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Cattaneo RA, González N, Leafe A, Fleishman R. Pediatric Resident Perceptions of a Narrative Medicine Curriculum. THE JOURNAL OF MEDICAL HUMANITIES 2024; 45:157-169. [PMID: 38051391 DOI: 10.1007/s10912-023-09817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 12/07/2023]
Abstract
Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents' perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated in at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection.
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Affiliation(s)
- Raymond A Cattaneo
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Natalie González
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Abby Leafe
- New Leafe Research, 103 Hillborn Drive, Newtown, PA, 18940, USA
| | - Rachel Fleishman
- Department of Pediatric and Adolescent Medicine, Jefferson Einstein Hospital, 5501 Old York Road, Philadelphia, PA, 19141, USA.
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Phua GLG, Owyong JLJ, Leong ITY, Goh S, Somasundaram N, Poon EYL, Chowdhury AR, Ong SYK, Lim C, Murugam V, Ong EK, Mason S, Hill R, Krishna LKR. A systematic scoping review of group reflection in medical education. BMC MEDICAL EDUCATION 2024; 24:398. [PMID: 38600515 PMCID: PMC11007913 DOI: 10.1186/s12909-024-05203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study. METHODS A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion. RESULTS 1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections. CONCLUSIONS Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.
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Affiliation(s)
- Gillian Li Gek Phua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- School of Humanities and Behavioural Sciences, Singapore University of Social Sciences, 463 Clementi Road, Singapore, Singapore
| | - Ian Tze Yong Leong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Suzanne Goh
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- KK Women's and Children Hospital, 100 Bukit Timah Rd, Singapore, 169854, Singapore
| | - Nagavalli Somasundaram
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Crystal Lim
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Medical Social Services, Singapore General Hospital, 16 College Road, Block 3 Level 1, Singapore, 169854, Singapore
| | - Vengadasalam Murugam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Rd, Singapore, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, 31 Third Hospital Ave, Singapore, 168753, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK
| | - Ruaridh Hill
- Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, Singapore, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
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Bhugra D, Smith AJ, Ventriglio A, Rao N, Ng R, Javed A, Chisolm MS, Malhi G, Kar A, Chumakov E, Liebrenz M. World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates. Asian J Psychiatr 2024; 93:103943. [PMID: 38342035 DOI: 10.1016/j.ajp.2024.103943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
Historically, doctors have migrated for a range of personal, educational, economic, and political reasons. Likewise, medical students from many countries have moved abroad to complete their training and education and may or may not return to their country of origin. Within this context, globalisation has had a major impact on medical education and healthcare workforces, contributing to recent migration trends. Globalisation is a complex phenomenon with positive and negative outcomes. For example, lower-income countries are regularly losing doctors to higher-income areas, thereby exacerbating strains on existing services. Across various national healthcare settings, migrating International Medical Graduates (IMGs) can face socioenvironmental and psychosocial pressures, which can lead to lower mental wellbeing and undermine their contributions to clinical care. Rates of stress and burnout are generally increasing for doctors and medical students. For IMGs, stressors related to migration, acculturation, and adjustment are not dissimilar to other migrants but may carry with them specific nuances. Accordingly, this Commission will explore the history of IMG trends and the challenges faced by IMGs, proposing recommendations and solutions to support their mental health and wellbeing.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College London, De Crespigny Park, London SE5 8AF, UK.
