Perspectives on Medical Education最新文献

{"title":"An Interprofessional Faculty Development Program for Workplace-Based Learning.","authors":"Eveline Booij, Marjel van Dam, Gersten Jonker, Lisette van Bruggen, Marije Lesterhuis, Marieke F van der Schaaf, Reinier G Hoff, Marije P Hennus","doi":"10.5334/pme.1242","DOIUrl":"https://doi.org/10.5334/pme.1242","url":null,"abstract":"<p><strong>Background: </strong>Most faculty development programs in health professions education, pivotal in cultivating competent and effective teachers, focus on systematic, planned and formal learning opportunities. A large part of clinical teaching however, encompasses ad-hoc, informal and interprofessional workplace-based learning whereby individuals learn as part of everyday work activities. To fully harness the educational potential embedded in daily healthcare practices, prioritizing interprofessional faculty development for workplace-based learning is crucial.</p><p><strong>Approach: </strong>Utilizing the 'ADDIE' instructional design framework we developed, implemented and evaluated an interprofessional faculty development program for workplace-based learning. This program, encompassing seven formal training sessions each with a different theme and five individual workplace-based assignments, aimed to support clinical teachers in recognizing and optimizing informal learning.</p><p><strong>Outcomes: </strong>The pilot program (n = 10) and first two regular courses (n = 13 each) were evaluated using questionnaires containing Likert scale items and open textboxes for narrative comments. The quality and relevance of the program to the clinical work-place were highly appreciated. Additional valued elements included practical knowledge provided and tools for informal workplace-based teaching, the interprofessional aspect of the program and the workplace-based assignments. Since its development, the program has undergone minor revisions twice and has now become a successful interprofessional workplace-based alternative to existing faculty development programs.</p><p><strong>Reflection: </strong>This faculty development program addresses the specific needs of healthcare professionals teaching in clinical settings. It stands out by prioritizing informal learning, fostering collaboration, and supporting integration of formal training into daily practice, ensuring practical application of learned knowledge and skills. Furthermore, it emphasizes interprofessional teaching and learning, enhancing workplace environments.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"266-273"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11067978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858652","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":"Examining How Black Women Medical Students Rate Their Experiences with Medical School Mistreatment on the Aamc Graduate Questionnaire.","authors":"Sacha Sharp, Christen Priddie, Ashley H Clarke","doi":"10.5334/pme.1188","DOIUrl":"10.5334/pme.1188","url":null,"abstract":"<p><strong>Introduction: </strong>Few researchers have examined how medical student mistreatment varies by race/ethnicity and gender, specifically highlighting Black women's experiences. Moreover, researchers often fail to use theoretical frameworks when examining the experiences of minoritized populations. The purpose of this study was to examine the frequency of mistreatment US Black women medical students experience and how this compared to other students underrepresented in medicine (URiM) using intersectionality as a theoretical framework.</p><p><strong>Methods: </strong>We used the Association of American Medical Colleges Graduate Questionnaire (GQ) as the data source for examining descriptive statistics and frequencies. We examined differences between US Black women (N = 2,537) and other URiM students (N = 7,863) with Mann-Whitney U tests.</p><p><strong>Results: </strong>The results from this study highlighted that most Black women medical students did not experience mistreatment, yet a higher proportion of these trainees reported experiencing gendered (χ²(1) = 28.59, p < .01) and racially/ethnically (χ²(1) = 2935.15, p < .01) offensive remarks at higher frequency than their URiM counterparts. We also found US Black women medical students infrequently (27.3%) reported mistreatment from a lack of confidence for advocacy on their behalf, fear of reprisal, and seeing the incident as insignificant.</p><p><strong>Discussion: </strong>A paucity of research exists on Black women medical students and even less using relevant theoretical frameworks such as intersectionality. Failure to extract Black women's experiences exacerbates alienation, invisibility, and inappropriate attention to their mistreatment.