Perspectives on Medical Education最新文献

{"title":"Identity Work: A Qualitative Study of Residents' Experiences Navigating Identity Struggles.","authors":"Adam P Sawatsky, Caroline L Matchett, Frederic W Hafferty, Sayra Cristancho, William E Bynum, Jonathan S Ilgen, Lara Varpio","doi":"10.5334/pme.1549","DOIUrl":"10.5334/pme.1549","url":null,"abstract":"<p><strong>Introduction: </strong>Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training.</p><p><strong>Method: </strong>We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles.</p><p><strong>Results: </strong>We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance.</p><p><strong>Discussion: </strong>This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"540-552"},"PeriodicalIF":4.8,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649377","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":"How Do Paediatricians Manage Comfort with Uncertainty in Clinical Decision-Making.","authors":"Colin J McMahon, Muirne Spooner, Matthew Sibbald, Maryam Asoodar","doi":"10.5334/pme.1394","DOIUrl":"10.5334/pme.1394","url":null,"abstract":"<p><strong>Background: </strong>While healthcare practice is inherently characterised by uncertainty, there is a paucity of formal curricular training to support comfort with uncertainty (CWU) in postgraduate training. Indeed, some evidence suggests medical training inherently conflicts with CWU in emphasizing pedagogies focussing on \"fixing\" the problem. While referral patterns increase significantly, dealing with uncertainty has direct implications for patient referral rates and use of valuable healthcare resources.</p><p><strong>Methods: </strong>Paediatricians in Ireland were invited to participate. Face-to-face interviews were conducted after participants watched videos of varied clinician-patient interactions.. Two researchers independently analysed the collected data using thematic analysis. Triangulation and member checking was performed to ensure validity of findings. A reflection journal documented the research journey.</p><p><strong>Results: </strong>Thirty four paediatricians participated. Five themes were identified: the interplay between quality of information, uncertainty and decision-making, confidence in clinical assessment and first-hand patient evaluation, anxiety and fear experienced by medical professionals when dealing with complex and serious conditions, strategies employed by medical professionals in managing their own uncertainty and the impact of societal and parental expectations on medical decision-making. These are moderated by a number of factors, most significantly the child's caregivers' comfort with doctors reassurance (CDR). Enacted management will diverge from the consultant's clinical plan when the caregiver's CDR cannot be satisfactorily supported.</p><p><strong>Discussion: </strong>Clinician CWU in the paediatric context is inextricably linked to caregiver CDR. The complexities and central importance of social context in understanding CWU has important implications for how we develop educational activities to support clinician CWU and patient/care-giver CDR. This may translate to efficient use of limited resources in healthcare settings.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"527-539"},"PeriodicalIF":4.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510621","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":"Integrating a Longitudinal Course on the Principles of Research in an Outcomes-Based Undergraduate Medical Education Curriculum.","authors":"Paul Farand, Tim Dubé, Marco Zaccagnini, Linda Bergeron, Justine Benoit-Piau, Christina St-Onge","doi":"10.5334/pme.1264","DOIUrl":"10.5334/pme.1264","url":null,"abstract":"<p><strong>Background and need for innovation: </strong>Teaching and learning approaches can support medical students in developing the research skills necessary to be adept consumers of scientific research. Despite various influencing factors, existing literature on effective strategies in undergraduate medical education remains limited.</p><p><strong>Goal of innovation: </strong>Using a spiraled curriculum, we created and evaluated a longitudinal course to enhance medical students' research abilities.</p><p><strong>Steps taken for development and implementation of innovation: </strong>During a recent curriculum renewal at one medical school, a three-year longitudinal course on the principles of research was developed and implemented. The innovation of this course includes the sequential nature and deliberate redundancy of curriculum content, how new knowledge is linked to prior learning, and the progressive level of difficulty in knowledge application and skill development.</p><p><strong>Evaluation of innovation: </strong>The authors analysed faculty members' and students' satisfaction and their perceptions of each session of the course using program evaluation data collected between 2019 and 2021. Both faculty members and students recognized the benefits of revisiting concepts and highlighted learning outcomes like improved synthesis of information, explaining findings to patients, and enhanced critical thinking.