Perspectives on Medical Education最新文献

{"title":"Professional Resistance: Why Korean Medical Students are Boycotting Over Increasing Medical School Places.","authors":"Anna de Beer, Adelina S Werner, Seunggeun Kim, Frederike A Jenne","doi":"10.5334/pme.1426","DOIUrl":"https://doi.org/10.5334/pme.1426","url":null,"abstract":"<p><p>In February 2024, medical students in South Korea began submitting leave-of-absence requests in protest of a 65% increase in the number of medical school places in 2025. 14,000 medical students have boycotted classes and 12,000 doctors have resigned en masse. The 2024 Korean medical student collective action highlights the 'power' of medical students, the need for independent medical licensing bodies and the risks to the quality of medical education when places in medical schools are rapidly increased. The South Korean healthcare system is consistently ranked as one of the best in the world but there is now a significant risk that few new doctors will graduate and enter the workforce in March 2025.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"602-607"},"PeriodicalIF":4.8,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773884","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":"Museum-Based Education in Health Professions Learning: A 5-Year Retrospective.","authors":"Kain Kim, Sujal Manohar, Meher Kalkat, Kayla Iuliano, Margaret S Chisolm","doi":"10.5334/pme.1448","DOIUrl":"https://doi.org/10.5334/pme.1448","url":null,"abstract":"<p><p>A growing evidence base suggests that the integration of museum-based activities into health professions education can contribute to learner resilience and wellbeing, promote capacity for patient-centered care, and encourage equity in learning environments. However, the styles and methods for implementing museum-based programs vary widely across different institutions. This retrospective leverages the lessons learned from 5 years of experience implementing museum-based programs at one large academic institution to examine the various operational and logistical considerations in implementing a museum-based program for health professions learners. These efforts are intended to support the Association of American Medical Colleges and National Academies of Sciences, Engineering, and Medicine's aims to formally integrate the arts and humanities into health professions education. We structure our recommendations under the subheadings of program form, audience, function, and evaluation, with hopes of providing medical educators with starting guidelines that are broadly adoptable across different institutions.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"585-591"},"PeriodicalIF":4.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773879","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 Rollercoaster of Grades Versus Growth in the Clerkship Year: A Phenomenological Study of Medical Student Experience with Competency Development.","authors":"Matthew Kelleher, Benjamin Kinnear, Danielle Weber, Abigail Martini, Sally A Santen, Pamela Baker, Laurah Turner, Eric Warm, Melissa Klein, Daniel Schumacher","doi":"10.5334/pme.1564","DOIUrl":"https://doi.org/10.5334/pme.1564","url":null,"abstract":"<p><strong>Purpose: </strong>As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated.</p><p><strong>Methods: </strong>In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice.</p><p><strong>Results: </strong>Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback.</p><p><strong>Conclusions: </strong>Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"592-601"},"PeriodicalIF":4.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773875","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":"Development and Validation of an Instrument to Measure Career Decision-Making Challenges of International Medical Students in China.","authors":"Wen Li, Asaduzzaman Khan, Robyn Gillies, Hong Sun","doi":"10.5334/pme.1384","DOIUrl":"10.5334/pme.1384","url":null,"abstract":"<p><strong>Introduction: </strong>International medical students (IMSs) experience various problems preventing them from making career decisions. Assessing the difficulties involved in the career decision-making process is instrumental for identifying the sources of their career indecision, which may assist them in making more informed career decisions. This study aims to develop and validate an instrument to measure career decision-making challenges of IMSs in China, who are mainly from low- and middle-income countries.</p><p><strong>Methods: </strong>A new scale, INternational meDical studEnt Carrer decISION-making Scale (INDECISION Scale) was developed utilising data from IMSs in China. Initial item generation stemmed from a literature review and qualitative interviews (n = 20), with items adapted or formulated referencing phrasing used in prior instruments. Subsequent expert validation and cognitive interviews (n = 6) informed adjustments, followed by a pilot study (n = 52) and focus group discussions (n = 6). Exploratory factor analysis (EFA) was performed on data from four Chinese universities (n = 334), followed by confirmatory factor analysis (CFA) on data from eight other Chinese universities (n = 514). Convergent validity (n = 102) and test-retest reliability (n = 86) were evaluated using subsets of respondents.