| | - Alexander J Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | - Nyapati Rao
- Stony Brook University Health Sciences Center School of Medicine, New York, USA
| | - Roger Ng
- World Psychiatric Association, Geneva, Switzerland
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | | | - Gin Malhi
- School of Psychiatry, University of Sydney, Sydney, Australia
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
| | - Egor Chumakov
- Department of Psychiatry & Addiction, St Petersburg State University, St Petersburg, Russia
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
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Al-Haddad M. Facilitating international medical graduates' acculturation: From theory to practice. MEDICAL EDUCATION 2024; 58:136-148. [PMID: 37524527 DOI: 10.1111/medu.15175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Abstract
CONTEXT International medical graduates (IMGs) are forming an ever-increasing proportion of the medical workforce. Much of the discourse around IMGs is about their performance at work and interventions to improve it. This discourse, however, is rarely situated in the wider context of the experiences of IMGs as migrants despite the wider context of migration and acculturation being likely to have a significant impact on IMGs' well-being and, ultimately, performance at work. OBJECTIVES The objectives of this article were to (1) raise awareness of the inextricable broader context within which IMGs are situated as migrants; (2) outline the impact this context might have on IMGs' performance; (3) discuss literature from the social sciences related to acculturation that could better inform the way we view IMG transition and performance; (4) highlight how acculturation theory can help inform the design, implementation and evaluation of interventions to facilitate the transition of IMGs into the host country and the workplace; (5) list some interventions that can provide support; and (6) suggest theory driven lines of enquiry to study acculturation in IMGs and the impact related issues might have on performance. METHODS This is a cross-cutting edge review drawing on selected theory and literature from the social sciences to explore its relevance to IMGs. CONCLUSION The broader context of migration and acculturation should not be ignored when discussing IMG performance in the workplace or when instigating interventions to improve it. There is an urgent need to further evaluate the impact this broader context has on IMGs' well-being and performance.
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Affiliation(s)
- Mo Al-Haddad
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
- NHS Education, Scotland, UK
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5
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Porras Fimbres DC, Zeng S, Phillips BT. Prevalence of International Medical Graduates in Integrated Plastic Surgery Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5140. [PMID: 37577252 PMCID: PMC10419534 DOI: 10.1097/gox.0000000000005140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/12/2023] [Indexed: 08/15/2023]
Abstract
International medical graduates (IMGs) are physicians who did not attend medical school in the USA or Canada. IMGs comprise nearly one-quarter of the physician workforce and play a vital role in health care. Here, we aimed to identify the prevalence of IMGs in integrated programs and evaluate factors that influence their success in the residency match. Methods The annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents. Results The number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship. Conclusion IMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.
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Affiliation(s)
| | - Steven Zeng
- From the Department of Medicine, Duke University School of Medicine, Durham, N.C
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Khoujah D, Ibrahim A. Exploring Teamwork Challenges Perceived by International Medical Graduates in Emergency Medicine Residency. West J Emerg Med 2023; 24:50-58. [PMID: 36735007 PMCID: PMC9897247 DOI: 10.5811/westjem.2022.11.58002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/20/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Non-US international medical graduates (IMG) represent a gradually increasing portion of emergency medicine (EM) residents in the United States. Yet there are no previous studies that explore the needs of this learner population. We conducted a qualitative study to examine non-US IMGs' perceptions of challenges they face specifically regarding team dynamics during their first year of an EM residency. METHOD Nine non-US IMGs in EM from all over the US participated in anonymous, semi-structured phone interviews lasting 45-60 minutes. We then coded and analyzed the interviews to identify axes and themes using an inductive approach informed by grounded theory. Focused coding and member checking were employed. RESULTS Non-US IMGs' perceptions of challenges regarding team dynamics during their first year of an EM residency coalesced into two themes: system-based challenges, such as a new power dynamic and understanding the local hospital system, and interpersonal challenges, such as establishing rapport and articulation of critical thinking. CONCLUSION Non-US IMGs perceived several unique challenges regarding team dynamics during their first year of an EM residency, whether system-based or interpersonal-based. We propose solutions such as a transitional curriculum (as suggested by the participants as well) and cultural-competence training for academic leadership.
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Affiliation(s)
- Danya Khoujah
- Tampa AdventHealth, Emergency Medicine, Tampa, Florida,University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ahmed Ibrahim
- Johns Hopkins University, School of Education, Baltimore, Maryland
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7
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Murillo Zepeda C, Alcalá Aguirre FO, Luna Landa EM, Reyes Güereque EN, Rodríguez García GP, Diaz Montoya LS. Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review. Cureus 2022; 14:e27351. [PMID: 35910699 PMCID: PMC9334519 DOI: 10.7759/cureus.27351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
International medical graduates (IMGs) have become a vital part of the US graduate medical education (GME) and health care system (HCS) workforce; they contribute to essential diversity that relieves cultural and linguistic barriers to health care. The number of IMGs looking for medical training in the United States. has constantly been increasing in the last decades. The challenges they meet begin long before residency application, continue during their transition to residency programs, through early medical training, and eventually subside in senior years. IMGs' hurdles permeate the themes of navigating the US GME and HCS, adaptation to the US culture, communication skills, racial discrimination, emotional distress, and finances. This article aims to comprehensively review available information concerning the challenges encountered by IMGs in their transition to the US GME and HCS environments.
