Teaching and Learning in Medicine最新文献

{"title":"Student, Staff and Faculty Experience with a Medical School Racial and Sociopolitical Trauma Protocol: A Mixed Methods Study.","authors":"India Perez-Urbano, Ziad M Jowhar, Jazzmin C Williams, Sally A Collins, Denise Davis, Christy K Boscardin, Tami Cowell, Evolve Benton, Karen E Hauer","doi":"10.1080/10401334.2024.2361912","DOIUrl":"10.1080/10401334.2024.2361912","url":null,"abstract":"<p><p><b><i>Problem</i>:</b> Medical students experience racial and sociopolitical trauma that disrupts their learning and wellbeing. <b><i>Intervention</i>:</b> University of California, San Francisco (UCSF) School of Medicine students advocated for a systems approach to responding to traumatic events. Students partnered with educators to introduce an innovative protocol that affords short-term flexibility in curricular expectations (e.g., defer attendance, assignments, assessments) to empower students to rest, gather, or pursue community advocacy work. This study explored students' protocol utilization and student, staff, and faculty experience with its implementation. <b><i>Context</i>:</b> UCSF is a public medical school with a diverse student body. Students raised the need to acknowledge the effects of trauma on their learning and wellbeing. Consequently, students and educators created the UCSF Racial and Sociopolitical Trauma protocol ('protocol') to allow students time-limited flexibility around academic obligations following events anticipated to inflict trauma on a school community level. The protocol affords students space to process events and engage with affected communities while ensuring all students achieve school competencies and graduation requirements. <b><i>Impact</i>:</b> We conducted a two-phase mixed methods study: (1) retrospective analysis of quantitative data on students' protocol use and (2) focus groups with students, staff, and faculty. We used descriptive statistics to summarize students' protocol use to adjust attendance, assignment submission, and assessments and thematic analysis of focus group data. Across eight protocol activations June 2020 - November 2021, 357 of 664 (54%) students used it for 501 curricular activities: 56% (<i>n</i> = 198) for attendance, 71% (<i>n</i> = 252) for assignments, and 14% (<i>n</i> = 51) for assessments. When deciding to utilize the protocol, student focus group participants considered sources of restoration; impact on their curricular/patient responsibilities; and their identities. The protocol symbolized an institutional value system that made students feel affirmed and staff and faculty proud. Staff and faculty initially faced implementation challenges with questions around how to apply the protocol to curricular components and how it would affect their roles; however, these questions became clearer with each protocol activation. Questions remain regarding how the protocol can be best adapted for the clerkship setting. <b><i>Lessons Learned</i>:</b> High protocol usage and focus group data confirmed that students found value in the protocol, and staff and faculty felt invested in the protocol mission. This student-initiated intervention supports a cultural shift beyond diversity toward trauma-informed medical education. Partnership among learners and educators can contribute to transforming learning and healthcare environments by enacting systems and structures that enable all l","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting on Academic Armor: How Black Physicians and Trainees Take Stances to Make Racism Visible Amid Publishing Constraints.","authors":"Monnique Johnson, Lauren A Maggio, Abigail Konopasky","doi":"10.1080/10401334.2023.2215744","DOIUrl":"10.1080/10401334.2023.2215744","url":null,"abstract":"<p><p><b><i>Starting with reflexivity:</i></b> As a Black woman medical student at a predominately white institution, a white woman full professor and deputy editor-in-chief of a journal, and a white woman associate professor with a deep interest in language, we understand that medicine and medical education interpellate each of us as a particular kind of subject. As such, we begin with a narrative grounding in our personal stances. <b><i>Phenomenon:</i></b> While there are a growing number of empirical studies of Black physicians' and trainees' experiences of racism, there are still few accounts from a first-person perspective. Black authors of these personal commentaries or editorials, who already experience microaggressions and racial trauma in their work spaces, must put on their academic armor to further experience them in publishing spaces. This study seeks to understand the stances Black physicians and trainees take as they share their personal experiences of racism. <b><i>Approach:</i></b> We searched four databases, identifying 29 articles authored by Black physicians and trainees describing their experiences. During initial analysis, we identified and coded for three sets of discursive strategies: <i>identification</i>, <i>intertextuality</i>, and <i>space-time.