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Jaros S, Beck Dallaghan G. Medical education research study quality instrument: an objective instrument susceptible to subjectivity. MEDICAL EDUCATION ONLINE 2024; 29:2308359. [PMID: 38266115 PMCID: PMC10810632 DOI: 10.1080/10872981.2024.2308359] [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: 08/28/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND The medical education research study quality instrument (MERSQI) was designed to appraise medical education research quality based on study design criteria. As with many such tools, application of the results may have unintended consequences. This study applied the MERSQI to published medical education research identified in a bibliometric analysis. METHODS A bibliometric analysis identified highly cited articles in medical education that two authors independently evaluated using the MERSQI. After screening duplicate or non-research articles, the authors reviewed 21 articles with the quality instrument. Initially, five articles were reviewed independently and results were compared to ensure agreed upon understanding of the instrument items. The remainder of the articles were independently reviewed. Overall scores for the articles were analyzed with a paired samples t-test and individual item ratings were analyzed for inter-rater reliability. RESULTS There was a significant difference in mean MERSQI score between reviewers. Inter-rater reliability for MERSQI items labeled response rate, validity and outcomes were considered unacceptable. CONCLUSIONS Based on these results there is evidence that MERSQI items can be significantly influenced by interpretation, which lead to a difference in scoring. The MERSQI is a useful guide for identifying research methodologies. However, it should not be used to make judgments on the overall quality of medical education research methodology in its current format. The authors make specific recommendations for how the instrument could be revised for greater clarity and accuracy.
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Affiliation(s)
- Scott Jaros
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Gary Beck Dallaghan
- Department of Medical Education, University of Texas at Tyler School of Medicine, Tyler, TX, USA
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Teo YH, Peh TY, Abdurrahman ABHM, Lee ASI, Chiam M, Fong W, Wijaya L, Krishna LKR. A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore. Singapore Med J 2024; 65:313-325. [PMID: 34823327 DOI: 10.11622/smedj.2021224] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore. METHODS A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used. RESULTS A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. CONCLUSION The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Assisi Hospice, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, United Kingdom
- Centre of Biomedical Ethics, National University of Singapore, Singapore
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Peters C, Doering J. Characteristics of background check findings in nursing students. J Prof Nurs 2024; 52:86-93. [PMID: 38777531 DOI: 10.1016/j.profnurs.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Background checks are used in nursing education to assess public risk. To date, no study has described the most common and most serious findings in nursing students. PURPOSE Our study describes the most common and most serious characteristics of BGC findings in nursing students attending large universities. METHOD Our retrospective study describes characteristics of aggregated, de-identified background check data from a convenience sample of 16 US nursing programs set in large universities 2014-2019. FINDINGS Sampled programs collected 45,613 background checks, with 1548 findings (3.4 %). Severity of findings included criminal (62.5 %), non-criminal (4.6 %), felony (0.8 %), and other (11.6 %). Severity data were missing from 20.4 % of records. Finding types included substance use (23.7 %), disorderly conduct (8.7 %), property crimes (2.4 %) and crimes against persons (1 %). Type data was missing from 64.3 % of records. DISCUSSION Future research should examine whether background check type or severity indicates a nursing student poses a public risk.
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Affiliation(s)
- Christopher Peters
- University of Wisconsin - Milwaukee, School of Nursing, United States of America.
| | - Jennifer Doering
- University of Wisconsin - Milwaukee, School of Nursing, United States of America.
