黎巴嫩的研究生医学教育:在复杂危机中的挑战、支持和适应。

IF 3.9 2区 医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Perspectives on Medical Education Pub Date : 2025-09-10 eCollection Date: 2025-01-01 DOI:10.5334/pme.1721
Fatima Msheik-El Khoury, Carine Zeeni, Halah Ibrahim, Frida Atallah, Salah Zeineldine
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引用次数: 0

摘要

研究生医学教育(GME)系统经常面临中断。在黎巴嫩,过去几年中,包括政治不稳定、经济崩溃、COVID-19大流行和军事冲突在内的多次危机引发了对机构支持、临床住院医生准备和GME系统复原力的质疑。本研究旨在探讨临床住院医师在毕业时的认知准备和能力,他们在复杂的国家危机中面临的挑战,以及培训机构如何支持他们并适应GME以保持培训和福祉。方法:2024年6月,我们在黎巴嫩的一个大型学术医疗中心对即将毕业的临床住院医师(包括研究员和住院医师)进行了横断面调查。来自不同专业的项目主管们提出了13个问题。定量数据评估了居民对六项ACGME核心能力的自我感知准备。同时,定性数据探讨了居民面临的挑战、机构干预和居民的建议。定量资料采用描述性统计分析。以马斯洛需求层次理论为指导,对开放式调查结果进行定性分析,了解居民面临的挑战;以归纳主题分析为指导,综合制度策略。结果:133名住院医生和研究员中有127名(95%)完成了调查,他们的专业范围很广,包括内科-外科专业。尽管持续的培训中断,大多数住院医生认为在核心能力方面准备充分,包括67%的患者护理,54%的医学知识,57%的系统实践,69%的沟通技巧,72%的专业精神,61%的基于实践的学习和改进。开放式回答显示,危机为居民提供了发展他们在基于系统的实践能力领域的技能的机会。关于住院医生面临的挑战,出现了五个主题:满足基本需求、确保健康、维持家庭和社会生活、促进专业成长和临床经验,以及实现职业抱负。机构战略,特别是通过提供必要的财政支持、结构化的情感和心理支持项目、教师和项目领导的社会支持、危机中的持续职业支持和监督、职业指导和支持,帮助住院医生在面临严峻挑战的情况下保持培训的连续性。有些挑战超出了该机构的资源和控制范围。讨论:尽管受到多重外部干扰,黎巴嫩GME项目仍具有独特的韧性,这凸显了机构支持系统的优势和脆弱性。虽然该研究确定了住院医生和研究员面临的几项重大挑战,但它强调了优先考虑他们的福祉、培养支持性学习环境和培养与危机相关的能力的重要性,以确保医学教育在面对未来挑战时继续取得成功。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Graduate Medical Education in Lebanon: Challenges, Support, and Adaptation Amid the Compounding Crises.

Graduate Medical Education in Lebanon: Challenges, Support, and Adaptation Amid the Compounding Crises.

Graduate Medical Education in Lebanon: Challenges, Support, and Adaptation Amid the Compounding Crises.

Introduction: Graduate Medical Education (GME) systems often face disruptions. In Lebanon, repeated crises over the past several years, including political instability, economic collapse, the COVID-19 pandemic, and military conflict, raise questions about institutional support, clinical residents' preparedness, and the resilience of the GME system. This study aims to examine clinical residents' perceived preparedness and competency at graduation, the challenges they faced during compounding national crises, and how training institutions supported them and adapted GME to maintain training and well-being.

Methods: In June 2024, we conducted a cross-sectional survey of graduating clinical residents including fellows and residents, in a large academic medical center in Lebanon. Thirteen questions were developed by a group of program directors from different specialties. Quantitative data assessed residents' self-perceived preparedness across six ACGME core competencies. In parallel, qualitative data explored the challenges residents faced, institutional interventions, and residents' recommendations. Descriptive statistics were used to analyze quantitative data. Qualitative analysis of open-ended survey responses was guided by Maslow's Hierarchy of Needs to understand residents' challenges, while inductive thematic analysis was used to synthesize the institutional strategies.

Results: 127 of 133 (95%) residents and fellows across a wide range of specialties, including medical-surgical specialties, completed the survey. Despite ongoing training disruptions, most residents felt well-prepared in core competencies, including 67% for patient care, 54% for medical knowledge, 57% for systems-based practice, 69% for communication skills, 72% for professionalism, and 61% for Practice-Based Learning and Improvement. Open-ended responses revealed that the crises provided opportunities for residents to develop their skills in the systems-based practice competency domain. Five themes on residents' challenges emerged: meeting basic needs, ensuring well-being, maintaining family and social life, fostering professional growth and clinical experience, and fulfilling career aspirations. Institutional strategies, particularly through the provision of essential financial support, structured emotional and psychological support programs, faculty and program leadership social support, sustained career support and supervision amid crisis, and career mentorship and support, helped maintain continuity in resident training despite severe challenges. Some challenges were beyond the institution's resources and control.

Discussion: The unique resilience of Lebanese GME programs despite multiple external disruptions highlights the strengths and vulnerabilities of institutional support systems. While the study identified several significant challenges faced by residents and fellows, it underscored the importance of prioritizing their well-being, fostering a supportive learning environment, and developing crisis-relevant competencies to ensure the continued success of medical education in the face of future challenges.

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来源期刊
CiteScore
5.70
自引率
8.30%
发文量
31
审稿时长
28 weeks
期刊介绍: Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Official journal of the The Netherlands Association of Medical Education (NVMO). Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary. The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members. The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission. Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary. The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members. The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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