</p><p><strong>Critical reflection: </strong>The adoption of a spiraled curriculum in undergraduate medical education offers a systematic approach for developing students' research skills. The positive reception of this innovation underscores its potential to help future health professionals form a professional identity as adept researchers. However, its implications demand careful consideration and ongoing evaluation to ensure that the desired outcomes are sustained.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"518-526"},"PeriodicalIF":4.8,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478063","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":"Time to Publication in Medical Education Journals: An Analysis of Publication Timelines During COVID-19 (2019-2022).","authors":"Lauren A Maggio, Joseph A Costello, Kirsten R Brown, Anthony R Artino, Steven J Durning, Ting Lan Ma","doi":"10.5334/pme.1287","DOIUrl":"https://doi.org/10.5334/pme.1287","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 changed scholarly publishing. Yet, its impact on medical education publishing is unstudied. Because journal articles and their corresponding publication timelines can influence academic success, the field needs updated publication timelines to set evidence-based expectations for academic productivity. This study attempts to answer the following research questions: did publication timelines significantly change around the time of COVID-19 and, if so, how?</p><p><strong>Methods: </strong>We conducted a bibliometric study; our sample included articles published between January 2018, and December 2022, that appeared in the Medical Education Journals List-24 (MEJ-24). We clustered articles into three time-based groups (pre-COVID, COVID-overlap, and COVID-endemic), and two subject-based groups (about COVID-19 and not about COVID-19). We downloaded each article's metadata from the National Library of Medicine and analyzed data using descriptive statistics, analysis of variance, and post-hoc tests to compare mean time differences across groups.</p><p><strong>Results: </strong>Overall, time to publish averaged 300.8 days (<i>SD</i> = 200.8). One-way between-groups ANOVA showed significant differences between the three time-based groups <i>F</i> (2, 7473) = 2150.7, <i>p</i> < .001. The post-hoc comparisons indicated that COVID-overlap articles took significantly longer (<i>n</i> = 1470, <i>M</i>= 539; <i>SD</i> = 210.6) as compared to pre-COVID (<i>n</i> = 1281; <i>M</i> = 302; <i>SD</i> = 172.5) and COVID-endemic articles (<i>n</i> = 4725; <i>M</i> = 226; <i>SD</i> = 136.5). Notably, COVID-endemic articles were published in significantly less time than pre-pandemic articles, <i>p</i> < .001.</p><p><strong>Discussion: </strong>Longer publication time was most pronounced for COVID-overlap articles. Publication timelines for COVID-endemic articles have shortened. Future research should explore how the shift in publication timelines has shaped medical education scholarship.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"507-517"},"PeriodicalIF":4.8,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478074","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 Within Medical Education: Exploring Intersections of Context and Implementation.","authors":"Aliya Kassam, Ingrid de Vries, Sondra Zabar, Steven J Durning, Eric Holmboe, Brian Hodges, Christy Boscardin, Adina Kalet","doi":"10.5334/pme.1128","DOIUrl":"https://doi.org/10.5334/pme.1128","url":null,"abstract":"<p><p>In competency-based medical education (CBME), which is being embraced globally, the patient-learner-educator encounter occurs in a highly complex context which contributes to a wide range of assessment outcomes. Current and historical barriers to considering context in assessment include the existing post-positivist epistemological stance that values objectivity and validity evidence over the variability introduced by context. This is most evident in standardized testing. While always critical to medical education the impact of context on assessment is becoming more pronounced as many aspects of training diversify. This diversity includes an expanding interest beyond individual trainee competence to include the interdependency and collective nature of clinical competence and the growing awareness that medical education needs to be co-produced among a wider group of stakeholders. In this Eye Opener, we wish to consider: <i>1) How might we best account for the influence of context in the clinical competence assessment of individuals in medical education? and by doing so, 2) How could we usher in the next era of assessment that improves our ability to meet the dynamic needs of society and all its stakeholders?