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Hajjar L, Sullivan E, Maurer M, Yang J. Lessons for tomorrow: The role of relationships and mindfulness in sustaining services during a crisis. Health Care Manage Rev 2024; 49:176-185. [PMID: 38775753 DOI: 10.1097/hmr.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND The COVID-19 pandemic placed unprecedented demands on hospitals around the globe, making timely crisis response critical for organizational success. One mechanism that has played an effective role in health care service management during large-scale crises is the Hospital Incident Command System. PURPOSE The aim of this article was to understand the role of HICS in the management of a large academic medical center and its impact on relationships and communication among providers in the delivery of services during a crisis. METHODOLOGY This mixed methods study was based on meeting observations, document reviews, semistructured interviews, and two measures of team performance within an academic medical center in the Northeast during the COVID-19 pandemic. Descriptive and bivariate analyses were applied, and qualitative data were coded and analyzed for themes. RESULTS HICS provided a systematic information-sharing and decision-making process that increased communication and coordination among team members. Analyses indicate a correlation between dimensions of relational coordination and organizational mindfulness. Qualitative data revealed the importance of shared meetings and huddles and the evolution of HICS across multiple waves of the crisis. CONCLUSION HICS facilitated organizational improvements during the crisis response and generated opportunities to maintain specific coordination practices beyond the crisis. The prolonged implementation of HICS during the COVID-19 pandemic created challenges, including the disruption of the routine leadership structure. PRACTICAL IMPLICATIONS Applying relational coordination and organizational mindfulness frameworks may allow hospitals to leverage communications and relationships within a high-stakes environment to improve service delivery.
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Araújo-Neto FDC, Santos LGD, Tavares TMA, Fonseca FLD, Prado FO, Silva RDOS, Mesquita AR, Lyra DPD. Teaching Strategies for Professional Identity Education in Pharmacy: A Scoping Review. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100597. [PMID: 37805042 DOI: 10.1016/j.ajpe.2023.100597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy. FINDINGS We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation. SUMMARY The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.
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Affiliation(s)
- Fernando de Castro Araújo-Neto
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Hospital Universitary of Sergipe - Federal University of Sergipe - Campus Aracaju, Health Science Postgraduate Program, Aracaju, Brazil
| | - Lívia Gois Dos Santos
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Thaís Maria Araújo Tavares
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Francielly Lima da Fonseca
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Federal University of Sergipe - Campus São Cristóvão, Pharmacy Science Postgraduate Program, São Cristóvão, Brazil
| | - Fernanda Oliveira Prado
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Hospital Universitary of Sergipe - Federal University of Sergipe - Campus Aracaju, Health Science Postgraduate Program, Aracaju, Brazil
| | - Rafaella de Oliveira Santos Silva
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Alessandra Rezende Mesquita
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Divaldo Pereira de Lyra
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil.
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Stergiopoulos E, Martimianakis MAT. What makes a 'good doctor'? A critical discourse analysis of perspectives from medical students with lived experience as patients. MEDICAL HUMANITIES 2023; 49:613-622. [PMID: 37185337 DOI: 10.1136/medhum-2022-012520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
What constitutes a 'good doctor' varies widely across groups and contexts. While patients prioritise communication and empathy, physicians emphasise medical expertise, and medical students describe a combination of the two as professional ideals. We explored the conceptions of the 'good doctor' held by medical learners with chronic illnesses or disabilities who self-identify as patients to understand how their learning as both patients and future physicians aligns with existing medical school curricula. We conducted 10 semistructured interviews with medical students with self-reported chronic illness or disability and who self-identified as patients. We used critical discourse analysis to code for dimensions of the 'good doctor'. In turn, using concepts of Bakhtinian intersubjectivity and the hidden curriculum we explored how these discourses related to student experiences with formal and informal curricular content.According to participants, dimensions of the 'good doctor' included empathy, communication, attention to illness impact and boundary-setting to separate self from patients. Students reported that formal teaching on empathy and illness impact were present in the formal curriculum, however ultimately devalued through day-to-day interactions with faculty and peers. Importantly, teaching on boundary-setting was absent from the formal curriculum, however participants independently developed reflective practices to cultivate these skills. Moreover, we identified two operating discourses of the 'good doctor': an institutionalised discourse of the 'able doctor' and a counterdiscourse of the 'doctor with lived experience' which created a space for reframing experiences with illness and disability as a source of expertise rather than a source of stigma. Perspectives on the 'good doctor' carry important implications for how we define professional roles, and hold profound consequences for medical school admissions, curricular teaching and licensure. Medical students with lived experiences of illness and disability offer critical insights about curricular messages of the 'good doctor' based on their experiences as patients, providing important considerations for curriculum and faculty development.
