Perspectives on Medical Education最新文献

{"title":"Strategies to Enable Transformation in Medical Education: Faculty and Trainee Development in Competence By Design.","authors":"Adelle R Atkinson, Cynthia Abbott, Anna Oswald, Andree Boucher, Rodrigo B Cavalcanti, Jason R Frank, Linda S Snell","doi":"10.5334/pme.960","DOIUrl":"10.5334/pme.960","url":null,"abstract":"<p><p>Transformative changes in health professions education need to incorporate effective faculty development, but few very large-scale faculty development designs have been described. The Royal College of Physicians and Surgeons of Canada's Competence by Design project was launched to transform the delivery of postgraduate medical education in Canada using a competency-based model. In this paper we outline the goals, principles, and rationale of the Royal College's national strategy for faculty and resident development initiatives to support the implementation of Competence by Design. We describe the activities and resources for both faculty and trainees that facilitated the redesign of training programs for each specialty and subspecialty at the national level, as well as supporting the implementation of the redesign at the local level. This undertaking was not without its challenges: we thus reflect on those challenges, enablers, and the lessons learned, and discuss a continuous quality improvement approach that was taken to iteratively inform the implementation process moving forward.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"85-94"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724576","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":"Evaluating Competence by Design as a Large System Change Initiative: Readiness, Fidelity, and Outcomes.","authors":"Andrew K Hall, Anna Oswald, Jason R Frank, Tim Dalseg, Warren J Cheung, Lara Cooke, Lisa Gorman, Stacey Brzezina, Sinthiya Selvaratnam, Natalie Wagner, Stanley J Hamstra, Elaine Van Melle","doi":"10.5334/pme.962","DOIUrl":"10.5334/pme.962","url":null,"abstract":"<p><p>Program evaluation is an essential, but often neglected, activity in any transformational educational change. Competence by Design was a large-scale change initiative to implement a competency-based time-variable educational system in Canadian postgraduate medical education. A program evaluation strategy was an integral part of the build and implementation plan for CBD from the beginning, providing insights into implementation progress, challenges, unexpected outcomes, and impact. The Competence by Design program evaluation strategy was built upon a logic model and three pillars of evaluation: readiness to implement, fidelity and integrity of implementation, and outcomes of implementation. The program evaluation strategy harvested from both internally driven studies and those performed by partners and invested others. A dashboard for the program evaluation strategy was created to transparently display a real-time view of Competence by Design implementation and facilitate continuous adaptation and improvement. The findings of the program evaluation for Competence by Design drove changes to all aspects of the Competence by Design implementation, aided engagement of partners, supported change management, and deepened our understanding of the journey required for transformational educational change in a complex national postgraduate medical education system. The program evaluation strategy for Competence by Design provides a framework for program evaluation for any large-scale change in health professions education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"95-107"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724574","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":"Implementing Competence Committees on a National Scale: Design and Lessons Learned.","authors":"Anna Oswald, Daniel Dubois, Linda Snell, Robert Anderson, Jolanta Karpinski, Andrew K Hall, Jason R Frank, Warren J Cheung","doi":"10.5334/pme.961","DOIUrl":"10.5334/pme.961","url":null,"abstract":"<p><p>Competence committees (CCs) are a recent innovation to improve assessment decision-making in health professions education. CCs enable a group of trained, dedicated educators to review a portfolio of observations about a learner's progress toward competence and make systematic assessment decisions. CCs are aligned with competency based medical education (CBME) and programmatic assessment. While there is an emerging literature on CCs, little has been published on their system-wide implementation. National-scale implementation of CCs is complex, owing to the culture change that underlies this shift in assessment paradigm and the logistics and skills needed to enable it. We present the Royal College of Physicians and Surgeons of Canada's experience implementing a national CC model, the challenges the Royal College faced, and some strategies to address them. With large scale CC implementation, managing the tension between standardization and flexibility is a fundamental issue that needs to be anticipated and addressed, with careful consideration of individual program needs, resources, and engagement of invested groups. If implementation is to take place in a wide variety of contexts, an approach that uses multiple engagement and communication strategies to allow for local adaptations is needed. Large-scale