</i> Throughout the study, we reflected on our <i>own</i> stances in relation to the experience of conducting the study and its findings. <b><i>Findings:</i></b> Authors engaged in stance-taking, which aligned with the concept of donning academic armor, by evaluating and positioning themselves with respect to racism and the norms of academic discourse in response to ongoing conversations both within medicine and in the broader U.S. culture. They did this by (a) positioning themselves as being Black and, therefore, qualified to notice and name personal racist experiences while also aligning themselves with the reader through shared professional experiences and goals; (b) intertextual connections to other related events, people, and institutions that they-and their readers-value; and (c) aligning themselves with a hoped-for future rather than a racist present. <b><i>Personal insights:</i></b> Because the discourses of medicine and medical publishing interpellate Black authors as Others they must carefully consider the stances they take, particularly when naming racism. The academic armor they put on must be able to not only defend them from attack but also help them slip unseen through institutional bodies replete with mechanisms to eject them. In addition to analyzing our own personal stance, we leave readers with thought-provoking questions regarding this armor as we return to narrative grounding.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"337-347"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9586828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar.","authors":"Dalia Albahari","doi":"10.1080/10401334.2023.2209076","DOIUrl":"10.1080/10401334.2023.2209076","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> <i>As a core competency in medical education, clinical reasoning</i> is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. <b><i>Approach</i></b>: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. <b><i>Findings:</i></b> I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. <b><i>Insights:</i></b> The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"323-336"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9587885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Masked Interviewing Encourage Holistic Review in Residency Selection? A Mixed-Methods Study.","authors":"Justin T Clapp, Sarah J Heins, Timothy G Gaulton, Melanie A Kleid, Meghan B Lane-Fall, Jaya Aysola, Dimitry Y Baranov, Lee A Fleisher, Emily K B Gordon","doi":"10.1080/10401334.2023.2204074","DOIUrl":"10.1080/10401334.2023.2204074","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Problem:&lt;/i&gt;&lt;/b&gt; Medical educators increasingly champion holistic review. However, in U.S. residency selection, holistic review has been difficult to implement, hindered by a reliance on standardized academic criteria such as board scores. Masking faculty interviewers to applicants' academic files is a potential means of promoting holistic residency selection by increasing the interview's ability to make a discrete contribution to evaluation. However, little research has directly analyzed the effects of masking on how residency selection committees evaluate applicants. This mixed-methods study examined how masking interviews altered residency selection in an anesthesiology program at a large U.S. academic medical center. &lt;b&gt;&lt;i&gt;Intervention:&lt;/i&gt;&lt;/b&gt; During the 2019-2020 residency selection season in the University of Pennsylvania's Department of Anesthesiology & Critical Care, we masked interviewers to the major academic components of candidates' application files (board scores, transcripts, letters) on approximately half of interview days. The intent of the masking intervention was to mitigate the tendency of interviewers to form predispositions about candidates based on standardized academic criteria and thereby allow the interview to make a more independent contribution to candidate evaluation. &lt;b&gt;&lt;i&gt;Context:&lt;/i&gt;&lt;/b&gt; Our examination of the masking intervention used a concurrent, partially mixed, equal-status mixed-methods design guided by a pragmatist approach. We audio-recorded selection committee meetings and qualitatively analyzed them to explore how masking affected the process of candidate evaluation. We also collected independent candidate ratings from interviewers and consensus committee ratings and statistically compared ratings of candidates interviewed on masked days to ratings from conventional days. &lt;b&gt;&lt;i&gt;Impact:&lt;/i&gt;&lt;/b&gt; In conventional committee meetings, interviewers focused on how to reconcile academic metrics and interviews, and their evaluations of interviews were framed according to predispositions about candidates formed through perusal of application files. In masked meetings, members instead spent considerable effort evaluating candidates' \"fit\" and whether they came off as tactful. Masked interviewers gave halting opinions of candidates and sometimes pushed for committee leaders to reveal academic information, leading to masking breaches. Higher USMLE Step 1 score and higher medical school ranking were statistically associated with more favorable consensus rating. We found no significant differences in rating outcomes between masked and conventional interview days. &lt;b&gt;&lt;i&gt;Lessons learned:&lt;/i&gt;&lt;/b&gt; Elimination of academic metrics during the residency interview phase does not straightforwardly promote holistic review. While critical reflection among medical educators about the fairness and utility of such metrics has been productive, research and intervention should focus on the more proximate topic of how programs","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"369-380"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9344152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Around the World in 60 Minutes: How a Virtual Morning Report has Created an International Community for Clinical Reasoning and Medical Education.","authors":"Yue-Ting Kara Lau, María J Alemán, Rafael Medina, Sam Brondfield, Saman Nematollahi","doi":"10.1080/10401334.2023.2226661","DOIUrl":"10.1080/10401334.2023.2226661","url":null,"abstract":"<p><p><b><i>Problem:</i></b> Traditionally, clinical reasoning is developed with purposeful exposure to clinical problems through case-based learning and clinical reasoning conferences that harvest a