Perspectives on Medical Education最新文献

{"title":"Intersectionality in Medical Education: A Meta-Narrative Review.","authors":"Maham Rehman, Divya Santhanam, Javeed Sukhera","doi":"10.5334/pme.1161","DOIUrl":"10.5334/pme.1161","url":null,"abstract":"<p><strong>Introduction: </strong>Despite increasing attention to improving equity, diversity, and inclusion in academic medicine, a theoretically informed perspective to advancing equity is often missing. Intersectionality is a theoretical framework that refers to the study of the dynamic nature of social categories with which an individual identifies and their unique localization within power structures. Intersectionality can be a useful lens to understand and address inequity, however, there is limited literature on intersectionality in the context of medical education. Thus, we explored how intersectionality has been conceptualized and applied in medical education.</p><p><strong>Methods: </strong>We employed a meta-narrative review, analyzing existing literature on intersectionality theory and frameworks in medical education. Three electronic databases were searched using key terms yielding 32 articles. After, title, abstract and full-text screening 14articles were included. Analysis of articles sought a meaningful synthesis on application of intersectionality theory to medical education.</p><p><strong>Results: </strong>Existing literature on intersectionality discussesthe role of identity categorization and the relationship between identity, power, and social change. There are contrasting narratives on the practical application of intersectionality to medical education, producing tensions between how intersectionality is understood as theory and how it is translated in practice.</p><p><strong>Discussion: </strong>A paucity in literature on intersectionality in medical education suggests that there is a risk intersectionality may be understood in a superficial manner and considered a synonym for diversity. Drawing explicit attention to its core tenets of reflexivity, transformational identity, and analysis of power is important to maintain fidelity to how intersectionality is understood in broader critical social science literature.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"517-528"},"PeriodicalIF":3.6,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720034","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":"Contradictions and Opportunities: Reconciling Professional Identity Formation and Competency-Based Medical Education.","authors":"Robert Sternszus, Natasha Khursigara Slattery, Richard L Cruess, Olle Ten Cate, Stanley J Hamstra, Yvonne Steinert","doi":"10.5334/pme.1027","DOIUrl":"10.5334/pme.1027","url":null,"abstract":"<p><p>The widespread adoption of Competency-Based Medical Education (CBME) has resulted in a more explicit focus on learners' abilities to effectively demonstrate achievement of the competencies required for safe and unsupervised practice. While CBME implementation has yielded many benefits, by focusing explicitly on what learners are doing, curricula may be unintentionally overlooking who learners are becoming (i.e., the formation of their professional identities). Integrating professional identity formation (PIF) into curricula has the potential to positively influence professionalism, well-being, and inclusivity; however, issues related to the definition, assessment, and operationalization of PIF have made it difficult to embed this curricular imperative into CBME. This paper aims to outline a path towards the reconciliation of PIF and CBME to better support the development of physicians that are best suited to meet the needs of society. To begin to reconcile CBME and PIF, this paper defines three contradictions that must and can be resolved, namely: (1) CBME attends to behavioral outcomes whereas PIF attends to developmental processes; (2) CBME emphasizes standardization whereas PIF emphasizes individualization; (3) CBME organizes assessment around observed competence whereas the assessment of PIF is inherently more holistic. Subsequently, the authors identify curricular opportunities to address these contradictions, such as incorporating process-based outcomes into curricula, recognizing the individualized and contextualized nature of competence, and incorporating guided self-assessment into coaching and mentorship programs. In addition, the authors highlight future research directions related to each contradiction with the goal of reconciling 'doing' and 'being' in medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"507-516"},"PeriodicalIF":3.6,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89720033","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":"An Analysis of Written and Numeric Scores in End-of-Rotation Forms from Three Residency Programs.","authors":"Lauren M Anderson, Kathleen Rowland, Deborah Edberg, Katherine M Wright, Yoon Soo Park, Ara Tekian","doi":"10.5334/pme.41","DOIUrl":"10.5334/pme.41","url":null,"abstract":"<p><strong>Introduction: </strong>End-of-Rotation Forms (EORFs) assess resident progress in graduate medical education and are a major component of Clinical Competency Committee (CCC) discussion. Single-institution studies suggest EORFs can detect deficiencies, but both grades and comments skew positive. In this study, we sought to determine whether the EORFs from three programs, including multiple specialties and institutions, produced useful information for residents, program directors, and CCCs.</p><p><strong>Methods: </strong>Evaluations from three programs were included (Program 1, Institution A, Internal Medicine: n = 38; Program 2, Institution A, Anesthesia: n = 9; Program 3, Institution B, Anesthesia: n = 11). Two independent researchers coded each written comment for relevance (specificity and actionability) and orientation (praise or critical) using a standardized rubric. Numeric scores were analyzed using descriptive statistics.</p><p><strong>Results: </strong>4869 evaluations were collected from the programs. Of the 77,434 discrete numeric scores, 691 (0.89%) were considered \"below expected level.\" 71.2% (2683/3767) of the total written comments were scored as irrelevant, while 3217 (85.4%) of total comments were scored positive and 550 (14.6%) were critical. When combined, 63.2% (n = 2379) of comments were scored positive and irrelevant while 6.5% (n = 246) were scored critical and relevant.