implementation of CCs, like any transformative initiative, does not occur at a single point but is an evolutionary process requiring both upfront resources and ongoing support. As such, it is important to consider embedding a plan for program evaluation at the outset. We hope these shared lessons will be of value to other educators who are considering a large-scale CBME CC implementation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"56-67"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724575","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 Next Era of Assessment: Building a Trustworthy Assessment System.","authors":"Holly A Caretta-Weyer, Alina Smirnova, Michael A Barone, Jason R Frank, Tina Hernandez-Boussard, Dana Levinson, Kiki M J M H Lombarts, Kimberly D Lomis, Abigail Martini, Daniel J Schumacher, David A Turner, Abigail Schuh","doi":"10.5334/pme.1110","DOIUrl":"10.5334/pme.1110","url":null,"abstract":"<p><p>Assessment in medical education has evolved through a sequence of eras each centering on distinct views and values. These eras include measurement (e.g., knowledge exams, objective structured clinical examinations), then judgments (e.g., workplace-based assessments, entrustable professional activities), and most recently systems or programmatic assessment, where over time multiple types and sources of data are collected and combined by competency committees to ensure individual learners are ready to progress to the next stage in their training. Significantly less attention has been paid to the social context of assessment, which has led to an overall erosion of trust in assessment by a variety of stakeholders including learners and frontline assessors. To meaningfully move forward, the authors assert that the reestablishment of trust should be foundational to the next era of assessment. In our actions and interventions, it is imperative that medical education leaders address and build trust in assessment at a systems level. To that end, the authors first review tenets on the social contextualization of assessment and its linkage to trust and discuss consequences should the current state of low trust continue. The authors then posit that trusting and trustworthy relationships can exist at individual as well as organizational and systems levels. Finally, the authors propose a framework to build trust at multiple levels in a future assessment system; one that invites and supports professional and human growth and has the potential to position assessment as a fundamental component of renegotiating the social contract between medical education and the health of the public.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"12-23"},"PeriodicalIF":4.8,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10809864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565140","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":"Struggles and Joys: A Mixed Methods Study of the Artefacts and Reflections in Medical Student Portfolios.","authors":"Jenny McDonald, Wendy Hu, Sylvia Heeneman","doi":"10.5334/pme.1029","DOIUrl":"10.5334/pme.1029","url":null,"abstract":"<p><strong>Introduction: </strong>Portfolios scaffold reflection on experience so students can plan their learning. To elicit reflection, the learning experiences documented in portfolios must be meaningful. To understand what experiences first- and second-year medical students find meaningful, we studied the patterns in the artefacts chosen for portfolios and their associated written reflections.</p><p><strong>Methods: </strong>This explanatory mixed methods study of a longitudinal dataset of 835 artefacts from 37 medical student' portfolios, identified patterns in artefact types over time. Mixed model logistic regression analysis identified time, student and curriculum factors associated with inclusion of the most common types of artefacts. Thematic analysis of participants' reflections about their artefacts provided insight into their choices. Interpretation of the integrated findings was informed by Transformative Learning (TL) theory.</p><p><strong>Results: </strong>Artefact choices changed over time, influenced by curriculum changes and personal factors. In first year, the most common types of artefacts were Problem Based Learning mechanism diagrams and group photos representing classwork; in second year written assignments and 'selfies' representing social and clinical activities. Themes in the written reflections were Landmarks and Progress, Struggles and Strategies, Connection and Collaboration, and Joyful Memories for Balance. Coursework artefacts and photographic self-portraits represented all levels of transformative learning from across the curriculum.</p><p><strong>Conclusions: </strong>Medical students chose artefacts to represent challenging and/or landmark experiences, balanced by experiences that were joyful or fostered peer connection. Novelty influenced choice. To maximise learning students should draw from all experiences, to promote supported reflection with an advisor. Tasks should be timed to coincide with the introduction of new challenges.