Perspectives on Medical Education最新文献

{"title":"What can Designing Learning-by-Concordance Clinical Reasoning Cases Teach Us about Instruction in the Health Sciences?","authors":"Nicolas Fernandez, Marie-France Deschênes, Haifa Akremi, Lise Lecours, Vincent Jobin, Bernard Charlin","doi":"10.5334/pme.898","DOIUrl":"10.5334/pme.898","url":null,"abstract":"<p><strong>Introduction: </strong>Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators' broader uptake of LbC.</p><p><strong>Methods: </strong>A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically.</p><p><strong>Results: </strong>We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship.</p><p><strong>Discussion: </strong>A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners' attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"160-168"},"PeriodicalIF":4.8,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9936163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers.","authors":"Katherine Wisener,&nbsp;Kimberlee Hart,&nbsp;Erik Driessen,&nbsp;Cary Cuncic,&nbsp;Kiran Veerapen,&nbsp;Kevin Eva","doi":"10.5334/pme.818","DOIUrl":"10.5334/pme.818","url":null,"abstract":"<p><strong>Introduction: </strong>Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners' goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations.</p><p><strong>Findings: </strong>Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one's image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted.</p><p><strong>Discussion: </strong>Our findings offer a nuanced understanding of the complexities that influence learners' approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"2 1","pages":"99-108"},"PeriodicalIF":3.6,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9459282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Religious Culture in Medical Professionalism in a Muslim Arab Society.","authors":"Haythum O Tayeb, Ara Tekian, Mukhtiar Baig, Harold G Koenig, Lorelei Lingard","doi":"10.5334/pme.920","DOIUrl":"10.5334/pme.920","url":null,"abstract":"<p><strong>Purpose: </strong>Calls have been made to integrate concepts and practices derived from Muslim culture into medical professionalism in Muslim societies. Little is known about how these religious cultural concepts (RCCs) influence medical practice and education. This study explored the influence of RCCs on medical professionalism in Saudi Arabia.</p><p><strong>Methods: </strong>This was a qualitative study that implemented a constructivist, grounded theory approach. Semi-structured interviews about RCCs and medical professionalism were conducted with 15 Saudi physicians at a single academic medical center. Purposive sampling was used to recruit participants of different genders, generations, and specialties. Data collection and analysis were iterative. A theoretical framework was formulated.</p><p><strong>Results: </strong>Key findings: (i) the role of RCCs in medical professionalism is perceived to be constantly evolving due to the evolution of societal interpretations of RCCs; (ii) participants described applying two standards to judge what is professional: a medical standard and a religious cultural standard. Participants shifted between these two standards variably and non-linearly. This variable shifting altered the values shaping medical professionalism, at times unpredictably.</p><p><strong>Discussion: </strong>Academic Saudi physicians argued against assuming a stable traditional interpretation of RCCs, emphasized the evolving contribution of RCCs to medical professionalism, and indicated that the process of merging religious cultural and medical standards in medical practice is variable and may alter medical practice values. Therefore, these physicians perceived RCCs to be useful as supplements to but not as a backbone for medical professionalism. Careful consideration of the potential impact of RCCs on the values of medical professionalism is warranted.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"56-67"},"PeriodicalIF":3.6,"publicationDate":"2023-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9402191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-creation to Develop Interventions to Facilitate Deep Reflection for Dental Students.","authors":"Faith Campbell,&nbsp;Nicole Hassoon,&nbsp;Khalil Jiwa,&nbsp;Julia Ridsdill-Smith,&nbsp;Amie Smith,&nbsp;Helen Wilson,&nbsp;Kirsten Jack,&nbsp;Helen Rogers","doi":"10.5334/pme.16","DOIUrl":"https://doi.org/10.5334/pme.16","url":null,"abstract":"<p><strong>Background: </strong>Deep reflective practice is important in healthcare education to allow students to explore emotions associated with the learning experience, access deeper learning and develop their personal and professional identity. Previous research demonstrated that the current methods of reflective practice using logbooks at the end of a clinical session to facilitate reflection within this setting were viewed as suboptimal by staff and student users. To address this problem co-creation, or a 'students as partners' approach, was used to develop and implement a comprehensive intervention to facilitate deep reflection for undergraduate dental students. This included the production of educational resources, and development of an online safe space to reflect.</p><p><strong>Approach: </strong>In this paper we discuss the process of using co-creation with undergraduate dental students as a research methodology to successfully produce curricular change with respect to reflective practice by involving the voice and experience of student partners. These student partners were part of a team that included researchers and teaching staff and worked with other stakeholders within the institution within a wider team.</p><p><strong>Evaluation: </strong>This paper demonstrates the positive benefits of using co-creation with undergraduate dental students for students such as increased confidence, developing professional and personal skills and impacting meaningful change.