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Smith JF, Sinclair ML, Madhavan KM, Eno CA, Piemonte NM. Learning How to Learn: An Innovative Medical School Orientation Activity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1026-1031. [PMID: 36940396 DOI: 10.1097/acm.0000000000005211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PROBLEM In 2018, Creighton University School of Medicine initiated a multiyear strategy to redesign the pedagogic approach of its educational program, transitioning from large-group, lecture-based experiences to small-group, active learning experiences using case-based learning (CBL) as required prework for team-based learning (TBL). In July 2019, the authors introduced their first-year medical students to the pedagogic and empiric underpinnings of the new curriculum they would experience. Initially, and ironically, this introduction was presented as a 30-minute didactic lecture, and students' ability to assimilate this information in any meaningful way was challenged. In addition, students required several sessions of the CBL-TBL activities during the official curriculum before they were able to effectively function as a team of learners. The authors created a novel introduction to their educational program that was active, meaningful, and efficient. APPROACH In 2022, the authors created a 2-hour, small-group CBL activity using a fictional narrative of a medical student encountering their curriculum. During development, the authors recognized that the narrative was conducive to introduction of affective responses to medical education stressors, such as imposter phenomenon and Stanford duck syndrome. The CBL activity was given 4 hours during the formal 2022 orientation; 230 students participated. The CBL activity occurred on the second day of orientation and the TBL activity on the third (final) day of orientation. OUTCOMES The results of the TBL activity indicate that students acquired a fundamental understanding of the attributes of active learning, features of imposter syndrome, substance abuse associated with Stanford duck syndrome, and peer evaluation. NEXT STEPS This CBL-TBL activity will become a permanent part of orientation. The authors hope to evaluate the qualitative outcomes of this innovation on students' professional identity formation, institutional affiliation, and motivation. The authors will assess for any negative impact of this experience and the overall orientation.
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Affiliation(s)
- James F Smith
- J.F. Smith Jr is professor of medical education and medical humanities, Departments of Medical Education and Medical Humanities, Creighton University School of Medicine, Omaha, Nebraska
| | - Mary L Sinclair
- M.L. Sinclair is assistant dean of medical education: curriculum and faculty development, Office of Medical Education, Creighton University School of Medicine, Omaha, Nebraska
| | - Kiely M Madhavan
- K.M. Madhavan is assistant professor of medical humanities and academic success consultant, Office of Student Affairs, Creighton University School of Medicine, Omaha, Nebraska
| | - Cassie A Eno
- C.A. Eno is assistant professor of medical education and assistant dean for evaluation and analytics, Office of Accreditation and Quality Improvement, Creighton University School of Medicine, Omaha, Nebraska
| | - Nicole M Piemonte
- N.M. Piemonte is associate professor of medical humanities, assistant dean of student affairs, and the Peekie Nash Carpenter Endowed Chair in Medicine, Creighton University School of Medicine Phoenix Regional Campus, Phoenix, Arizona
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The pharmacist as safety net: an interview-based study of the intersecting dependencies between doctors and pharmacists. J Pharm Policy Pract 2023; 16:40. [PMID: 36894977 PMCID: PMC9999512 DOI: 10.1186/s40545-023-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/11/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Social science research has demonstrated how health practitioners negotiate and contest professional roles and jurisdictions in practice, and in ways that reflect the power dynamics that permeate medicine. This article further explores these relational dynamics by examining how general practitioners (GPs) in Aotearoa New Zealand frame their working relationships with pharmacists. METHODS We conducted semi-structured interviews with 16 GPs from around the country. Interviews had a mean duration of 46 min, and were thematically analysed. RESULTS GPs saw and used pharmacists as a key source of information about both medicines and patients; thus it was not only pharmacists' training and expertise, but also their community setting and patient proximity, that made them a useful resource to doctors. Furthermore, GPs framed pharmacists as a critical 'safety net' due to their role in catching errors and checking prescribing details. The pharmacy 'safety net' also came through in participants' comments on discount pharmacies, which have introduced pronounced cost-cutting logics to Aotearoa New Zealand's pharmaceutical landscape; in their reflections on these organisations, prescribers express the importance of robust pharmacy practice to their own work. CONCLUSIONS Whilst the literature often foregrounds tensions in how health providers reinscribe their professional roles, this research highlights the interdependence that doctors identify with pharmacists, and their aspirations for working together. Both professional groups navigate a pressed health system that presents a set of common challenges to good medicines practice.
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Wasserman JA, Browne BJ. On Triggering and Being Triggered: Civil Society and Building Brave Spaces in Medical Education. TEACHING AND LEARNING IN MEDICINE 2021; 33:561-567. [PMID: 33632036 DOI: 10.1080/10401334.2021.1887740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
IssueHow educators should respond to student reports of intense emotional reactions to curricular content-i.e., being triggered-invites intense debate. There are claims of insensitivity on one side and calls to "toughen up" on the other. These polemics aside, such instances sometimes represent a true dilemma, particularly within medical education where engaging highly sensitive content is essential to future patient care and where managing one's own emotions is a core competency. Parsing this convoluted and emotional debate into these domains illustrates how medical educators can simultaneously legitimize the lived experiences of students, engage in honest dialogue, and maintain a shared commitment to education. Evidence: While substantial energy has been spent debating the legitimacy of students' emotional reactions, the discourse lacks a clear conceptual framework and we often end up talking past each other. The concept of brave spaces offers an important alternative where sensitive subject matter can be engaged with civility. Implications: This paper offers a model for building brave spaces within medical education by clarifying the rights and responsibilities of both teachers and learners in each of three intersecting domains: intrapersonal, interpersonal, and civic. This model is exemplified in a case where students reported being triggered by course content. By parsing this case across the three domains, we can clarify how responses are multifaceted and we can simultaneously avoid indictment of another's lived experiences while preserving the pedagogical integrity of the curriculum.