collaborative exchange of information in real-life settings. While virtual platforms have greatly expanded access to remote clinical learning, case-based clinical reasoning opportunities are scarce in low and middle income countries. <b><i>Intervention:</i></b> The Clinical Problem Solvers (CPSolvers), a nonprofit organization focused on clinical reasoning education, launched Virtual Morning Report (VMR) during the COVID-19 pandemic. VMR is an open-access, case-based clinical reasoning virtual conference on the Zoom platform modeled after an academic morning report format available to participants worldwide. The authors conducted 17 semi-structured interviews with CPSolvers' VMR participants from 10 different countries to explore the experiences of the international participants of VMR. <b><i>Context:</i></b> The CPSolvers was founded by US physicians and has now expanded to include international members throughout all levels of the organization. VMR is open-access to all learners. Preliminary survey data collected from VMR sessions revealed 35% of the attendees were from non-English speaking countries and 53% from non US countries. <b><i>Impact:</i></b> Analysis generated four themes that captured the experiences of international participants of VMR: 1) Improving clinical reasoning skills where participants had little to no access to this education or content; 2) Creating a global community from a diverse, safe, and welcoming environment made possible by the virtual platform; 3) Allowing learners to become agents of change by providing tools and skills that are directly applicable in the setting in which they practice medicine; 4) Establishing a global platform, with low barriers to entry and open-access to expertise and quality teaching and content. Study participants agreed with the themes, supporting trustworthiness. <b><i>Lessons Learned:</i></b> Findings suggest VMR functions as and has grown into a global community of practice for clinical reasoning. The authors propose strategies and guiding principles based on the identified themes for educators to consider when building effective global learning communities. In an interdependent world where the virtual space eliminates the physical boundaries that silo educational opportunities, emphasis on thoughtful implementation of learning communities in a global context has the potential to reduce medical education disparities in the clinical reasoning space and beyond.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"348-357"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9669209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Identity Formation in Medical Education: Some Virtue-Based Insights.","authors":"Daniel T Kim, Megan K Applewhite, Wayne Shelton","doi":"10.1080/10401334.2023.2209067","DOIUrl":"10.1080/10401334.2023.2209067","url":null,"abstract":"<p><p><b><i>Issue</i></b>: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well. However, in its conceptual formulations, the literature risks underappreciating the pedagogical significance of the moral basis of identity formation-that is, the developing moral agencies and aspirations of learners to be good physicians. <b><i>Evidence</i></b>: Our conceptual analysis and argument build on a critical review of the medical education literature on PIF and draw on relevant insights from virtue ethics to deepen the conceptualization of PIF in moral, and not just psychosocial, terms. We show that a narrowly psychosocial view risks perpetuating institutional perceptions that can conceive professionalism norms primarily as standards of discipline or social control. By drawing on the conceptual resources of virtue ethics, we highlight not just the psychosocial development of medical learners but also their self-reflective, critical development as particular moral agents aspiring to embody the excellences of a good physician and, ultimately, to exhibit those traits and behaviors in the practice of medicine. <b><i>Implications</i></b>: We consider the pedagogical relevance of this insight. We show that drawing on virtue theory can more adequately orient medical pedagogy to socialize learners into the medical community in ways that nurture their personal growth as moral agents-in terms of their particular, restless aspirations to be a good physician and to flourish as such.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"399-409"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9772021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confidence, Connection & Collaboration: Creating a Scalable Bias Reduction Improvement Coaching Train-the-Trainer Program to Mitigate Implicit Bias across a Medical Center.","authors":"Susan M Cheng, Caleb C McKinney, Alejandra Hurtado-de-Mendoza, Samuel Chan, Kristi D Graves","doi":"10.1080/10401334.2023.2201289","DOIUrl":"10.1080/10401334.2023.2201289","url":null,"abstract":"<p><p><b><i>Problem:</i></b> Academic medical centers need to mitigate the negative effects of implicit bias with approaches that are empirically-based, scalable, sustainable, and specific to departmental needs. Guided by Kotter's Model of Change to create and sustain cultural change, we developed the Bias Reduction Improvement Coaching Program (BRIC), a two-year, train-the-trainer implicit bias coaching program designed to meet the increasing demand for bias training across a university medical center. <b><i>Intervention:</i></b> BRIC trained a cohort of faculty and staff as coaches during four quarterly training sessions in Year 1 that covered 1) the science of bias, 2) bias in selection and hiring, 3) bias in mentoring, and 4) bias in promotion, retention, and workplace culture. In Year 2, coaches attended two booster sessions and delivered at least