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8
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Al-Haddad M, Jamieson S, Germeni E. International medical graduates' experiences before and after migration: A meta-ethnography of qualitative studies. MEDICAL EDUCATION 2022; 56:504-515. [PMID: 34859484 DOI: 10.1111/medu.14708] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION International medical graduates (IMGs) represent a large portion of practising doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK's General Medical Council (GMC) recently set targets to 'eliminate disproportionate complaints' and 'eradicate disadvantage and discrimination in medical education'. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs to identify factors affecting IMGs' professional practice (either directly or indirectly). METHODS In September 2019, we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors' themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts. RESULTS Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practising in all six continents in a range of settings, including primary and secondary care. We developed five key concepts: migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the four main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented. CONCLUSIONS This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
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Affiliation(s)
- Mo Al-Haddad
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Susan Jamieson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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9
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Transition experiences of internationally qualified health care professionals: A narrative scoping review. Int J Nurs Stud 2022; 129:104221. [DOI: 10.1016/j.ijnurstu.2022.104221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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Russel SM, Geraghty JR, Renaldy H, Thompson TM, Hirshfield LE. Training for Professional Uncertainty: Socialization of Medical Students Through the Residency Application Process. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S144-S150. [PMID: 34348371 DOI: 10.1097/acm.0000000000004303] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Uncertainty in medical decision making is a well-described phenomenon, and numerous scholars have acknowledged and illustrated the process of training medical students to grapple with this aspect of medical practice. While clinical uncertainty has been defined previously, medical trainees face additional forms of uncertainty beyond the clinical setting that have not, as yet, been investigated empirically. One area in which uncertainty can manifest outside of the clinical setting is during professional development. Medical students face substantial stress and ambiguity throughout their training, with the residency application period representing a culmination of these pressures. Here, the authors examined medical students' experiences during the residency application period and used these findings to define training for professional uncertainty. METHOD In 2018-2019, 6 focus groups of fourth-year medical students were conducted exploring students' experiences during the residency application period, including but not limited to Step 2 Clinical Knowledge, away rotations, and securing letters of recommendation. The authors then used constructivist, phenomenological methods to analyze participant responses. RESULTS Students frequently discussed challenges they faced during the residency application period. From these conversations, 2 themes were identified: (1) professional uncertainty related to career-based advice, which resulted from mixed messaging and inadequate information, and (2) professional uncertainty related to competing responsibilities, which students experienced when determining how to allocate a limited amount of time to multiple conflicting forces. CONCLUSIONS These results were used to define a novel concept-training for professional uncertainty. By navigating the residency application process, students learned to face various facets of professional uncertainty that they will continue to face throughout their careers. Since uncertainty can have many negative effects, including declining performance and burnout, defining professional uncertainty and training students to grapple with it is necessary to maximize their success throughout their careers.
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Affiliation(s)
- Sarah M Russel
- S.M. Russel is a second-year resident, Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0001-9299-8047
| | - Joseph R Geraghty
- J.R. Geraghty is an MD-PhD student who has completed his PhD and returned to his third year of medical school, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-6828-4893
| | - Hilary Renaldy
- H. Renaldy is a third-year resident, Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California
| | - Trevonne M Thompson
- T.M. Thompson is associate dean for admissions and associate professor of emergency medicine and medical toxicology, Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, Illinois. Previously, he was assistant dean for residency preparedness, University of Illinois College of Medicine, Chicago, Illinois
| | - Laura E Hirshfield
- L.E. Hirshfield is associate professor of medical education and sociology, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0894-2994
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Jenkins TM, Underman K, Vinson AH, Olsen LD, E. Hirshfield L. The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:255-270. [PMID: 34528486 PMCID: PMC8446898 DOI: 10.1177/0022146521996275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.