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"255-265"},"PeriodicalIF":4.8,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11067982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873126","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 to Use and Report on <i>p</i>-values.","authors":"Christy K Boscardin, Justin L Sewell, Martin G Tolsgaard, Martin V Pusic","doi":"10.5334/pme.1324","DOIUrl":"https://doi.org/10.5334/pme.1324","url":null,"abstract":"<p><p>The use of the p-value in quantitative research, particularly its threshold of \"P < 0.05\" for determining \"statistical significance,\" has long been a cornerstone of statistical analysis in research. However, this standard has been increasingly scrutinized for its potential to mislead findings, especially when the practical significance, the number of comparisons, or the suitability of statistical tests are not properly considered. In response to controversy around use of p-values, the American Statistical Association published a statement in 2016 that challenged the research community to abandon the term \"statistically significant\". This stance has been echoed by leading scientific journals to urge a significant reduction or complete elimination in the reliance on p-values when reporting results. To provide guidance to researchers in health professions education, this paper provides a succinct overview of the ongoing debate regarding the use of p-values and the definition of p-values. It reflects on the controversy by highlighting the common pitfalls associated with p-value interpretation and usage, such as misinterpretation, overemphasis, and false dichotomization between \"significant\" and \"non-significant\" results. This paper also outlines specific recommendations for the effective use of p-values in statistical reporting including the importance of reporting effect sizes, confidence intervals, the null hypothesis, and conducting sensitivity analyses for appropriate interpretation. These considerations aim to guide researchers toward a more nuanced and informative use of p-values.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"250-254"},"PeriodicalIF":3.6,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11049675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853217","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":"From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative.","authors":"Jason R Frank, Andrew K Hall, Anna Oswald, J Damon Dagnone, Paul L P Brand, Richard Reznick","doi":"10.5334/pme.1342","DOIUrl":"10.5334/pme.1342","url":null,"abstract":"","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"224-228"},"PeriodicalIF":3.6,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319537","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":"Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education.","authors":"Jason R Frank, Jolanta Karpinski, Jonathan Sherbino, Linda S Snell, Adelle Atkinson, Anna Oswald, Andrew K Hall, Lara Cooke, Susan Dojeiji, Denyse Richardson, Warren J Cheung, Rodrigo B Cavalcanti, Timothy R Dalseg, Brent Thoma, Leslie Flynn, Wade Gofton, Nancy Dudek, Farhan Bhanji, Brian M-F Wong, Saleem Razack, Robert Anderson, Daniel Dubois, Andrée Boucher, Marcio M Gomes, Sarah Taber, Lisa J Gorman, Jane Fulford, Viren Naik, Kenneth A Harris, Rhonda St Croix, Elaine van Melle","doi":"10.5334/pme.1096","DOIUrl":"10.5334/pme.1096","url":null,"abstract":"<p><p>Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"201-223"},"PeriodicalIF":3.6,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207890","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":"Disorienting or Transforming? Using the Arts and Humanities to Foster Social Advocacy.","authors":"Snow Wangding, Lorelei Lingard, Paul Haidet, Benjamin Vipler, Javeed Sukhera, Tracy Moniz","doi":"10.5334/pme.1213","DOIUrl":"10.5334/pme.1213","url":null,"abstract":"<p><strong>Introduction: </strong>The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education.</p><p><strong>Methods: </strong>Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue.</p><p><strong>Results: </strong>We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue.</p><p><strong>Discussion: </strong>The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"192-200"},"PeriodicalIF":3.6,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144352","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 Confidentiality Dilemmas in Student Support: An Institutional Ethnography Informed Study.","authors":"Emmanuel Tan, Grainne P Kearney, Jennifer Cleland, Erik Driessen, Janneke Frambach","doi":"10.5334/pme.1151","DOIUrl":"10.5334/pme.1151","url":null,"abstract":"<p><strong>Introduction: </strong>School-level student support programmes provide students with pastoral care and support for academic, wellbeing and other issues often via a personal tutor (PT). PT work is a balancing act between respecting the confidential information divulged by students and doing what is expected in terms of accountability and duty of care. We aimed to explore how tutors manage this tension, with the aim of advancing understanding of student support programmes.</p><p><strong>Methods: </strong>This qualitative study was informed by an Institutional Ethnography approach. We conducted 11 semi-structured interviews with PTs from one medical school in Singapore. We considered how they worked in relation to relevant national and institutional-level policy documents and reporting guidelines. Data collection and analysis were iterative.</p><p><strong>Results: </strong>We crafted two composite accounts to illustrate the dilemmas faced by PTs. The first depicts a PT who supports student confidentiality in the same way as doctor-patient confidentiality. The second account is a PT who adopted a more mentoring approach. Both tutors faced confidentiality challenges, using different strategies to \"work around\" and balance tensions between accountability and maintaining trust. PTs were torn between school and student expectations.