excellent contribution to the study of medical education through their paper entitled ‘How Do Medical Students' Expectations Shape Their Experiences of Wellbeing Programs?’1 The authors explore an important gap in the literature by asking how individual medical students' personal backgrounds relate to their experiences of the well-being programmes offered by their institution. Through a qualitative case study methodology and an ‘Institutional Ethnographic’ lens, semi-structured interviews were conducted with medical students. Further, document analysis was conducted, and field notes were analysed alongside the interviews.The article contextualises the school's well-being programme by explaining it to be mandatory, offered through a ‘House System’, and involving the assignment of personal tutors to students. In parallel, partially funded by the medical school in an unofficial capacity, runs the ‘HouseFam’ system of student-for-student well-being support. Tan et al.1 explored how students make meaning from these systems by focusing on promises, sense-making, reciprocity, empowerment and legitimacy. The contrast between the two systems is particularly compelling and informative.The well-being supports offered through the institutionally-run House System appear to play a useful role in forming friendships, building peer support and implementing events such as the White Coat Ceremony. It appears, in other words, to be a valuable resource, while at the same time, raising important questions about the extent to which some medical students can relate to formalised programmes. The experiences of those who ‘felt like outsiders’ is of particular interest in this regard as they appeared more likely to have unmet ‘expectations’. It is unfortunately ironic that even our wellness programmes can leave people feeling ‘othered’ or ‘excluded’. Further research is needed to understand the factors that cause such feelings and the relationship between intersectionality, bias and prejudice.2, 3 Tan et al. offer an intriguing lead though when they observe that some students felt their interactions with well-being tutors to be ‘transactional’ rather than ‘relational’ in nature.In hindsight, we should likely not be surprised that reciprocity between student and tutor is ‘continuously contested’ even within the social contract intended to enable wellness. Any programme that does not actively include its participants in every stage of planning, development and quality improvement is likely to struggle to create an engaged and embodied student user-base. That the medical school indirectly supports the parallel programme established by the medical students suggests an institution that is very much working towards supporting well-being among its students; that students felt compelled to establish a secondary ","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 3","pages":"258-260"},"PeriodicalIF":4.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882497","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}

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