Teaching and Learning in Medicine最新文献

{"title":"The Influence of Photographic Representations on U.S. Medical Students' Attitudes and Beliefs About Persons With Disabilities: A Qualitative Study.","authors":"James R Barnett, Samantha DiSalvo, Emma McGill, Luisa Alvarez, Nina Samuel, Joanne Siegel, Vincent Siasoco, Gabriella Amaya, Rick Guidotti, Karen Bonuck, David W Lounsbury","doi":"10.1080/10401334.2024.2444622","DOIUrl":"10.1080/10401334.2024.2444622","url":null,"abstract":"<p><p><b><i>Phenomenon:</i></b> There is a crucial need to more deeply understand the impact and etiology of bias toward persons with developmental disabilities (PWDD). A largely unstudied area of concern and possible intervention is the portrayal of PWDD in medical education. Often, medical photographs portray PWDD with obscured faces, emotionless, and posed in an undignified way. This exploratory, qualitative study aimed to explore how photo representations of PWDD influences medical students' attitudes and beliefs toward disability. <b><i>Approach:</i></b> We recruited 10 medical students from a single medical school in the northeastern United States to participate in in-depth, individual semi-structured interviews via Zoom. During the interviews, we asked students to reflect on and respond to two image sets of PWDD: a standard image set, which were photos from medical textbooks, and a positive image set, which were photos from the U.S.-based disability nonprofit, Positive Exposure. Using thematic analysis underpinned by the Health Stigma and Discrimination Framework, we coded and organized the transcripts into four themes that characterized participants' attitudes and beliefs about PWDD. <b><i>Findings:</i></b> The four themes we identified were as follows. <i>Humanization vs. dehumanization</i>: Standard imagery characteristics (e.g., black bars, unnatural posing, lack of clothing) were perceived as dehumanizing and raised concerns about consent and autonomy, whereas positive imagery characteristics (e.g., clothing, natural poses, nonclinical settings) were seen as humanizing and enhanced perceptions of agency. <i>Quality of life</i>: Standard imagery often led to assumptions of compromised quality of life, while positive imagery suggested a good quality of life. <i>Discomfort vs. comfort with communication in a clinical setting:</i> Dehumanizing portrayals increased perceived difficulty in establishing rapport, while humanizing imagery mitigated these perceived barriers. <i>Diversity:</i> Image sets showcasing a diverse spectrum of presentations for a given diagnosis were valued for medical education. <b><i>Insights:</i></b> We conclude that photographic representation of disability in medical education can influence medical students' attitudes and beliefs about PWDD. Photographic elements can either humanize or dehumanize, with humanizing representation leading to more positive attitudes and therefore also an educational benefit. Thoughtful and inclusive visual content is needed in medical education to encourage positive attitudes and foster a more empathetic healthcare environment. Our results support future plans to further investigate how photo representation affects attitudes in a larger sample. Additionally, our study's insights contribute to the ongoing initiative Textbook Beauty, providing guidance for the selection of photography to improve attitudes toward disabilities.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958070","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":"Asian Conscientization: Reflections on the Experiences of Asian Faculty in Academic Medicine.","authors":"Zareen Zaidi, Candace J Chow, Heeyoung Han, Syed Kumail R Zaidi, Saleem Razack","doi":"10.1080/10401334.2023.2274560","DOIUrl":"10.1080/10401334.2023.2274560","url":null,"abstract":"<p><strong>Issue: </strong>Asians have experienced a rise in racialized hate crimes due to the anti-Asian rhetoric that has accompanied the COVID-19 pandemic. However, there has been little acknowledgement of anti-Asian discrimination within the medical education community. While anti-Asian hate is not new or unfamiliar to us, four authors of Asian descent, it has given us an opportunity to reflect on how we have been complicit in and resistant to the larger racial narratives that circulate in our communities.</p><p><strong>Evidence: </strong>In this article, we provide a brief history of Asians in the Americas with a focus on anti-Asian hate. Next, while presenting stories from the perspective of Asian medical education researchers who were born/have settled in the U.S. and Canada, we take the opportunity to reflect on how our personal experiences have shaped our perceptions of ourselves, and the representations of Asians in the field of medicine.</p><p><strong>Implications: </strong>We hope to create awareness about how stereotypes of success tied to Asians can be used as a tool of oppression creating strife between Black communities, Asian communities, and other people of color. There is a need to develop critical consciousness to address the issues of equity in academia and in clinical practice.