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"3 1","pages":"1-11"},"PeriodicalIF":4.8,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10768569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378596","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":"'Click, I Guess I'm Done': Applicants' and Assessors' Experiences Transitioning to a Virtual Multiple Mini Interview Format.","authors":"Zoe Abraham, Carolyn Melro, Sarah Burm","doi":"10.5334/pme.1035","DOIUrl":"10.5334/pme.1035","url":null,"abstract":"<p><strong>Introduction: </strong>During the COVID-19 pandemic, medical schools were forced to suspend in-person interviews and transition to a virtual Multiple Mini Interview (vMMI) format. MMIs typically comprise multiple short assessments overseen by assessors, with the aim of measuring a wide range of non-cognitive competencies. The adaptation to vMMI required medical schools to make swift changes to their MMI structure and delivery. In this paper, we focus on two specific groups greatly impacted by the decision to transition to vMMIs: medical school applicants and MMI assessors.</p><p><strong>Methods: </strong>We conducted an interpretive qualitative study to explore medical school applicants' and assessors' experiences transitioning to an asynchronous vMMI format. Ten assessors and five medical students from one Canadian medical school participated in semi-structured interviews. Data was analyzed using a thematic analysis framework.</p><p><strong>Results: </strong>Both applicants and assessors shared a mutual feeling of longing and nostalgia for an interview experience that, due to the pandemic, was understandably adapted. The most obvious forms of loss experienced - albeit in different ways - were: 1) human connection and 2) missed opportunity. Applicants and assessors described several factors that amplified their grief/loss response. These were: 1) resource availability, 2) technological concerns, and 3) the virtual interview environment.</p><p><strong>Discussion: </strong>While virtual interviewing has obvious advantages, we cannot overlook that asynchronous vMMIs do not lend themselves to the same caliber of interaction and camaraderie as experienced in in-person interviews. We outline several recommendations medical schools can implement to enhance the vMMI experience for applicants and assessors.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"594-602"},"PeriodicalIF":3.6,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075566","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":"A Qualitative Textual Analysis of Feedback Comments in ePortfolios: Quality and Alignment with the CanMEDS Roles","authors":"Sofie Van Ostaeyen, M. Embo, Tijs Rotsaert, Orphée De Clercq, T. Schellens, Martin Valcke","doi":"10.5334/pme.1050","DOIUrl":"https://doi.org/10.5334/pme.1050","url":null,"abstract":"Introduction: Competency-based education requires high-quality feedback to guide students’ acquisition of competencies. Sound assessment and feedback systems, such as ePortfolios, are needed to facilitate seeking and giving feedback during clinical placements. However, it is unclear whether the written feedback comments in ePortfolios are of high quality and aligned with the current competency focus. Therefore, this study investigates the quality of written feedback comments in ePortfolios of healthcare students, as well as how these feedback comments align with the CanMEDS roles. Methods: A qualitative textual analysis was conducted. 2,349 written feedback comments retrieved from the ePortfolios of 149 healthcare students (specialist medicine, general practice, occupational therapy, speech therapy and midwifery) were analysed retrospectively using deductive content analysis. Two structured categorisation matrices, one based on four literature-derived feedback quality criteria (performance, judgment, elaboration and improvement) and another one on the seven CanMEDS roles (Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional), guided the analysis. Results: The minority of the feedback comments (n = 352; 14.9%) could be considered of high quality because they met all four quality criteria. Most feedback comments were of moderate quality and met only two to three quality criteria. Regarding the CanMEDS roles, the Medical Expert role was most frequently represented in the feedback comments, as opposed to the roles Leader and Health Advocate. Discussion: The results highlighted that providing high-quality feedback is challenging. To respond to these challenges, it is recommended to set up individual and continuous feedback training.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"4 3","pages":"584 - 593"},"PeriodicalIF":3.6,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138947549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Does a Group Reflection Intervention (Schwartz Rounds) Work within Healthcare Undergraduate Settings? A Realist Review","authors":"Duncan Hamilton, Cath Taylor, J. Maben","doi":"10.5334/pme.930","DOIUrl":"https://doi.org/10.5334/pme.930","url":null,"abstract":"Introduction: Schwartz Rounds (“Rounds”) are a confidential group reflection forum, increasingly adopted to support pre-registration healthcare students. This realist review aims to understand what the available literature and key informant interviews can tell us about Rounds in this setting, asking what works, for whom, in what circumstances, and why? Methods: Published literature discussing Rounds in undergraduate settings were analysed using realist methods to