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Affiliation(s)
- Tania M. Jenkins
- The University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
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12
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Katz C, Barnes M, Osta A, Walker-Descartes I. The Acculturation Toolkit: An Orientation for Pediatric International Medical Graduates Transitioning to the United States Medical System. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10922. [PMID: 32704536 PMCID: PMC7373352 DOI: 10.15766/mep_2374-8265.10922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 12/26/2019] [Indexed: 06/11/2023]
Abstract
INTRODUCTION International medical graduates (IMGs) consistently contribute to the US physician workforce. In fact, 25% of practicing pediatricians in the US are IMGs, highlighting the needs of IMG trainees. IMGs face unique challenges with acculturation compared to their peers due to unfamiliarity with the US medical system, especially the dynamics around patient-centered care. The literature supports the need for formal acculturation curricula. METHODS A cohort of program directors who train pediatric IMGs coupled findings from the literature with local themes from IMG focus groups to identify topics for an acculturation curriculum. Three small-group workshops utilized didactics, discussion, and role-play to cover topics related to patient-centered care, challenging communication with patients, complex psychosocial histories, and health literacy. The pilot was modified based on feedback and to enhance generalizability. The resulting four-module curriculum with presentations and supplemental materials is presented here. RESULTS After a 3-year pilot with 36 PGY 1 trainees, postcurriculum surveys reported 8.1 out of 10 in workshop satisfaction, plus increased knowledge and skills related to patient-centered care and communication with patients. Role-plays were the favorite activity. A 1-year follow-up survey reported the workshops to be influential on satisfaction with patient relationships and easing transition to residency. DISCUSSION A pilot acculturation curriculum addressing needs of pediatric IMG trainees was well received by participants and improved their comfort level in addressing challenging patient-communication scenarios. Pediatric programs that train IMGs can incorporate this curriculum to aid residents' transition to clinical practice in the US.
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Affiliation(s)
- Cynthia Katz
- Assistant Clinical Professor, Department of Pediatrics, Icahn School of Medicine at Mount Sinai; Associate Residency Program Director, Department of Pediatrics, Icahn School of Medicine at Mount Sinai
| | - Michelle Barnes
- Associate Professor, Department of Pediatrics, University of Illinois College of Medicine; Associate Residency Program Director, Department of Pediatrics, University of Illinois College of Medicine
| | - Amanda Osta
- Associate Professor, Department of Pediatrics, University of Illinois College of Medicine; Residency Program Director, Department of Pediatrics, University of Illinois College of Medicine
| | - Ingrid Walker-Descartes
- Assistant Professor, Department of Pediatrics, State University of New York Downstate Medical Center College of Medicine; Residency and Fellowship Program Director, Department of Pediatrics, Maimonides Infants and Children's Hospital of Brooklyn
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13
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Ho KHM, Chiang VCL, Leung D, Cheung DSK. A feminist phenomenology on the emotional labor and morality of live-in migrant care workers caring for older people in the community. BMC Geriatr 2019; 19:314. [PMID: 31744456 PMCID: PMC6862863 DOI: 10.1186/s12877-019-1352-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Global societal changes, such as increasing longevity and a shortage of family caregivers, have given rise to a popular worldwide trend of employing live-in migrant care workers (MCWs) to provide homecare for older people. However, the emotional labor and morality inherent in their interactions with older people are largely unknown. The aim of the present study is to understand the corporeal experiences of live-in migrant care workers in the delivery of emotional labor as seen in their interactions with older people by: (1) describing the ways by which they manage emotional displays with older people; and (2) exploring their morality as enacted through emotional labor. Methods We performed a secondary analysis drawing on feminist phenomenology to thematically analyze data from interviews with 11 female MCWs. Follow-up interviews were conducted with 10 participants. The participants had two to 15 years of experience in caring for older people in their homes in Hong Kong. Results Performing emotional labor by suppressing and inducing emotions is morally demanding for live-in MCWs, who experience socio-culturally oppressive relationships. However, developing genuine emotions in their relationships with older people prompted the MCWs to protect the interests of older people. Through demonstrating both fake and genuine emotions, emotional labor was a tactic that live-in MCWs demonstrated to interact morally with older people. Conclusions Emotional labor allowed live-in MCWs to avoid conflict with older people, and to further protect their own welfare and that of others. This study highlights the significance of empowering live-in MCWs by training them in ways that will help them to adapt to working conditions where they will encounter diverse customs and older people who will develop an increasing dependence on them. Thus, there is a need to develop culturally appropriate interventions to empower live-in MCWs to deliver emotional labor in a moral manner.