two presentations. BRIC raises awareness of bias mitigation strategies in a scalable way by uniquely building capacity through department-level champions, providing programming that addresses the 'local context,' and setting a foundation for sustained institutional change. <b><i>Context:</i></b> In a U.S. academic medical center, 27 faculty and staff from 24 departments were trained as inaugural BRIC coaches. We assessed outcomes at multiple levels: BRIC coach outcomes (feedback on the training sessions; coach knowledge, attitudes, and skills), departmental-level outcomes (program attendee feedback, knowledge, and intentions) and institutional outcomes (activities to sustain change). <b><i>Impact:</i></b> After Year 1, coaches reported high satisfaction with BRIC and a statistically significant increase in self-efficacy in their abilities to recognize, mitigate, and teach about implicit bias. In Year 2, attendees at BRIC coach presentations reported an increase in bias mitigation knowledge, and the majority committed to taking follow-up action (e.g., taking an Implicit Association Test). Coaches also launched activities for sustaining change at the broader university and beyond. <b><i>Lessons Learned:</i></b> The BRIC Program indicates a high level of interest in receiving bias mitigation training, both among individuals who applied to be BRIC coaches and among presentation attendees. BRIC's initial success supports future expansion. The model appears scalable and sustainable; future efforts will formalize the emerging community of practice around bias mitigation and measure elements of on-going institutional culture change.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"381-398"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9383432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Education on Homophobia and Attitudes Toward Gay Men and Lesbian Women among Medical Faculty Students: A Turkish Sample.","authors":"Servet Aker, Özlem Mıdık, Ömer Böke","doi":"10.1080/10401334.2023.2215751","DOIUrl":"10.1080/10401334.2023.2215751","url":null,"abstract":"<p><p><b><i>Problem</i>:</b> Gay men (GMs) and lesbian women (LWs) can be exposed to misunderstanding, pressure, condemnation, obstructed access to public services, social isolation, and discrimination in many countries. They may also encounter various difficulties in accessing health services. Being GM and LW is generally unacceptable in Turkey, and both are perceived as abnormal. Medical students may require education on the subject of sexual orientation to improve their knowledge of and attitudes toward LGBT individuals, to help them remain neutral and avoid prejudice in providing health services for such individuals, and to ensure that such care is unbiased. <b><i>Intervention</i>:</b> This <i>one-group pretest-post-test design</i> study was performed with third-year students at the Ondokuz Mayıs University Medical Faculty (Samsun-Turkey) on 01-31 September, 2021. Three hundred twenty-five students took part. We evaluated students' attitudes toward homophobia and being GM and LW following a two-week multidisciplinary education program. The program included such topics as \"Marginalization,\" \"Interaction between cultures,\" \"Sexual orientation,\" \"Faith-based marginalization,\" \"Sub-cultures,\" \"Health protection,\" \"Gender,\" and \"Marginalized groups.\" For objective acquisition, we organized small group work, experience-sharing sessions (such as different orientation groups, different ethnic groups, and different behavioral templates), presentations, and panel activities. <b><i>Context</i>:</b> Some circles in Türkiye regard LGBT individuals as representing an attack on national and spiritual values, and they are used as part of the political discourse. Studies are being performed in some medial faculties in Türkiye concerning the inclusion of subjects related to LGBT individuals in the educational curriculum. However, these studies have not yet assumed the form of a curriculum design including content, method, and testing. It is important for subjects concerning LGBT individuals to be considered more extensively in medical education in Türkiye, and for awareness of the rights of these individuals in the community and of combating discrimination to be improved. <b><i>Outcome</i>:</b> We observed a significant decrease in students' homophobia after education. Significant decreases were observed in agreement with statements to the effect that being a GM or LW is a disease, that it can be treated, that people can be identified as GMs and LWs based on their behavior, and that they pose a major threat to society. <b><i>Lessons Learned</i>:</b> It is unclear whether education aimed at all marginalized groups will produce different results to those of programs aimed specifically at GMs and LWs, but we think that applying programs directed toward discrimination and prejudice together will yield more effective results.