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Saxena A, Desanghere L, Dore K, Reiter H. Incorporating a situational judgement test in residency selections: clinical, educational and organizational outcomes. BMC MEDICAL EDUCATION 2024; 24:339. [PMID: 38532412 DOI: 10.1186/s12909-024-05310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Computer-based assessment for sampling personal characteristics (Casper), an online situational judgement test, is a broad measure of personal and professional qualities. We examined the impact of Casper in the residency selection process on professionalism concerns, learning interventions and resource utilization at an institution. METHODS In 2022, admissions data and information in the files of residents in difficulty (over three years pre- and post- Casper implementation) was used to determine the number of residents in difficulty, CanMEDS roles requiring a learning intervention, types of learning interventions (informal learning plans vs. formal remediation or probation), and impact on the utilization of institutional resource (costs and time). Professionalism concerns were mapped to the 4I domains of a professionalism framework, and their severity was considered in mild, moderate, and major categories. Descriptive statistics and between group comparisons were used for quantitative data. RESULTS In the pre- and post- Casper cohorts the number of residents in difficulty (16 vs. 15) and the number of learning interventions (18 vs. 16) were similar. Professionalism concerns as an outcome measure decreased by 35% from 12/16 to 6/15 (p < 0.05), were reduced in all 4I domains (involvement, integrity, interaction, introspection) and in their severity. Formal learning interventions (15 vs. 5) and informal learning plans (3 vs. 11) were significantly different in the pre- and post-Casper cohorts respectively (p < 0.05). This reduction in formal learning interventions was associated with a 96% reduction in costs f(rom hundreds to tens of thousands of dollars and a reduction in time for learning interventions (from years to months). CONCLUSIONS Justifiable from multiple stakeholder perspectives, use of an SJT (Casper) improves a clinical performance measure (professionalism concerns) and permits the institution to redirect its limited resources (cost savings and time) to enhance institutional endeavors and improve learner well-being and quality of programs.
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Affiliation(s)
- Anurag Saxena
- College of Medicine, University of Saskatchewan, Room 3A10, Health Sciences Bldg., 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Loni Desanghere
- College of Medicine, University of Saskatchewan, Room 3A10, Health Sciences Bldg., 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Kelly Dore
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
- Department of Medicine, McMaster University, Hamilton, Canada, Science and Innovation at Acuity Insights, Toronto, ON, Canada
| | - Harold Reiter
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Godschalx-Dekker JA, Gerritse FL, Pronk SA, Duvivier RJ, van Mook WNKA. Is insufficient introspection a reason to terminate residency training? - Scrutinising introspection among residents who disputed dismissal. MEDICAL TEACHER 2024:1-8. [PMID: 38506085 DOI: 10.1080/0142159x.2024.2323175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Insufficient introspection as part of the 4I's model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals. METHODS We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed 'insufficient' regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection. RESULTS Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents' insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training. CONCLUSIONS Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I's model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents' introspection, but further research is needed for effective implementation in medical education.
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Affiliation(s)
| | - Frank L Gerritse
- Department of Hospital Psychiatry, Tergooi MC, Hilversum, The Netherlands
| | - Sebastiaan A Pronk
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
| | - Robbert J Duvivier
- Center for Education Development And Research in Health Professions (CEDAR), UMC Groningen, Groningen, The Netherlands
- Emergency Services, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Walther N K A van Mook
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht UMC+, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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da Rosa MI, Ceretta LB, Martins MA, Colonetti L, Colonetti T, Grande AJ, Tempski P. The effects of academic unprofessional behaviour on disciplinary action by medical boards: Systematic review and meta-analysis. CLINICAL TEACHER 2024. [PMID: 38323699 DOI: 10.1111/tct.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/05/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate the association of disciplinary actions by regulatory councils and unprofessional behaviour during medical graduation. METHODS A search strategy was developed using the terms: 'physicians', 'disciplinary action', 'education', 'medical', 'undergraduate' and their synonyms, subsequently applied to the electronic databases MEDLINE, Embase, Cochrane Library, LILACs and grey literature, with searches up to November 2023. The risk of bias was assessed using the Newcastle-Ottawa scale and statistical analysis was performed using the RevMan software. RESULTS A total of 400 studies were found in the databases, and 15 studies were selected for full-texting reading. Four studies met the inclusion criteria and were included, bringing together a total of 3341 evaluated physicians. Three studies were included in the meta-analysis, showing a greater chance of disciplinary actions among physicians who exhibited unprofessional behaviour during medical graduation (OR: 2.54; 95%CI: 1.87-3.44; I2 : 0%; P < 0.0001; 3077 participants; physicians with disciplinary action: 107/323; control physicians: 222/2754). CONCLUSIONS There is a statistically significant association between unprofessional behaviour during medical undergraduate study and subsequent disciplinary actions by Medical Councils. The tools for periodic assessments of student behaviour during undergraduate studies can be a perspective for future studies aimed at reducing disciplinary actions among physicians.