</p><p><strong>Results: </strong>The EFA retained 21 items, identifying six factors: unreadiness; lack of self-knowledge; lack of options knowledge; external complexity; lack of decision-making competence; and negative mentality. The CFA confirmed the six-factor model, demonstrating satisfactory model fit indices. Convergent validity and test-retest reliability were supported.</p><p><strong>Conclusions: </strong>The INDECISION Scale exhibits adequate psychometric properties, helping IMSs systematically navigate their decision-making process, allowing for individual challenges to be effectively identified for discussion in counselling. This study serves as a starting point for further research on career indecision and career guidance for IMSs.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"572-584"},"PeriodicalIF":4.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711417","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":"Shut up, or Set Free: Poetic Inquiry into Disabled Students' Experiences of Differential Attainment.","authors":"Megan E L Brown, Gabrielle Finn","doi":"10.5334/pme.1392","DOIUrl":"10.5334/pme.1392","url":null,"abstract":"<p><strong>Introduction: </strong>Differential attainment (DA) - systematic differences in training and assessment outcomes when grouping individuals by demographic characteristics - is a pervasive problem in health professions education. Despite evidence of its prevalence, there have been few qualitative studies relating to disabled learners' experiences of differential attainment. This represents a significant gap, as understanding disabled learners' experiences is key to developing effective interventions that mitigate the impact of differential attainment.</p><p><strong>Methods: </strong>We used critical poetic inquiry to explore the lived experiences - including emotional, cultural, and contextual dimensions - of differential attainment for disabled health professions students. We constructed poems following a secondary analysis of a large interview dataset (n = 123 participants) from one institution. We focused on students who disclosed disability (n = 18), narrowing to health professions education (n = 10).</p><p><strong>Results: </strong>Poems reflect individuals' experiences of DA. Four themes were constructed, within which we use poems to illustrate key connections: The perseverance stereotype, Managing the hidden curriculum, Privilege and access, and Surviving, not thriving. These themes illustrate the complex interplay of systemic barriers, ableist stereotypes, and privilege in the educational journey of disabled students.</p><p><strong>Discussion: </strong>The poems reveal the often-unseen struggles of disabled learners, challenging ableist perceptions and highlighting the necessity of inclusive practices. Our findings underscore the need for a shift in educational approaches, advocating for universal design and comprehensive support systems that consider the unique experiences of disabled learners. This study lays the groundwork for future research to develop interventions that address DA in a more inclusive and equitable manner, ensuring educational environments support all learners effectively.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"561-571"},"PeriodicalIF":4.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733530","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":"Digital Evidence: Revisiting Assumptions at the Intersection of Technology and Assessment.","authors":"Andrew E Krumm, Saad Chahine, Abigail M Schuh, Daniel J Schumacher, Sondra Zabar, Brian C George, Kayla Marcotte, Stefanie S Sebok-Syer, Michael A Barone, Alina Smirnova","doi":"10.5334/pme.1270","DOIUrl":"10.5334/pme.1270","url":null,"abstract":"<p><p>The increasing use of technology in health care and health professions education is an invitation to examine how digital sources of evidence are used in making assessment claims. In this paper, we describe how four sets of terms-primary and secondary data; structured and unstructured data; development and use; and deterministic and generative-can aid in examining how data from digital sources are used in evaluating what learners know and can do. Drawing on multiple examples, this paper shows how the four sets of terms can help both developers and users of technology-based assessment systems.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"553-560"},"PeriodicalIF":4.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711418","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":"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}