</p><p><strong>Reflection: </strong>For researchers and educators, the process gave motivation and enjoyment in curricular development to address pedagogical problems and ensured that the developed intervention was sustainable and appropriate. The paper discusses benefits and challenges of co-creation to develop curricular change. This co-creation approach is recommended for solving similar problems in healthcare education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"76-85"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9403063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Dismantling Fixed Time, Variable Outcome Education: Abandoning 'Ready or Not, Here they Come' is Overdue\".","authors":"Carol Carraccio,&nbsp;Alison Lentz,&nbsp;Daniel J Schumacher","doi":"10.5334/pme.10","DOIUrl":"https://doi.org/10.5334/pme.10","url":null,"abstract":"<p><p>Two decades after competency-based medical education appeared in the lexicon of medical educators, the community continues to struggle with realizing its full potential. The implementation of the time variable, fixed outcome component has languished based on complexity compounded by resistance to change. Learners continue to transition from medical school to residency, and then practice, primarily based on time rather than having achieved the ability to meet the needs of the patient populations they will serve. Only those few who demonstrate glaring deficiencies do not graduate. The authors urge the medical education community to move from the current fixed time path of medical education toward the implementation of a true continuum of time variable, fixed outcome education, training, and <i>deliberate</i> practice. The latter is defined by purposeful learning, coaching, feedback, and repetition on the path to achieving and maintaining expertise. The opportunities afforded by such a time-variable, fixed outcome approach include: 1) development of a career long growth mindset, 2) ability to address evolving population health needs and careers within the context of one's practice, and 3) continual improvement of care quality and outcomes for patients on the journey towards expertise for providers.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"68-75"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9403064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Narratives in Assessment: Piloting a List of Evidence-Based Quality Indicators.","authors":"Molk Chakroun,&nbsp;Vincent R Dion,&nbsp;Kathleen Ouellet,&nbsp;Ann Graillon,&nbsp;Valérie Désilets,&nbsp;Marianne Xhignesse,&nbsp;Christina St-Onge","doi":"10.5334/pme.925","DOIUrl":"https://doi.org/10.5334/pme.925","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Appraising the quality of narratives used in assessment is challenging for educators and administrators. Although some quality indicators for writing narratives exist in the literature, they remain context specific and not always sufficiently operational to be easily used. Creating a tool that gathers applicable quality indicators and ensuring its standardized use would equip assessors to appraise the quality of narratives.</p><p><strong>Steps taken for development and implementation of innovation: </strong>We used DeVellis' framework to develop a checklist of evidence-informed indicators for quality narratives. Two team members independently piloted the checklist using four series of narratives coming from three different sources. After each series, team members documented their agreement and achieved a consensus. We calculated frequencies of occurrence for each quality indicator as well as the interrater agreement to assess the standardized application of the checklist.</p><p><strong>Outcomes of innovation: </strong>We identified seven quality indicators and applied them on narratives. Frequencies of quality indicators ranged from 0% to 100%. Interrater agreement ranged from 88.7% to 100% for the four series.</p><p><strong>Critical reflection: </strong>Although we were able to achieve a standardized application of a list of quality indicators for narratives used in health sciences education, it does not exclude the fact that users would need training to be able to write good quality narratives. We also noted that some quality indicators were less frequent than others and we suggested a few reflections on this.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"XX"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9556200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Challenging Conversations: The Interplay Between Inquiry and Knowledge Drives Preparation for Future Learning.","authors":"Anne A Kawamura,&nbsp;Leah Brown,&nbsp;Angela Orsino,&nbsp;Mohammad S Zubairi,&nbsp;Maria Mylopoulos","doi":"10.5334/pme.949","DOIUrl":"https://doi.org/10.5334/pme.949","url":null,"abstract":"<p><strong>Introduction: </strong>While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of <i>why</i> some physicians seek improvement and <i>how</i> they use the workplace context to build their capabilities. Because physicians rarely pursue formal professional development activities to improve communication skills, examining physician-patient communication offers a powerful opportunity to illuminate important aspects of preparation for future learning in the workplace.</p><p><strong>Methods: </strong>This qualitative observational study involved over 100 hours of observation of eight pediatric rehabilitation physicians as they interacted with patients and families at an academic teaching hospital in 2018-2020. Detailed field notes of observations, post-observation interviews, and exit interviews were the data sources. Data collection and analysis using a constructivist grounded theory approach occurred iteratively, and themes were identified through constant comparative analysis.</p><p><strong>Results: </strong>Through their daily work, experienced physicians employ 'habits of inquiry' by constantly seeking a better understanding of how to navigate challenging conversations in practice through monitoring and attuning to situational and contextual cues, taking risks and navigating uncertainty while exploring new and varied ways of practicing, and seeking why their strategies are successful or not.