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Affiliation(s)
- Jason Adam Wasserman
- Department of Foundational Medical Studies and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Berkley Jennifer Browne
- Student Affairs, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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van Buuren A, Yaseen W, Veinot P, Mylopoulos M, Law M. Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation. MEDICAL TEACHER 2021; 43:538-545. [PMID: 33529540 DOI: 10.1080/0142159x.2021.1874326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND While there is increasing effort among medical schools to recruit diverse students, there is a paucity of research into the unique experiences of these students during their transition to medicine. This study explored how experiences during medical school orientation influence students' transition into the medical profession. METHODS Semi-structured interviews were conducted (April-August 2019) with 16 first-year Canadian medical students. We applied descriptive thematic analysis using a constant comparative approach. Verbatim transcripts were coded and analyzed to elucidate themes. RESULTS Participants highlighted the importance of social orientation during their transition into medical school and noted experiencing complex social pressures during this time. They shared how incoming students were introduced to the dominant medical professional identity during orientation. Participants noted tensions during this period, many of which revolved around the dominant identity and their past, present and future selves. CONCLUSIONS Longstanding issues of diversity and inclusion in medicine manifest from day one of medical school. While orientation may be intended as a transition period to welcome students into the profession, it is a crucial period for medical schools to intentionally establish a commitment to an inclusive culture. Waiting to do so after identity formation has already begun is a missed opportunity.
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Affiliation(s)
- Asia van Buuren
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Wid Yaseen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Paula Veinot
- Independent Research Consultant, Halifax, Canada
| | - Maria Mylopoulos
- Temerty Faculty of Medicine and Wilson Centre, University of Toronto, Toronto, Canada
| | - Marcus Law
- Department of Family and Community Medicine, and MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Poola VP, Suh B, Parr T, Boehler M, Han H, Mellinger J. Medical students' reflections on surgical educators' professionalism: Contextual nuances in the hidden curriculum. Am J Surg 2020; 221:270-276. [PMID: 32943180 DOI: 10.1016/j.amjsurg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Surgical educators' professional behavior constitutes a hidden curriculum and impacts trainee's professional identity formation. This study explores the nuances of professional behaviors as observed in varying surgical settings. METHODS 411 Transcripts originated from essays written by MS3 students during their surgical clerkship from 2010 to 2016 were collated. Employing a qualitative research methodology, we conducted a thematic analysis to uncover specific meaning emerging from medical student reflections' on surgical professionalism. RESULTS In clinics, taking time and protecting patient privacy; in the OR, control over emotion during difficult situations and attention to learners; and in the inpatient setting, showing accountability above normal expected behavior were noted as professional. Similarly, unprofessional behaviors in these contexts paralleled lack of these attributes. CONCLUSIONS Behaviors observed and the attributes of professionalism in the surgical learning environment have contextual nuances. These variations in professionalism can be utilized in deliberate development of professionalism in surgery.
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Affiliation(s)
- V Prasad Poola
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Boyung Suh
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA.
| | - Trevor Parr
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Margaret Boehler
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - Heeyoung Han
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
| | - John Mellinger
- SIU School of Medicine, Department of Surgery, 701 North Rutledge Street, PO Box 19638, Springfield, IL, 62794-9638, USA
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Santos VHD, Ferreira JH, Alves GCA, Naves NM, Oliveira SLD, Raimondi GA, Paulino DB. Currículo oculto, educação médica e profissionalismo: uma revisão integrativa. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2020. [DOI: 10.1590/interface.190572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
O currículo oculto resulta das relações interpessoais vividas academicamente, extrapolando o currículo formal, podendo ser um facilitador e também um empecilho ao aprendizado. Essa revisão objetiva compreender a abordagem da temática na educação médica e sua relação com o profissionalismo. A revisão integrativa nos permitiu observar uma sobrecarga cognitiva e emocional do(a)s estudantes causada pelo currículo oculto. Todavia, constatamos como a educação médica tem trabalhado com a finalidade de reduzir esses prejuízos. Nesse sentido, é importante problematizar os modelos hegemônicos que influenciam valores, interesses, discursos, saberes e práticas ao longo da formação. Para isso, é fundamental o debate em torno de conceitos/ações como identidade, diversidade, inclusão, hegemonia, ideologia, poder e cultura, que pode ocorrer de forma longitudinal e integrada em unidades curriculares relacionadas às humanidades.
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