</i> The purpose of this Eye Opener is thus two-fold. First, we conceptualize - from a variety of viewpoints, how we might address context in assessment of competence at the level of the individual learner. Second, we present recommendations that address how to approach implementation of a more contextualized competence assessment.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"496-506"},"PeriodicalIF":4.8,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478065","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":"Sharing Is Caring: Helping Institutions and Health Organizations Leverage Data for Educational Improvement.","authors":"Stefanie S Sebok-Syer, Alina Smirnova, Ethan Duwell, Brian C George, Marc M Triola, Christopher A Feddock, Saad Chahine, Jonathan D Rubright, Brent Thoma","doi":"10.5334/pme.1081","DOIUrl":"https://doi.org/10.5334/pme.1081","url":null,"abstract":"<p><p>Competency-based medical education (CBME) has produced large collections of data, which can provide valuable information about trainees and medical education systems. Many organizations continue to struggle with accessing, collecting, governing, analyzing, and visualizing their clinical and/or educational data. This hinders data sharing efforts within and across organizations, which are foundational in supporting system-wide improvements. Challenges to data sharing within medical education include variability in legislation, existing data policies, heterogeneity of data, inadequate data infrastructure, and various intended purposes or uses. In this eye opener, the authors describe four case studies to illustrate some of the aforementioned challenges and characterize the complexity of data sharing within medical education along two dimensions: organizational (single vs. multiple) and data type (clinical and/or educational). With the goal of better supporting data sharing initiatives, the authors introduce an action-oriented blueprint that includes a three-stage process (i.e., preparation, execution, and iteration) to highlight crucial aspects of data sharing. This evidence-informed model incorporates current best practices and aims to support data sharing initiatives within their own organizations and across multiple organizations. Finally, organizations can use this model to conceptually guide and track their progression throughout the data sharing process.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"486-495"},"PeriodicalIF":4.8,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478064","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":"Creating <i>Effects</i> in Your Writing-<i>Tools</i> to 'Use' (or Not).","authors":"Lara Varpio","doi":"10.5334/pme.1540","DOIUrl":"10.5334/pme.1540","url":null,"abstract":"<p><p>We all want our writing to have impact but realizing that goal is difficult. Prompting specific responses from readers takes savvy and the know-how to wield grammatical tools. This Writer's Craft addresses the skill of varying emphasis in academic writing through five grammatical tools: italics, bold, dashes, parentheses, and scare quotes. It describes each of these tools, and illustrates when and how to use them effectively. 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?</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"481-485"},"PeriodicalIF":4.8,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382040","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":"Gaining Respect and Mitigating Risk: A Qualitative Exploration of How New Attendings Navigate Interpersonal Relationships with Recent Resident Peers.","authors":"Cameryn C Garrett, Hannah Robinson, Jacob David, Brian Utz, Michelle B Azimov","doi":"10.5334/pme.1396","DOIUrl":"10.5334/pme.1396","url":null,"abstract":"<p><strong>Background: </strong>Physicians moving through training experience changes in personal and professional relationships, which can increase stress, uncertainty, and burnout. Social connection can be an important resource but can introduce complexity and conflict. This study aimed to explore how early-career attendings navigate and manage changing organizational and friendship roles with recent resident peers (near-peers) through this critical transition.</p><p><strong>Methods: </strong>We conducted a reflexive thematic analysis of interviews with early-career attendings working with near-peers from the same institution where they trained. Twenty three of 27 (85%) eligible attendings from two United States health systems participated in semi-structured interviews between April and June 2023.