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"137-147"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415174","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":"Faculty Decision Making in Ad Hoc Entrustment of Pediatric Critical Care Fellows: A National Case-Based Survey.","authors":"Rachel Stork Poeppelman, Melissa Moore-Clingenpeel, Ashley Siems, Diana L Mitchell, Priti Jani, Claire Stewart","doi":"10.1080/10401334.2023.2269402","DOIUrl":"10.1080/10401334.2023.2269402","url":null,"abstract":"<p><p><b><i>Phenomenon</i>:</b> Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. <b><i>Approach</i>:</b> A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by \"high entrustment\" versus \"low entrustment\" (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. <b><i>Findings</i>:</b> One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected \"direct supervision\" as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as \"low entrustment.\" There was no relationship between faculty or institutional demographics and the entrustment level selected. <b><i>Insights</i>:</b> As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the \"direct supervision\" level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"56-63"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488651","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 Balancing Act of Assessment Validity in Interprofessional Healthcare Education: A Qualitative Evaluation Study.","authors":"Hester Wilhelmina Henrica Smeets, Laurie E C Delnoij, Dominique M A Sluijsmans, Albine Moser, Jeroen J G van Merrienboer","doi":"10.1080/10401334.2023.2280855","DOIUrl":"10.1080/10401334.2023.2280855","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Construct & background: &lt;/strong&gt;In order to determine students' level of interprofessional competencies, there is a need for well-considered and thoroughly designed interprofessional assessments. Current literature about interprofessional assessments focuses largely on the development and validation of assessment instruments such as self-assessments or questionnaires to assess students' knowledge or attitudes. Less is known about the design and validity of integral types of assessment in interprofessional education, such as case-based assessments, or performance assessments. The aim of this study is to evaluate the evidence for and threats to the validity of the decisions about students' interprofessional performances based on such integral assessment task. We investigated whether the assessment prototype is a precursor to practice (authenticity) and whether the assessment provides valid information to determine the level of interprofessional competence (scoring).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Approach: &lt;/strong&gt;We used a design-based qualitative research design in which we conducted three group interviews with teachers, students, and interprofessional assessment experts. In semi-structured group interviews, participants evaluated the evidence for and threats to the validity of an interprofessional assessment task, which were analyzed using deductive and inductive content analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Although both evidence for and threats to validity were mentioned, the threats refuting the assessment's validity prevailed. Evidence for the authenticity aspect was that the assessment task, conducting a team meeting, is common in practice. However, its validity was questioned because the assessment task appeared more structured as compared to practice. The most frequently mentioned threat to the scoring aspect was that the process of interprofessional collaboration between the students could not be evaluated sufficiently by means of this assessment task.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study showed that establishing interprofessional assessment validity requires three major balancing acts. The first is the balance between authenticity and complexity. As interprofessional practice and competencies are complex, interprofessional tasks require build-up or guidance toward this complexity and chaotic practice. The second is that between authenticity and scoring, in which optimal authenticity might lead to threats to scoring and vice versa. Simultaneous optimal authenticity and scoring seems impossible, requiring ongoing evaluation and monitoring of interprofessional assessment validity to ensure authentic yet fair assessments for all participating professions. The third balancing act is between team scoring and individual scoring. As interprofessional practice requires collaboration and synthesis of diverse professions, the team process is at the heart of solving interprofessional tasks. However, to stimulate individual accountability","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"99-112"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592755","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":"Academic Leadership Academy Summer Program: Clerkship Transition Preparation for Underrepresented in Medicine Medical Students.","authors":"Denise M Connor, Alicia Fernandez, Sarah Alba-Nguyen, Sally Collins, Arianne Teherani","doi":"10.1080/10401334.2023.2269133","DOIUrl":"10.1080/10401334.2023.2269133","url":null,"abstract":"<p><strong>Problem: </strong>Enhancing workforce diversity by increasing the recruitment of students who have been historically excluded/underrepresented in medicine (UIM) is critical to addressing healthcare inequities. However, these efforts are inadequate when undertaken without also supporting students' success. The transition to clerkships is an important and often difficult to navigate inflection point in medical training where attention to the specific needs of UIM students is critical.