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"358-368"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9615734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Curricular Audit Method: Addressing the Erasure of Intersex, Trans and Two-Spirit People and the Imprecise Use of Gender and Sex Concepts in Undergraduate Medical Education.","authors":"A J Lowik, Jack Parkyn, Emily Wiesenthal, Maria Hubinette, Mei-Ling Wiedmeyer","doi":"10.1080/10401334.2023.2226651","DOIUrl":"10.1080/10401334.2023.2226651","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: Intersex, trans, and Two-Spirit people report overwhelmingly negative experiences with health care providers, including having to educate their providers, delaying, foregoing, and discontinuing care due to discrimination and being denied care. Medical education is a critical site of intervention for improving the health and health care experiences of these patients. Medical research studies, clinical guidelines, textbooks, and medical education generally, assumes that patients will be white, endosex, and cisgender; gender and sex concepts are also frequently misused. <b><i>Approach</i></b>: We developed and piloted an audit framework and associated tools to assess the quantity and quality of medical education related to gender and sex concepts, as well as physician training and preparedness to meet the needs of intersex, trans, and Two-Spirit patients. We piloted our framework and tools at a single Canadian medical school, the University of British Columbia, focused on their undergraduate MD program. We were interested in assessing the extent to which endosexnormativity, cisnormativity, transnormativity, and the coloniality of gender were informing the curriculum. In this paper, we detail our audit development process, including the role of advisory committees, student focus groups, and expert consultation interviews. We also detail the 3-pronged audit method, and include full-length versions of the student survey, faculty survey, and purpose-built audit question list. <b><i>Findings</i></b>: We reflect on the strengths, limits, and challenges of our audit, to inform the uptake and adaptation of this approach by other institutions. We detail our strategy for managing the volume of curricular content, discuss the role of expertise, identify a section of the student survey that needs to be reworked, and look ahead to the vital task of curricular reform and recommendations implementation. <b><i>Insights</i></b>: Our findings suggest that curricular audits focused on these populations are lacking but imperative for improving the health of all patients. We detail how enhancing curriculum in these areas, including by adding content about intersex, trans, and Two-Spirit people, and by using gender and sex concepts more accurately, precisely and inclusively, is in line with the CanMEDS competencies, the Medical Council of Canada's <i>Objectives for the Qualifying Examinations,</i> many institutions' stated values of equity, inclusion and diversity, and physicians' ethical, legal and professional obligations.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"280-292"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Exploration of Health Profession Students' Experiences of Resilience and Burnout Using the Coping Reservoir Model during the COVID-19 Pandemic.","authors":"Alla El-Awaisi, Sara Ismail, Ruba Sulaiman, Tanya Kane, Maguy Saffouh El Hajj, Mujahed Shraim","doi":"10.1080/10401334.2023.2209073","DOIUrl":"10.1080/10401334.2023.2209073","url":null,"abstract":"<p><p><b><i>Phenomenon</i></b>: The Coping Reservoir Model is a useful theoretical and analytical framework through which to examine student resilience and burnout. This model conceptualizes wellbeing as a reservoir which is filled or drained through students' adaptive and maladaptive coping mechanisms. This dynamic process has the capacity to foster resilience and reduce burnout or the inverse. This study aimed to explore health profession students' coping mechanisms and their experiences of resilience and burnout during the unprecedented COVID-19 pandemic. <b><i>Approach</i></b>: Employing the Coping Reservoir Model, qualitative focus groups involving health profession students enrolled at Qatar University were conducted, in October 2020, to solicit their lived experiences of stress and burnout during the pandemic. The Coping Reservoir Model was used to structure the topic guide for the focus group discussion and the Framework Analysis Approach was used in the data analysis. <b><i>Findings</i></b>: A total of 43 participants comprised eight focus groups. Health profession students encountered myriad personal, social, and academic challenges during the pandemic which adversely impacted their wellbeing and their capacity for coping. In particular, students reported high levels of stress, internal conflict, and heavy demands on their time and energy. The shift to online learning and uncertainty associated with adapting to online learning and new modes of assessment were exacerbating factors. Students sought to replenish their coping reservoir through engagement in a range of intellectual, social, and health-promoting activities and seeking psychosocial support in their efforts to mitigate these stressors. <b><i>Insights</i></b>: Students in this region have traditionally been left to their own devices to deal with stress and burnout during their academic training, wherein the institutions focus exclusively on the delivery of information. This study underscores student needs and potential avenues that health profession educators might implement to better support their students, for instance the development and inclusion of longitudinal wellbeing and mentorship curricula geared to build resilience and reduce burnout. The invaluable contributions of health professionals during the pandemic warrant emphasis, as does an examination of the stress associated with these roles to normalize and justify inclusion of wellbeing and resilience modules within the curriculum. Actively engaging health profession students in university-led volunteer activities during public health crises and campaigns would provide opportunities to replenish their coping reservoirs through social engagement, intellectual stimulation, and consolidating their future professional identities.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"256-268"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9473439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}