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Affiliation(s)
- Ken H M Ho
- School of Nursing, Tung Wah College, 31 Wiley Road, Kowloon, Hong Kong SAR
| | - Vico C L Chiang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.
| | - Doris Leung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
| | - Daphne S K Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR
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14
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Ryan MS, Darden A, Paik S, D'Alessandro D, Mogilner L, Turner TL, Fromme HB. Key Studies in Medical Education from 2017: ANarrative Review. Acad Pediatr 2019; 19:357-367. [PMID: 30611896 DOI: 10.1016/j.acap.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/05/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
Abstract
Education, like clinical medicine, should be based on the most current evidence in the field. Despite the overwhelming breadth of literature in medical education, pediatric educators desire and need to incorporate best practices into their educational approaches. This article provides an overview of 18 articles from the literature in 2017 that the authors consider to be key articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership experience and expertise across the continuum of pediatric medical education, used an iterative, staged process to review more than 1682 abstracts published in 2017. This process aimed to identify a subset of articles that were most relevant to educational practice and most applicable to pediatric medical education. In the process, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different pairs to select the final articles included in this review. This paper presents summaries of the 18 articles that were selected. The results revealed a cluster of studies related to feedback, coaching, and observation; trainee progression, educator development, trainee entrustment, culture, and climate; and the medical student experience. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field of medical education.
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Affiliation(s)
- Michael S Ryan
- Department of Pediatrics (MS Ryan), Virginia Commonwealth University School of Medicine, Richmond.
| | - Alix Darden
- College of Medicine (A Darden), University of Oklahoma Health Sciences Center, Oklahoma City
| | - Steve Paik
- Department of Pediatrics (S Paik), Columbia University College of Physicians and Surgeons, Sinai, New York, NY
| | - Donna D'Alessandro
- Department of Pediatrics (D D'Alessandro), University of Iowa, Iowa City
| | - Leora Mogilner
- Department of Pediatrics (L Mogilner), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Teri L Turner
- Department of Pediatrics (TL Turner), Clinical Care Center, Baylor College of Medicine, Houston, Tex
| | - H Barrett Fromme
- Department of Pediatrics (HB Fromme), University of Chicago Pritzker School of Medicine, Chicago, Ill
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15
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Najeeb U, Wong B, Hollenberg E, Stroud L, Edwards S, Kuper A. Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:103-123. [PMID: 30259266 DOI: 10.1007/s10459-018-9852-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/19/2018] [Indexed: 05/16/2023]
Abstract
Many international medical graduates (IMGs) enter North American residency programs every year. The Canadian IMG physician pool increasingly includes Canadian-born IMGs (C-IMGs) along with Immigrant-IMGs (I-IMGs). Similar trends exist in the United States. Our objective was to understand the similarities and differences in the challenges faced by both I-IMGs and C-IMGs during residency to identify actionable recommendations to support them during this critical time. We performed a multiple case study of IMGs' experiences at a large Canadian university. Within our two descriptive cases (I-IMGs, C-IMGs) we iteratively conducted twenty-two semi-structured interviews; we thematically analyzed our data within, between, and across both cases to understand challenges to IMGs' integration and opportunities for curricular innovations to facilitate their adaptation process. Research team members with different perspectives contributed reflexively to the thematic analysis. Participants identified key differences between medical culture and knowledge expected in Canada and the health systems and curricula in which they originally trained. I-IMG and C-IMG participants perceived two major challenges: discrimination because of negative labelling as IMGs and difficulties navigating their initial residency months. C-IMGs described a third challenge: frustration around the focus on the needs of I-IMGs. Participants from both groups identified two major opportunities: their desire to help other IMGs and a need for mentorship. I-IMGs and C-IMGs face diverse challenges during their training, including disorientation and discrimination. We identified specific objectives to inform the design of curriculum and support services that residency programs can offer trainees as well as important targets for resident education and faculty development.
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Affiliation(s)
- Umberin Najeeb
- Wilson Centre for Research in Education, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada.
- Faculty Lead R4 Internal Medicine Program, University of Toronto, Toronto, ON, Canada.