</p><p><strong>Intervention: </strong>We describe the design, delivery, and three-year evaluation outcomes of a strengths-based program for UIM second year medical students. The program emphasizes three content areas: clinical presentations/clinical reasoning, community building, and surfacing the hidden curriculum. Students are taught and mentored by faculty, residents, and senior students from UIM backgrounds, creating a supportive space for learning.</p><p><strong>Context: </strong>The program is offered to all UIM medical students; the centerpiece of the program is an intensive four-day curriculum just before the start of students' second year. Program evaluation with participant focus groups utilized an anti-deficit approach by looking to students as experts in their own learning. During focus groups mid-way through clerkships, students reflected on the program and identified which elements were most helpful to their clerkship transition as well as areas for programmatic improvement.</p><p><strong>Impact: </strong>Students valued key clinical skills learning prior to clerkships, anticipatory guidance on the professional landscape, solidarity and learning with other UIM students and faculty, and the creation of a community of peers. Students noted increased confidence, self-efficacy and comfort when starting clerkships.</p><p><strong>Lessons learned: </strong>There is power in learning in a community connected by shared identities and grounded in the strengths of UIM learners, particularly when discussing aspects of the hidden curriculum in clerkships and sharing specific challenges and strategies for success relevant to UIM learners. We learned that while students found unique benefits to preparing for clerkships in a community of UIM students, near peers, and faculty, future programs could be enhanced by pairing this formal intensive curriculum with more longitudinal opportunities for community building, mentoring, and career guidance.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"113-126"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232055","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":"Using Group Concept Mapping to Explore Medical Education's Blind Spots.","authors":"Sean Tackett, Yvonne Steinert, Susan Mirabal, Darcy A Reed, Scott M Wright","doi":"10.1080/10401334.2023.2274991","DOIUrl":"10.1080/10401334.2023.2274991","url":null,"abstract":"<p><strong>Phenomenon: </strong>All individuals and groups have blind spots that can lead to mistakes, perpetuate biases, and limit innovations. The goal of this study was to better understand how blind spots manifest in medical education by seeking them out in the U.S.</p><p><strong>Approach: </strong>We conducted group concept mapping (GCM), a research method that involves brainstorming ideas, sorting them according to conceptual similarity, generating a point map that represents consensus among sorters, and interpreting the cluster maps to arrive at a final concept map. Participants in this study were stakeholders from the U.S. medical education system (i.e., learners, educators, administrators, regulators, researchers, and commercial resource producers) and those from the broader U.S. health system (i.e., patients, nurses, public health professionals, and health system administrators). All participants brainstormed ideas to the focus prompt: \"To educate physicians who can meet the health needs of patients in the U.S. health system, medical education should become less blind to (or pay more attention to) …\" Responses to this prompt were reviewed and synthesized by our study team to prepare them for sorting, which was done by a subset of participants from the medical education system. GCM software combined sorting solutions using a multidimensional scaling analysis to produce a point map and performed cluster analyses to generate cluster solution options. Our study team reviewed and interpreted all cluster solutions from five to 25 clusters to decide upon the final concept map.</p><p><strong>Findings: </strong>Twenty-seven stakeholders shared 298 blind spots during brainstorming. To decrease redundancy, we reduced these to 208 in preparation for sorting. Ten stakeholders independently sorted the blind spots, and the final concept map included 9 domains and 72 subdomains of blind spots that related to (1) admissions processes; (2) teaching practices; (3) assessment and curricular designs; (4) inequities in education and health; (5) professional growth and identity formation; (6) patient perspectives; (7) teamwork and leadership; (8) health systems care models and financial practices; and (9) government and business policies.</p><p><strong>Insights: </strong>Soliciting perspectives from diverse stakeholders to identify blind spots in medical education uncovered a wide array of issues that deserve more attention. The concept map may also be used to help prioritize resources and direct interventions that can stimulate change and bring medical education into better alignment with the health needs of patients and communities.