</p><p><strong>Discussion: </strong>Fostering trust in the tutor-student relationship is a priority for tutors but tensions between confidentiality, accountability and governance sometimes make it difficult for tutors to reconcile with doing what they think is best for the student. A more nuanced understanding of the concept of confidentiality may help support PTs and ultimately students.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"182-191"},"PeriodicalIF":3.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144353","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":"Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions: A Q-study.","authors":"Gerbrich Galema, Johanna Schönrock-Adema, Debbie A D C Jaarsma, Götz J K G Wietasch","doi":"10.5334/pme.1189","DOIUrl":"10.5334/pme.1189","url":null,"abstract":"<p><strong>Introduction: </strong>To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences.</p><p><strong>Methods: </strong>Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments.</p><p><strong>Results: </strong>Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development.</p><p><strong>Discussion: </strong>This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"169-181"},"PeriodicalIF":3.6,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144393","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":"Medical Student Intentions to Move Abroad: A UK-Based Realist Evaluation.","authors":"Elizabeth Mcculloch, Dominic W Proctor, Karen Mattick","doi":"10.5334/pme.1170","DOIUrl":"https://doi.org/10.5334/pme.1170","url":null,"abstract":"<p><strong>Introduction: </strong>Medical students moving abroad after qualification may contribute to domestic healthcare workforce shortages. Greater insights into how medical students make decisions about moving abroad may improve post-qualification retention. The aim was to develop a programme theory explaining medical students' intentions to move abroad or not.</p><p><strong>Methods: </strong>In Phase 1 the initial programme theory was generated from a literature review. In Phase 2, the theory was developed through 30 realist interviews with medical students from a medical school in the United Kingdom. In Phase 3 the final programme theory was used to produce recommendations for stakeholders.</p><p><strong>Results: </strong>The findings highlight the complex decision-making that medical students undertake when deciding whether to move abroad. We identified five contexts and six mechanisms leading to two outcomes (<i>intention to move abroad and no intention to move abroad</i>).</p><p><strong>Conclusions: </strong>This realist evaluation has demonstrated how contexts and mechanisms may interact to enable specific outcomes. These insights have allowed evidence-based recommendations to be made with a view to retaining graduates, including protected time within medical curricula to experience other healthcare systems, improved availability of domestic postgraduate posts providing domestic career certainty and stronger domestic-based social support networks for graduates.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"141-150"},"PeriodicalIF":3.6,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974089","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":"Enabling Implementation of Competency Based Medical Education through an Outcomes-Focused Accreditation System.","authors":"Timothy R Dalseg, Brent Thoma, Keith Wycliffe-Jones, Jason R Frank, Sarah Taber","doi":"10.5334/pme.963","DOIUrl":"10.5334/pme.963","url":null,"abstract":"<p><p>Competency based medical education is being adopted around the world. Accreditation plays a vital role as an enabler in the adoption and implementation of competency based medical education, but little has been published about how the design of an accreditation system facilitates this transformation. The Canadian postgraduate medical education environment has recently transitioned to an outcomes-based accreditation system in parallel with the adoption of competency based medical education. Using the Canadian example, we characterize four features of an accreditation system that can facilitate the implementation of competency based medical education: theoretical underpinning, quality focus, accreditation standards, and accreditation processes. Alignment of the underlying educational theories within the accreditation system and educational paradigm drives change in a consistent and desired direction. An accreditation system that prioritizes quality improvement over quality assurance promotes educational system development and progressive change. Accreditation standards that achieve the difficult balance of being sufficiently detailed yet flexible foster a high fidelity of implementation without stifling innovation. Finally, accreditation processes that recognize the change process, encourage program development, and are not overly punitive all enable the implementation of competency based medical education. We also discuss the ways in which accreditation can simultaneously hinder the implementation of this approach. As education bodies adopt competency based medical education, particular attention should be paid to the role that accreditation plays in successful implementation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"75-84"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724573","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}