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Affiliation(s)
- Maria Inês da Rosa
- Laboratory of Translational Biomedicine, University of the Extreme South of Santa Catarina, Criciuma, Santa Catarina, Brazil
| | - Luciane Bisognin Ceretta
- Postgraduate Program in Collective Health, University of the Extreme South of Santa Catarina, Criciúma, Santa Catarina, Brazil
| | | | - Laura Colonetti
- Laboratory of Translational Biomedicine, University of the Extreme South of Santa Catarina, Criciuma, Santa Catarina, Brazil
| | - Tamy Colonetti
- Laboratory of Translational Biomedicine, University of the Extreme South of Santa Catarina, Criciuma, Santa Catarina, Brazil
| | - Antonio Jose Grande
- Laboratory of Evidence-Based Practice, University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Patricia Tempski
- Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, Brazil
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Wang Y, Ram S(S, Scahill S. Risk identification and prediction of complaints and misconduct against health practitioners: a scoping review. Int J Qual Health Care 2024; 36:mzad114. [PMID: 38155372 PMCID: PMC10791111 DOI: 10.1093/intqhc/mzad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/26/2023] [Indexed: 12/30/2023] Open
Abstract
Identifying the risk and predicting complaints and misconduct against health practitioners are essential for healthcare regulators to implement early interventions and develop long-term prevention strategies to improve professional practice and enhance patient safety. This scoping review aims to map out existing literature on the risk identification and prediction of complaints and misconduct against health practitioners. This scoping review followed Arksey and O'Malley's five-stage methodological framework. A comprehensive literature search was conducted on MEDLINE, EMBASE, and CINAHL databases and finished on the same day (6 September 2021). Articles meeting the eligibility criteria were charted and descriptively analysed through a narrative analysis method. The initial search generated 5473 articles. After the identification, screening, and inclusion process, 81 eligible studies were included for data charting. Three key themes were reported: methods used for identifying risk factors and predictors of the complaints and misconduct, synthesis of identified risk factors and predictors in eligible studies, and predictive tools developed for complaints and misconduct against health practitioners. The findings reveal that risk identification and prediction of complaints and misconduct are complex issues influenced by multiple factors, exhibiting non-linear patterns and being context specific. Further efforts are needed to understand the characteristics and interactions of risk factors, develop systematic risk prediction tools, and facilitate the application in the regulatory environment.
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Affiliation(s)
- Yufeng Wang
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Sanyogita (Sanya) Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Shane Scahill
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 503, 85 Park Road, Grafton, Auckland 1023, New Zealand
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Barry CL, Coombs J, Buchs S, Kim S, Grant T, Henry T, Parente J, Spackman J. Professionalism in Physician Assistant Education as a Predictor of Future Licensing Board Disciplinary Actions. J Physician Assist Educ 2023; 34:278-282. [PMID: 37467183 PMCID: PMC10653293 DOI: 10.1097/jpa.0000000000000515] [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: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to evaluate associations between postgraduate disciplinary actions (PGDA) by state licensing boards and physician assistant (PA) school documented professionalism violations (DPV) and academic probation. METHODS This was a retrospective cohort study comprising PA graduates from 2001 to 2011 at 3 institutions (n = 1364) who were evaluated for the main outcome of PGDA and independent variable of DPV and academic probation. Random-effects multiple logistic regression and accelerated failure time parametric survival analysis were used to investigate the association of PGDA with DPV and academic probation. RESULTS Postgraduate disciplinary action was statistically significant and positively associated with DPV when unadjusted (odds ratio [OR] = 5.15; 95% CI: 1.62-16.31; P = .01) and when adjusting for age, sex, overall PA program GPA (GPA), and Physician Assistant National Certifying Exam Score (OR = 5.39; 95% CI: 1.54-18.85; P = .01) (fully adjusted). Academic probation increased odds to 8.43 times (95% CI: 2.85-24.92; P < .001) and 9.52 times (95% CI: 2.38-38.01; P < .001) when fully adjusted. CONCLUSION Students with professionalism violation or academic probation while in the PA school had significant higher odds of receiving licensing board disciplinary action compared with those who did not. Academic probation had a greater magnitude of effect and could represent an intersection of professionalism and academic performance.