</p><p><strong>Discussion: </strong>Engaging in communication challenges drives physician learning through an interplay between habits of inquiry and knowledge: inquiry into how to improve their communication supported by existing conceptual knowledge to generate new strategies. These 'habits of inquiry' prompt continual reinvestment in problem solving to refine existing knowledge and to build new skills for navigating communication challenges in practice.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"304-314"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10377743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10294633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Continuing Professional Development for Physicians - Time for Change: A Scoping Review.","authors":"Shera Hosseini,&nbsp;Louise Allen,&nbsp;Faran Khalid,&nbsp;Donny Li,&nbsp;Elizabeth Stellrecht,&nbsp;Michelle Howard,&nbsp;Teresa M Chan","doi":"10.5334/pme.838","DOIUrl":"https://doi.org/10.5334/pme.838","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluation of education interventions is essential for continuous improvement as it provides insights into how and why outcomes occur. Specifically, for physicians' continuing professional development (CPD) programs, which aim to upskill physicians in a range of practice-essential domains, evaluations are crucial to assure physicians' continuous development, enhanced patient care and safety. However, evaluations of health professions education (HPE) interventions tend to be outcomes focused, failing to capture how and why outcomes occur. This scoping review aimed to identify evaluation techniques used to evaluate CPD programs for physicians, and to determine how these techniques are being implemented as well as the their quality.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, among others for English publications on evaluation of CPD programs for physicians, in the past decade. We used a data charting template to extract study details regarding the evaluation techniques and produced a checklist to assess the quality of the evaluations.</p><p><strong>Results: </strong>101 studies were included; of which 91 studies did not use an evaluation framework. Our findings revealed shortcomings in the evaluations of CPD programs including lack of attention to: intervention processes; unintended outcomes and contextual factors; use of theory; evaluation framework use; and rationale for chosen evaluation method.</p><p><strong>Discussion: </strong>Our findings highlighted major gaps in the evaluation techniques employed in physicians' CPD. Attention needs to be paid to evaluating both program processes and outcomes to illuminate how and why impacts are or are not occurring.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"198-207"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10237247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9994021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Support and Assessment in Health Professions Education: Mentors' and Mentees' Experiences in a Programmatic Assessment Context.","authors":"Lianne M Loosveld,&nbsp;Erik W Driessen,&nbsp;Mattias Theys,&nbsp;Pascal W M Van Gerven,&nbsp;Eline Vanassche","doi":"10.5334/pme.1004","DOIUrl":"https://doi.org/10.5334/pme.1004","url":null,"abstract":"<p><strong>Introduction: </strong>Mentors in programmatic assessment support mentees with low-stakes feedback, which often also serves as input for high-stakes decision making. That process potentially causes tensions in the mentor-mentee relationship. This study explored how undergraduate mentors and mentees in health professions education experience combining developmental support and assessment, and what this means for their relationship.</p><p><strong>Methods: </strong>The authors chose a pragmatic qualitative research approach and conducted semi-structured vignette-based interviews with 24 mentors and 11 mentees that included learners from medicine and the biomedical sciences. Data were analyzed thematically.</p><p><strong>Results: </strong>How participants combined developmental support and assessment varied. In some mentor-mentee relationships it worked well, in others it caused tensions. Tensions were also created by unintended consequences of design decisions at the program level. Dimensions impacted by experienced tensions were: relationship quality, dependence, trust, and nature and focus of mentoring conversations. Mentors and mentees mentioned applying various strategies to alleviate tensions: transparency and expectation management, distinguishing between developmental support and assessment, and justifying assessment responsibility.</p><p><strong>Discussion: </strong>Combining the responsibility for developmental support and assessment within an individual worked well in some mentor-mentee relationships, but caused tensions in others. On the program level, clear decisions should be made regarding the design of programmatic assessment: what is the program of assessment and how are responsibilities divided between all involved? If tensions arise, mentors and mentees can try to alleviate these, but continuous mutual calibration of expectations between mentors and mentees remains of key importance.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"271-281"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10327863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9866270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Writing with ChatGPT: An Illustration of its Capacity, Limitations & Implications for Academic Writers.","authors":"Lorelei Lingard","doi":"10.5334/pme.1072","DOIUrl":"https://doi.org/10.5334/pme.1072","url":null,"abstract":"In the writer’s craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how’syourwriting?","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"261-270"},"PeriodicalIF":3.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10312253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9763671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}