describe how, for whom and in which contexts Rounds work. Four key informants were interviewed using realist methods, to further develop, test and refine a programme theory of Rounds in undergraduate settings. Results: We identified five core features and five contextual adaptations. Core: Rounds provide a reflective space to discuss emotional challenges; Rounds promote an open and humanised professional culture; Rounds offer role-modelling of vulnerability, enabling interpersonal connectedness; Rounds are impactful when focused on emotional and relational elements; Rounds offer reflective insights from a wide range of perspectives. Contextual adaptations: Rounds allow reflection to be more engaging for students when they are non-mandatory; perceptions of safety within a Round varies based on multiple factors; adapting timing and themes to students’ changing needs may improve engagement; resonance with stories is affected by clinical experience levels; online adaptation can increase reach but may risk psychological safety. Discussion: Schwartz Rounds are a unique intervention that can support healthcare students through their pre-registration education. The five “core” and five “contextual adaptation” features presented identify important considerations for organisations implementing Rounds for their undergraduates.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":" 21","pages":"550 - 564"},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will ChatGPT’s Free Language Editing Service Level the Playing Field in Science Communication?: Insights from a Collaborative Project with Non-native English Scholars","authors":"L. Lingard, Madawa Chandritilake, Merel De Heer, J. Klasen, Fury Maulina, Francisco M. Olmos-Vega, Christina St-Onge","doi":"10.5334/pme.1246","DOIUrl":"https://doi.org/10.5334/pme.1246","url":null,"abstract":"ChatGPT has been widely heralded as a way to level the playing field in scientific communication through its free language editing service. However, such claims lack systematic evidence. A writing scholar (LL) and six non-native English scholars researching health professions education collaborated on this Writer’s Craft to fill this gap. Our overarching aim was to provide experiential evidence about ChatGPT’s performance as a language editor and writing coach. We implemented three cycles of a systematic procedure, describing how we developed our prompts, selected text for editing, incrementally prompted to refine ChatGPT’s responses, and analyzed the quality of its language edits and explanations. From this experience, we offer five insights, and we conclude that the optimism about ChatGPT’s capacity to level the playing field for non-native English writers should be tempered.\u0000In 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":" 984","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It is Challenging to Shift the Norm: Exploring how to Anticipate and Address Microaggressions in Clinical Learning Environments","authors":"J. Sukhera, Tess M. Atkinson, Justin L. Bullock","doi":"10.5334/pme.1251","DOIUrl":"https://doi.org/10.5334/pme.1251","url":null,"abstract":"Purpose: Increased attention to improving a culture of belonging in clinical learning environments has led to various approaches to addressing microaggressions. However, most approaches in the literature focus on responding or reacting to microaggressions with insufficient attention to building trust before microaggressions might occur. Research on microaggressions in clinical learning environments suggests anticipatory or pre-emptive conversations about microaggressions may foster greater trust. In this study, the authors explored how diverse participants perceived the experience of anticipatory conversations about potential microaggressions. Overall, the authors sought to gain a deeper understanding of how pre-emptive and anticipatory conversations may influence an organization’s approach to addressing microaggressions in clinical learning environments. Methods: The authors utilized constructivist grounded theory methodology and conducted individual qualitative interviews with 21 participants in an academic department within a larger health sciences center in the United States. Results: Findings suggest that anticipatory conversations about microaggressions were challenging due to existing norms in dynamic clinical learning and working environments. Participants shared that the idea of anticipating microaggressions elicited dissonance. Conversations about microaggressions could potentially be facilitated through leaders who role model vulnerability, organizational supports, and an individualized approach for each team member and their role within a complex hierarchical organization. Discussion: Anticipating and addressing microaggressions in clinical learning environments holds tremendous potential, however, any conversations about personal identity remain challenging in medical and healthcare environments. This study suggests that any attempts to address microaggressions requires attention to cultural norms within healthcare environments and the ways that hierarchical organizations can constrain individual agency.","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":" 91","pages":"575 - 583"},"PeriodicalIF":3.6,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}