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Affiliation(s)
- Carey L Barry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jennifer Coombs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Shalon Buchs
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Sooji Kim
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Travis Grant
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Trenton Henry
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jason Parente
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
| | - Jared Spackman
- Carey L. Barry, MHS, PA-C, DFAAPA, is a chair of the Department of Medical Sciences and Associate Clinical Professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jennifer Coombs, PhD, MPAS, PA-C, DFAAPA, is a director of graduate studies and is a professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, The University of Utah School of Medicine, Salt Lake City, Utah
- Shalon Buchs, MHS, PA-C, DFAAPA, is a director of evaluation for the Office of Continuous Quality Improvement and is an associate professor, Florida State University College of Medicine, Tallahassee, Florida
- Sooji Kim, BS, is a research assistant, PA Program, Northeastern University, Boston, Massachusetts
- Travis Grant, MS, PA-C, is an assistant clinical professor, University of Florida School of Physician Assistant Studies, Gainesville, Florida
- Trenton Henry, MSPH, is a research associate at Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jason Parente, MS, PA-C, is an associate program director and is an associate clinical professor, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Jared Spackman, MPAS, PA-C, is a PA program director and is an associate professor at University of Utah School of Medicine, Salt Lake City, Utah
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Veerabhadrappa SK, Pandarathodiyil AK, Ghani WMN, Termizi Bin Zamzuri A. Evaluation of Self-Reported professionalism lapses among dental undergraduate students: A cross-sectional study from a Malaysian dental faculty. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:1011-1022. [PMID: 36626271 DOI: 10.1111/eje.12893] [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: 04/12/2022] [Revised: 11/20/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Professionalism and academic integrity are important components of dental education as they influence not just the present-day learning process, but also the practice of dentistry in future. This study evaluated self-reported professional lapses, academic dishonesty behaviours among peers and recommended sanctions for such lapses. MATERIALS AND METHODS Dundee Polyprofessionalism Inventory I: Academic Integrity questionnaire was administered to BDS students of a private dental institution in Malaysia. Differences in the level of recommended sanctions were assessed by Mann-Whitney U and Kruskal-Wallis test. RESULTS There was unanimous agreement that all 34 statements of lapses of academic integrity as unacceptable. The highest agreement (95.6%) was related to threatening or abusing university employees or students and involvement in paedophilic activities, whereas the lowest agreement was observed for getting or giving help for coursework against rules (47.3%). The most frequent behaviours observed among peers were lack of class punctuality (55.1%) and providing and receiving proxy attendance services (49.3%). About 36% admitted to not being punctual themselves, 26.8% for accepting or providing help for course work and 22.9% for receiving and providing proxy attendance. Female students displayed stricter recommended sanctions, with the most significant difference relating to joking disrespectfully about body parts (p < .001). More lenient recommended sanctions were observed among Year 1 students compared with other years, with the most significant difference (p < .001) observed for exchanging information about the exam, forging a signature, plagiarising and cut-pasting materials without acknowledgement. CONCLUSION The majority of academic lapses were well comprehended. Significant differences were observed in sanctions imposed in terms of gender and year of study.
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Affiliation(s)
| | | | - Wan Maria Nabillah Ghani
- Oral Cancer Research & Coordinating Centre (OCRCC), Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
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Taşçı Aİ, Akdeniz E, Gülpınar MA, Danacıoğlu YO, Sarı EE, Yaşar L, Karandere F, Ferahman S. Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study. BMC MEDICAL EDUCATION 2023; 23:698. [PMID: 37752458 PMCID: PMC10523623 DOI: 10.1186/s12909-023-04675-6] [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: 01/28/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version. METHODS A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach's alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument. RESULTS A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach's alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX. CONCLUSION The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education. TRIAL REGISTRATION 2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.
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Affiliation(s)
- Ali İhsan Taşçı
- School of Medicine, Department of Medical Education, Marmara University, Istanbul, Turkey.