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"75-85"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232056","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":"Unclaimed Bodies in Anatomical Education: Medical Student Attitudes at One U.S. Medical Institution.","authors":"Malcolm A Matheson, John R Gatti, Lawrence D Reid, Sharaya N Gallozzi, Siobhán B Cooke","doi":"10.1080/10401334.2023.2277843","DOIUrl":"10.1080/10401334.2023.2277843","url":null,"abstract":"<p><strong>Phenomenon: </strong>Dissection of cadavers is a common practice in anatomical education. To meet demand for cadavers, some medical institutions facilitate dissection of individuals who did not provide consent during their life. This includes the bodies of individuals who passed away with either no living kin or no kin able to claim and bury their body. Recent literature demonstrates widespread discomfort with this practice among anatomy course directors at U.S. institutions, bringing into question continuation of this practice. However, attitudes among medical students must similarly be assessed as they represent key stakeholders in the dissection process. The purpose of this study was to assess prevailing attitudes among a sample of medical students at one U.S. medical institution regarding the dissection of unclaimed bodies and identify emerging themes in ethical viewpoints.</p><p><strong>Approach: </strong>Two-hundred-twelve students (35% response rate) at one U.S. medical institution completed an anonymous online survey. Students came from different class cohorts at various stages of their training. Survey items were developed to capture students' academic and emotional experience with anatomical dissection and to identify emerging themes in attitudes.</p><p><strong>Findings: </strong>Students reported high regard for cadaveric dissection in general with 170 (80%) respondents endorsing it as critical to anatomical education. Regarding dissection of unclaimed bodies, 30% of students found the practice ethical while 47% of students found the practice unethical. Multivariate analysis found that ethical view was directly associated with comfort level (OR= 156.16; 95% CI: 34.04, 716.40). Most students expressed comfort dissecting self-donated bodies (<i>n</i> = 206, 97%), while fewer students expressed comfort dissecting unclaimed bodies (<i>n</i> = 66, 31.1%). This latter finding significantly correlated with gender (<i>t</i> = 3.361. <i>p</i> < 0.05), class cohort (<i>F</i> = 3.576, <i>p</i> < 0.01), but not with religious affiliation or age. Thematic analysis revealed the following themes in student responses: (1) invoking ethical paradigms to either justify or condemn the practice, (2) subjective experiences, and (3) withholding judgment of the practice.</p><p><strong>Insights: </strong>Many students expressed negative attitudes toward the dissection of unclaimed bodies, with some citing issues of social vulnerability, justice, and autonomy. These findings indicate that many students' ethical code may conflict with institutional policies which permit this practice. Medical school represents a critical time in the professional development of trainees, and development practices which align with the moral code of local institutions and stakeholders is crucial.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592757","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":"Competency-Based Cultural Safety Training in Medical Education at <i>La Sabana</i> University, Colombia: A Roadmap of Curricular Modernization.","authors":"Juan Pimentel, Julio Cesar García, Alvaro Enrique Romero-Tapia, Germán Zuluaga, Camilo Correal, Anne Cockcroft, Neil Andersson","doi":"10.1080/10401334.2023.2246964","DOIUrl":"10.1080/10401334.2023.2246964","url":null,"abstract":"<p><p><b><i>Issue:</i></b> Cultural safety enhances equitable communication between health care providers and cultural groups. Most documented cultural safety training initiatives focus on Indigenous populations from high-income countries, and nursing students, with little research activity reported from low- and middle-income countries. Several cultural safety training initiatives have been described, but a modern competency-based cultural safety curriculum is needed. <b><i>Evidence:</i></b> In this article, we present the Competency-Based Education and Entrustable Professional Activities frameworks of the Faculty of Medicine at <i>La Sabana</i> University in Colombia, and illustrate how this informed modernization of medical education. We describe our co-designed cultural safety training learning objectives and summarize how we explored its impact on medical education through mixed-methods research. Finally, we propose five cultural safety intended learning outcomes adapted to the updated curriculum, which is based on the Competency-Based Education model. <b><i>Implications:</i></b> This article presents five cultural safety intended learning outcomes for undergraduate medical education. These learning outcomes are based on Competency-Based Education and the Entrustable Professional Activities framework and can be used by faculties of medicine interested in including the cultural safety approach in their curriculum.