- Faculty Lead IMG/IFT Mentorship Program, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Brian Wong
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre of Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Lynfa Stroud
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Core Internal Medicine Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Susan Edwards
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Urban Family Health Team, St. Joseph Health Centre, Toronto, ON, Canada
- Resident Wellness, Postgraduate Medical Education Office, University of Toronto, Toronto, ON, Canada
| | - Ayelet Kuper
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Massey College, Toronto, ON, Canada
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16
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Eriksson E, Berg S, Engström M. Internationally educated nurses' and medical graduates' experiences of getting a license and practicing in Sweden - a qualitative interview study. BMC MEDICAL EDUCATION 2018; 18:296. [PMID: 30518350 PMCID: PMC6282362 DOI: 10.1186/s12909-018-1399-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Swedish healthcare system has an increased need for nurses and physicians, and the number of International Educated Nurses (IENs) and International Medical Graduates (IMGs) seeking job opportunities and a license to practice in Sweden is rising. This study explored how IENs and IMGs describe their experience of getting a license to practice, their perceptions of working in Sweden and of how their intercultural competence is utilized. METHOD A qualitative study based on semi-structured interviews with 11 IENs and 11 IMGs. The interviews were conducted between 2015 and 2017. The data were analyzed using qualitative content analysis. RESULTS Three main themes were identified: 'Getting a license - a different story,' 'The work is familiar, yet a lot is new,' 'Trying to master a new language.' The time to obtain a license to practice and finding a job was shorter for IENs and IMGs coming from European countries than for those from non-European countries. Some of the experiences of getting a license to practice and of entering a new workplace in another country were the same for nurses and physicians. In general, both IENs and IMGs felt welcomed and used their intercultural competence at work. Lack of language skills was regarded as the main problem for both professions, while workplace introduction was shorter for IMGs than for IENs. CONCLUSIONS Problems related to language and culture are often underestimated, therefore organizations and managers employing IENs and IMGs should provide longer workplace introduction to facilitate the acculturation process. More time-efficient language courses specifically adapted to IENs and IMGs could make the transition easier and shorten the time to obtain a license to practice for both professions.
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Affiliation(s)
- Elisabet Eriksson
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Sören Berg
- Department of Medicine and Health Sciences, Department of Cardiothoracic Surgery, Linköping University, County Council of Östergötland, Linköping, Sweden
| | - Maria Engström
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Nursing Department, Medicine and Health College, Lishui University, Lishui, China
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17
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Jimenez-Gomez A, FitzGerald MR, Leon-Astudillo C, Gonzalez-delRey J, Schubert CJ. Performance of International Medical Graduates in Pediatric Residency: A Study of Peer and Faculty Perceptions. Acad Pediatr 2018; 18:728-732. [PMID: 30056222 DOI: 10.1016/j.acap.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND International medical graduates (IMGs) constitute approximately 25% of the US pediatric workforce. Their recruitment into US residency training raises concerns regarding their competence, although this has not been formally studied. Cincinnati Children's Hospital has systematically recruited IMGs over the past 16 years. This study evaluates perceptions of IMG performance by faculty and US graduate (USG) peers. METHODS We surveyed IMG, USG, and faculty groups, including current and former trainees, assessing perceived IMG performance compared with that of USGs in terms of clinical knowledge/skills, resource utilization, communication, public health knowledge and efficiency, and overall impact on the program. RESULTS Overall perceived performance was within 1 standard deviation of expected USG performance. IMGs outperformed USGs in clinical knowledge/skills and resource utilization but underperformed in communication, public health knowledge, and efficiency. Significant differences were noted in communication with patients and public health knowledge; IMGs ranked their performance significantly lower than USGs/faculty ranked their performance. Overall impact was perceived positively, including an increased interest in global health in among USGs. CONCLUSIONS Carefully recruited IMGs are perceived to perform nearly equal to their USG peers, and their presence is perceived as positive to a major pediatric residency program. Specific domains for educational interventions are identified for programs wishing to expand IMG recruitment.
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Affiliation(s)
- Andres Jimenez-Gomez
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass.
| | - Michael R FitzGerald
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Carmen Leon-Astudillo
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Javier Gonzalez-delRey
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
| | - Charles J Schubert
- Department of Child Neurology and Developmental Neuroscience, Texas Children's Hospital (Dr Jimenez-Gomez), Houston, Tex; Division of Emergency Medicine (Dr FitzGerald) and Department of Pediatrics, University of Cincinnati (Drs Gonzalez-del Rey and Schubert), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and Division of Respiratory Diseases, Boston Children's Hospital (Dr Leon-Astudillo), Boston, Mass
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