</p><p><strong>Discussion: </strong><1% of comments indicated below average performance; >70% of comments scored irrelevant. Critical, relevant comments were least frequently observed, consistent across all 3 programs. The low rate of constructive feedback and the high rate of irrelevant comments are inadequate for a CCC to make informed decisions. The consistency of these findings across programs, specialties, and institutions suggests both local and systemic changes should be considered.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"497-506"},"PeriodicalIF":3.6,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487641","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 the Effect of Virtual Learning on Canadian Pre-Clerkship Medical Student Well-Being During the COVID-19 Pandemic.","authors":"Nikita Ollen-Bittle,&nbsp;Asaanth Sivajohan,&nbsp;Joshua Jesin,&nbsp;Majid Gasim,&nbsp;Christopher Watling","doi":"10.5334/pme.1184","DOIUrl":"https://doi.org/10.5334/pme.1184","url":null,"abstract":"<p><strong>Introduction: </strong>The restrictions of the COVID-19 pandemic resulted in the broad and abrupt incorporation of virtual/online learning into medical school curricula. While current literature explores the effectiveness and economic advantages of virtual curricula, robust literature surrounding the effect of virtual learning on medical student well-being is needed. This study aims to explore the effects of a predominantly virtual curriculum on pre-clerkship medical student well-being.</p><p><strong>Methods: </strong>This study followed a constructivist grounded theory approach. During the 2020-2021 and 2021-2022 academic years, students in pre-clerkship medical studies at Western University in Canada were interviewed by medical student researchers over Zoom. Data was analyzed iteratively using constant comparison.</p><p><strong>Results: </strong>We found that students experiencing virtual learning faced two key challenges: 1) virtual learning may be associated with an increased sense of social isolation, negatively affecting wellbeing, 2) virtual learning may impede or delay the development of trainees' professional identity. With time, however, we found that many students were able to adapt by using protective coping strategies that enabled them to appreciate positive elements of online learning, such as its flexibility.</p><p><strong>Discussion: </strong>When incorporating virtual learning into medical education, curriculum developers should prioritize optimizing existing and creating new ways for students to interact with both peers and faculty to strengthen medical student identity and combat feelings of social isolation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"488-496"},"PeriodicalIF":3.6,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487644","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":"Diversity Awareness in Medical Education: An Innovative Training with Visual Reflection Tools.","authors":"Winny Ang,&nbsp;Liesbeth Verpooten,&nbsp;Benedicte De Winter,&nbsp;Katrien Bombeke","doi":"10.5334/pme.1080","DOIUrl":"https://doi.org/10.5334/pme.1080","url":null,"abstract":"<p><p>Dealing with a diverse population is one of the most challenging topics in medicine, with consequences for health disparities as evidenced by poorer health of marginalised groups. An urgent need exists to build a diversity-responsive curriculum in medical education. At the core of such a curriculum are experiential learning and a focus on self-awareness and reflexivity via small group trainings. This Show and Tell paper describes the development and qualitative evaluation of such a training, that was implemented at the University of Antwerp in Belgium, presenting answers to some of the gaps and challenges described in the literature. This training is guided by three visual reflection tools - the kaleidoscope, the iceberg and the communication compass - to inspire learners on how to deal with the diversity of their future patients. The content, method, and educational aim of this hands-on training are described. We discuss some of the challenges the educational methods pose on reflexivity and awareness, looking at the lessons learned based on participants' feedback. While the visual reflection tools offer a dynamic space to broaden the way we look at patients, it remains imperative to create a safe environment for discussing tensions, sharing difficult topics and being aware of different voices. Taking time (space for discussion, small groups, training of faculty) and allowing for continuous reflection of the educators are key in the development of diversity-responsive education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"480-487"},"PeriodicalIF":3.6,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487643","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":"Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues.","authors":"Claudia Tielemans,&nbsp;Renske de Kleijn,&nbsp;Emy van der Valk-Bouman,&nbsp;Sjoukje van den Broek,&nbsp;Marieke van der Schaaf","doi":"10.5334/pme.1069","DOIUrl":"https://doi.org/10.5334/pme.1069","url":null,"abstract":"<p><strong>Background: </strong>In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed.</p><p><strong>Approach: </strong>Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4^th-year nursing and 5^th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students' self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education.</p><p><strong>Outcomes: </strong>To understand student's learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set - largely unspecific - goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process.</p><p><strong>Reflection: </strong>The contrast between students' aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"472-479"},"PeriodicalIF":3.6,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487645","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":"Developing Computerized Adaptive Testing for a National Health Professionals Exam: An Attempt from Psychometric Simulations.","authors":"Lingling Xu,&nbsp;Zhehan Jiang,&nbsp;Yuting Han,&nbsp;Haiying Liang,&nbsp;Jinying Ouyang","doi":"10.5334/pme.855","DOIUrl":"https://doi.org/10.5334/pme.855","url":null,"abstract":"<p><strong>Introduction: </strong>The accurate assessment of health professionals' competence is critical for ensuring public health safety and quality of care. Computerized Adaptive Testing (CAT) based on the Item Response Theory (IRT) has the potential to improve measurement accuracy and reduce respondent burden. In this study, we conducted psychometric simulations to develop a CAT for evaluating the candidates' competence of health professionals.