</p><p><strong>Results: </strong>Familiarity from working at the same institution where new attendings completed training made it more difficult to command authority. Early-career attendings at times struggled with insecurities about their ability to fulfill their new role and challenges from others in recognizing their new attending identity. These tensions could heighten emotions in the clinical setting and spill over into relationships with residents outside the workplace, impacting social lives and well-being. Early-career attendings engaged in strategies to manage the social realm of their transition with near-peers, including prioritizing their organizational role in the clinical setting and mitigating risks to their professional reputation by creating stronger boundaries between their personal and professional lives.</p><p><strong>Conclusions: </strong>This study provides new insight into how attendings navigate changing personal and professional relationships with recent resident peers and offers strategies on how to manage the social realm of this liminal transition.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"460-468"},"PeriodicalIF":4.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382041","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":"Legitimation Without Argumentation: An Empirical Discourse Analysis of 'Validity as an Argument' in Assessment.","authors":"Benjamin Kinnear, Daniel J Schumacher, Lara Varpio, Erik W Driessen, Abigail Konopasky","doi":"10.5334/pme.1404","DOIUrl":"10.5334/pme.1404","url":null,"abstract":"<p><strong>Introduction: </strong>Validity is frequently conceptualized in health professions education (HPE) assessment as an argument that supports the interpretation and uses of data. However, previous work has shown that many validity scholars believe argument and argumentation are relatively lacking in HPE. To better understand HPE's discourse around argument and argumentation with regard to assessment validity, the authors explored the discourses present in published HPE manuscripts.</p><p><strong>Methods: </strong>The authors used a bricolage of critical discourse analysis approaches to understand how the language in influential peer reviewed manuscripts has shaped HPE's understanding of validity arguments and argumentation. The authors used multiple search strategies to develop a final corpus of 39 manuscripts that were seen as influential in how validity arguments are conceptualized within HPE. An analytic framework drawing on prior research on Argumentation Theory was used to code manuscripts before developing themes relevant to the research question.</p><p><strong>Results: </strong>The authors found that the elaboration of argument and argumentation within HPE's validity discourse is scant, with few components of Argumentation Theory (such as intended audience) existing within the discourse. The <i>validity as an argument</i> discourse was legitimized via authorization (reference to authority), rationalization (reference to institutionalized action), and mythopoesis (narrative building). This legitimation has cemented the <i>validity as an argument</i> discourse in HPE despite minimal exploration of what argument and argumentation are.</p><p><strong>Discussion: </strong>This study corroborates previous work showing the dearth of argument and argumentation present within HPE's validity discourse. An opportunity exists to use Argumentation Theory in HPE to better develop validation practices that support use of argument.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"469-480"},"PeriodicalIF":4.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382042","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":"Validity in the Next Era of Assessment: Consequences, Social Impact, and Equity.","authors":"Benjamin Kinnear, Christina St-Onge, Daniel J Schumacher, Mélanie Marceau, Thirusha Naidu","doi":"10.5334/pme.1150","DOIUrl":"https://doi.org/10.5334/pme.1150","url":null,"abstract":"<p><p>Validity has long held a venerated place in education, leading some authors to refer to it as the \"sine qua non\" or \"cardinal virtue\" of assessment. And yet, validity has not held a fixed meaning; rather it has shifted in its definition and scope over time. In this Eye Opener, the authors explore if and how current conceptualizations of validity fit a next era of assessment that prioritizes patient care and learner equity. They posit that health profession education's conceptualization of validity will change in three related but distinct ways. First, consequences of assessment decisions will play a central role in validity arguments. Second, validity evidence regarding impacts of assessment on patients and society will be prioritized. Third, equity will be seen as part of validity rather than an unrelated concept. The authors argue that health professions education has the agency to change its ideology around validity, and to align with values that predominate the next era of assessment such as high-quality care and equity for learners and patients.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"452-459"},"PeriodicalIF":4.8,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298929","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}