| | - Esra Akdeniz
- School of Medicine, Department of Medical Education, Marmara University, Istanbul, Turkey
| | - Mehmet Ali Gülpınar
- School of Medicine, Department of Medical Education, Marmara University, Istanbul, Turkey
| | - Yavuz Onur Danacıoğlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Emine Ergül Sarı
- Department of Pediatric Diseases, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Levent Yaşar
- Department of Gynecology and Obstetrics, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Faruk Karandere
- Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sina Ferahman
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Morreale MK, Balon R, Louie AK, Guerrero APS, Aggarwal R, Coverdale J, Beresin EV, Brenner AM. The Vital Importance of Professionalism in Medical Education. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:340-343. [PMID: 37548858 DOI: 10.1007/s40596-023-01840-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Mamiya KT, Takahashi K, Iwasaki T, Irie T. Japanese Pharmacists' Perceptions of Self-Development Skills and Continuing Professional Development. PHARMACY 2023; 11:pharmacy11020073. [PMID: 37104079 PMCID: PMC10143704 DOI: 10.3390/pharmacy11020073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The role of healthcare professionals, including pharmacists, is changing. Lifelong learning and continuing professional development (CPD) are more critical than ever for both current and future pharmacists in the face of global health challenges and new technologies, services and therapies that are continually and rapidly introduced into their daily practice. Currently, Japanese pharmacists' licences are not renewable, although most developed countries have a renewal system. Therefore, understanding Japanese pharmacists' perceptions of CPD is the first step in reviewing undergraduate and postgraduate education. METHODS The target population was Japanese pharmacists, i.e., community pharmacy pharmacists and hospital pharmacists. The participants were administered a questionnaire with 18 items related to continuing professional development. RESULTS Our study found that regarding item "Q16 Do you think you need further education in your undergraduate education to continue your professional development?", (a) the ability to identify one's own problems and issues, (b) the ability to make plans to solve problems and issues, (c) the ability to carry out plans to solve problems and issues and (d) the ability to repeat steps of self-development, approximately 60% of pharmacists answered that these aspects were "necessary" or "quite necessary". CONCLUSION As part of universities' responsibility for the lifelong education of pharmacists, it is necessary to systematically conduct teaching seminars or undergraduate education or postgraduate education on self-development while training pharmacists to meet the needs of citizens.
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Affiliation(s)
- Kayoko Takeda Mamiya
- Department of Pharmaceutical Education, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo 0068585, Japan
| | - Kiyoshi Takahashi
- Department of Pharmaceutical Education, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, Sapporo 0068585, Japan
| | - Tatsuyuki Iwasaki
- Department of Pharmaceutical Packaging Technology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0973, Japan
| | - Tetsumi Irie
- Department of Pharmaceutical Packaging Technology, Faculty of Life Sciences, Kumamoto University, Kumamoto 862-0973, Japan
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Santen SA, Hemphill RR. Embracing our responsibility to ensure trainee competency. AEM EDUCATION AND TRAINING 2023; 7:e10863. [PMID: 37013132 PMCID: PMC10066499 DOI: 10.1002/aet2.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Sally A. Santen
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Virginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Sheth BP, Schnabel SD, Comber BA, Martin B, McGowan M, Bartley GB. Relationship Between the American Board of Ophthalmology Maintenance of Certification Program and Actions Against the Medical License. Am J Ophthalmol 2023; 247:1-8. [PMID: 36370838 DOI: 10.1016/j.ajo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the likelihood of disciplinary actions against medical licenses of ophthalmologists who maintained board certification through successful completion of the American Board of Ophthalmology Maintenance of Certification program compared with ophthalmologists who did not maintain certification. METHODS This was a retrospective cohort study of ophthalmologists certified by the American Board of Ophthalmology from 1992 to 2012 with time-limited certificates. Rates and severity of disciplinary actions against medical licenses were analyzed among ophthalmologists who did and did not maintain certification. RESULTS Of 9111 ophthalmologists who earned initial board certification between 1992 and 2012, 8073 (88.6%) maintained their certification and 1038 (11.4%) did not maintain their certification. A total of 234 license actions were identified in the study group. Among ophthalmologists who did not maintain board certification, the risk of a license action was more than 2 times that of those who maintained board certification (hazard ratio = 2.34, 95% CI=1.73-3.18). License actions were significantly higher in men than in women (hazard ratio = 2.02, 95% CI=1.43-2.86). Ophthalmologists who had a lapse in their certification had a higher severity of disciplinary actions (χ2 = 9.21, p <.01) than ophthalmologists who maintained their certification. CONCLUSIONS This study supports prior literature in other specialties demonstrating a higher risk of disciplinary licensure actions in physicians who did not maintain board certification as compared with those who did. Physicians who did not maintain certification were also more likely to have actions against their license reflecting a higher severity violation. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Bhavna P Sheth