</p><p><strong>Methods: </strong>The initial CAT item bank was sourced from the Standardized Competence Test for Clinical Medicine Undergraduates (SCTCMU), a nationwide summative test in China, consisting of 300 multiple-choice items. We randomly selected response data from 2000 Chinese clinical medicine undergraduates for analysis. Two types of analyses were performed: first, evaluating the psychometric properties of all items to meet the requirements of CAT; and second, conducting multiple CAT simulations using both simulated and real response data.</p><p><strong>Results: </strong>The final CAT item bank consisted of 121 items, for which item parameters were calculated using a two-parameter logistic model (2PLM). The CAT simulations, based on both simulated and real data, revealed sufficient marginal reliability (coefficient of marginal reliability above 0.750) and criterion-related validity (Pearson's correlations between CAT scores and aggregate scores of the SCTCMU exceeding 0.850).</p><p><strong>Discussion: </strong>In national-level medical education assessment, there is an increasing need for concise yet valid evaluations of candidates' competence of health professionals. The CAT developed in this study demonstrated satisfactory reliability and validity, offering a more efficient assessment of candidates' competence of health professionals. The psychometric properties of the CAT could lead to shorter test durations, reduced information loss, and a decreased testing burden for participants.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"462-471"},"PeriodicalIF":3.6,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10624130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487642","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":"Developing Simulated and Virtual Patients in Psychological Assessment - Method, Insights and Recommendations.","authors":"Bartosz Zalewski,&nbsp;Mateusz Guziak,&nbsp;Maciej Walkiewicz","doi":"10.5334/pme.493","DOIUrl":"https://doi.org/10.5334/pme.493","url":null,"abstract":"<p><p>The phenomena of the simulated (SP) and virtual patient (VP) is widely described in the literature. Although it is difficult to find any practical information on developing these methods for teaching psychological assessment. Having conducted a long-term research project regarding this topic, we report the experience gained and retrospectively identify many mistakes. In this article, we present a summary of creating and using both SP and VP methods in clinical psychology and propose some insights and tips for their development, based on our experiences. While the project concerned clinical psychology, we believe the reflections might be applicable to a wider group of educational situations in which students develop competencies to carry out a diagnostic process with a real patient.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"455-461"},"PeriodicalIF":3.6,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414842","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":"Effectiveness of Life Goal Framing to Motivate Medical Students During Online Learning: A Randomized Controlled Trial.","authors":"Adam G Gavarkovs,&nbsp;Jeff Crukley,&nbsp;Erin Miller,&nbsp;Rashmi A Kusurkar,&nbsp;Kulamakan Kulasegaram,&nbsp;Ryan Brydges","doi":"10.5334/pme.1017","DOIUrl":"https://doi.org/10.5334/pme.1017","url":null,"abstract":"<p><strong>Introduction: </strong>Educators need design strategies to support medical students' motivation in online environments. Prompting students to frame a learning activity as preparing them to attain their life goals (e.g., helping others) via their clinical practice, a strategy called 'life goal framing', may enhance their autonomous motivation, learning strategy use, and knowledge retention. However, for students with low perceived competence for learning (PCL), life goal framing may have an adverse effect. A randomized controlled trial was conducted to test the effectiveness of life goal framing and the moderating effect of students' PCL.</p><p><strong>Methods: </strong>First- and second-year medical students across four Canadian universities (<i>n</i> = 128) were randomized to receive a version of an online module with an embedded prompt for life goal framing, or one without. Students' motivation, learning strategy use, and knowledge retention were assessed. Differences between conditions on each outcome were estimated using Bayesian regression.</p><p><strong>Results: </strong>Students' PCL was a moderator for autonomous motivation but no other outcomes. The prompt did not have a statistically significant effect on any outcome, even for learners with high PCL, except for a small effect on link-clicking behaviour.</p><p><strong>Discussion: </strong>The results of this study suggest that learners' autonomous motivation is influenced by how they make meaning of instruction in terms of their future life goals <i>and</i> their present confidence. We cannot recommend life goal framing as an effective design strategy at this point, but we point to future work to increase the benefit of life goal framing for learners with high confidence.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"444-454"},"PeriodicalIF":3.6,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414843","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":"Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community.","authors":"Zakia Dimassi, Halah Ibrahim","doi":"10.5334/pme.883","DOIUrl":"10.5334/pme.883","url":null,"abstract":"<p><p>Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"438-443"},"PeriodicalIF":4.8,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10607562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414844","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}