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"127-136"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488650","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":"\"Two Years Later I'm Still Just as Angry\": A Focus Group Study of Emergency and Internal Medicine Physicians on Disrespectful Communication.","authors":"Zahir Kanjee, Christine P Beltran, C Christopher Smith, Carrie D Tibbles, Jason J Lewis, Amy M Sullivan","doi":"10.1080/10401334.2023.2288706","DOIUrl":"10.1080/10401334.2023.2288706","url":null,"abstract":"<p><p><b>Phenomenon</b>: Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. <b>Approach</b>: In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center. <b>Findings</b>: We organized focus group results into four overarching categories related to disrespectful communication: characteristics and context (including specific phrasing that members from each department interpreted as disrespectful, effects of listener engagement/disengagement, and the tendency for communication that is not in-person to result in misunderstanding and conflict); differences across training levels (with disrespectful communication more likely when participants were at different training levels); the individual correspondent's tendency toward perceived rudeness; and negative/long-term impacts of disrespectful communication on the individual and environment (including avoidance and effects on patient care). <b>Insights</b>: In the context of predominantly positive descriptions of interdepartmental communication, participants described episodes of perceived disrespectful behavior that often had long-lasting, negative impacts on the quality of the learning environment and clinical work. We created a conceptual model illustrating the process and outcomes of these interactions. We make several recommendations to reduce disrespectful communication that can be applied throughout the hospital to potentially improve patient care, interdepartmental collaboration, and trainee and faculty quality of life.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"64-74"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479247","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 McMaster Narrative Comment Rating Tool: Development and Initial Validity Evidence.","authors":"Natalie McGuire, Anita Acai, Ranil R Sonnadara","doi":"10.1080/10401334.2023.2276799","DOIUrl":"10.1080/10401334.2023.2276799","url":null,"abstract":"<p><strong>Construct: </strong>The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness.</p><p><strong>Background: </strong>Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence. To develop solutions to mitigate this problem, robust measures of narrative comment quality are needed. While some tools exist, most were created in specialty-specific contexts, have focused on one or two features of feedback, or have focused on faculty perceptions of feedback, excluding learners from the validation process. In this study, we aimed to develop a detailed, broadly applicable narrative comment quality assessment tool that drew upon features of high-quality assessment and feedback and could be used by a variety of raters to inform future research, including applications related to automated analysis of narrative comment quality.</p><p><strong>Approach: </strong>In Phase 1, we used the literature to identify five critical features of feedback. We then developed rating scales for each of the features, and collected 670 competency-based assessments completed by first-year surgical residents in the first six-weeks of training. Residents were from nine different programs at a Canadian institution. In Phase 2, we randomly selected 50 assessments with written feedback from the dataset. Two education researchers used the scale to independently score the written comments and refine the rating tool. In Phase 3, 10 raters, including two medical education researchers, two medical students, two residents, two clinical faculty members, and two laypersons from the community, used the tool to independently and blindly rate written comments from another 50 randomly selected assessments from the dataset. We compared scores between and across rater pairs to assess reliability.</p><p><strong>Findings: </strong>Single and average measures intraclass correlation (ICC) scores ranged from moderate to excellent (ICCs = .51-.83 and .91-.98) across all categories and rater pairs. All tool domains were significantly correlated (<i>p</i>'<i>s</i> <.05), apart from valence, which was only significantly correlated with degree of correction versus reinforcement.</p><p><strong>Conclusion: </strong>Our findings suggest that the McMaster Narrative Comment Rating Tool can reliably be used by multiple raters, across a variety of rater types, and in different surgical contexts. As such, it has the potential to support faculty development initiatives on assessment and feedback, and may be used as a tool to conduct research on different assessment strategies, including automated analysis of narrative comments.</p>","PeriodicalId":51183,"journal":{"name":"Teaching and Learning in Medicine","volume":" ","pages":"86-98"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592756","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}