- From the Department of Ophthalmology & Visual Sciences (B.P.S), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Sarah D Schnabel
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Beth Ann Comber
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Martin
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan McGowan
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - George B Bartley
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
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Smith BK, Yamazaki K, Luman A, Tekian A, Holmboe E, Mitchell EL, Park YS, Hamstra SJ. Predicting Performance at Graduation From Early ACGME Milestone Ratings: Longitudinal Learning Analytics in Professionalism and Communication in Vascular Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:235-246. [PMID: 36182635 DOI: 10.1016/j.jsurg.2022.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/14/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Program directors in surgical disciplines need more tools from the ACGME to help them use Milestone ratings to improve trainees' performance. This is especially true in competencies that are notoriously difficult to measure, such as professionalism (PROF) and interpersonal and communication skills (ICS). It is now widely understood that skills in these two areas have direct impact on patient care outcomes. This study investigated the potential for generating early predictors of final Milestone ratings within the PROF and ICS competency categories. DESIGN This retrospective cohort study utilized Milestone ratings from all ACGME-accredited vascular surgery training programs, covering residents and fellows who completed training in June 2019. The outcome measure studied was the rate of achieving the recommended graduation target of Milestone Level 4 (possible range: 1-5), while the predictors were the Milestone ratings attained at earlier stages of training. Predictive probability values (PPVs) were calculated for each of the 3 PROF and two ICS sub-competencies to estimate the probability of trainees not reaching the recommended graduation target based on their previous Milestone ratings. SETTING All ACGME-accredited vascular surgery training programs within the United States. PARTICIPANTS All trainees completing a 2 year vascular surgery fellowship (VSF) in June 2019 (n = 119) or a 5 year integrated vascular surgery residency (IVSR) in June 2019 (n = 52) were included in the analyses. RESULTS The overall rate of failing to achieve the recommended graduation target across all PROF and ICS sub-competencies ranged from 7.7% to 21.8% of all trainees. For trainees with a Milestone rating at ≤ 2.5 with 1 year remaining in their training program, the predictive probability of not achieving the recommended graduation target ranged from 37.0% to 71.5% across sub-competencies, with the highest risks observed under PROF for "Administrative Tasks" (71.5%) and under ICS for "Communication with the Healthcare Team" (56.7%). CONCLUSIONS As many as 1 in 4 vascular surgery trainees did not achieve the ACGME vascular surgery Milestones targets for graduation in at least one of the PROF and ICS sub-competencies. Biannual ACGME Milestone assessment ratings of PROF and ICS during early training can be used to predict achievement of competency targets at time of graduation. Early clues to problems in PROF and ICS enable programs to address potential deficits early in training to ensure competency in these essential non-technical skills prior to entering unsupervised practice.
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Affiliation(s)
- Brigitte K Smith
- University of Utah, Department of Surgery, Division of Vascular Surgery, Salt Lake City, Utah.
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Abigail Luman
- University of Utah, School of Medicine, Salt Lake City, Utah
| | - Ara Tekian
- University of Illinois, Chicago, Department of Medical Education, Chicago, Illinois
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Erica L Mitchell
- University of Tennessee Health and Science Center, Vascular and Endovascular Surgery, Regional One Health Medical Center, Memphis, Tennessee
| | - Yoon Soo Park
- University of Illinois, Chicago, Department of Medical Education, Chicago, Illinois
| | - Stanley J Hamstra
- University of Toronto, Department of Surgery, Toronto, Ontario, Canada
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Rice DR, Rice GN, Baugh C, Cloutier RL. Correlation of Narrative Evaluations to Clerkship Grades Using Statistical Sentiment Analysis. MEDICAL SCIENCE EDUCATOR 2022; 32:1397-1403. [PMID: 36532400 PMCID: PMC9755442 DOI: 10.1007/s40670-022-01654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 06/17/2023]
Abstract
Introduction Narrative evaluations are essential components of medical student assessment. This study evaluated how well narrative clerkship evaluation word choice correlated with an assigned letter grade. Methods One hundred clerkship evaluations, 50 from family medicine (FM) and 50 from internal medicine (IM), with even distribution of "Honors" and "Near-Honors" among medical students that graduated in 2020 from the Oregon Health and Science University (OHSU) were examined. A textual sentiment analysis, which evaluates positive and negative word choice, was used to determine each evaluation's collective sentiment. An average sentiment score and character count were calculated for Honors and Near-Honors evaluations from both clerkship disciplines. Sentiment word totals were used to form "word clouds" that highlight the most frequent word selections. Results While sentiment scores positively correlated with the assigned grade, there was no statistically significant difference between the average sentiment scores among Honors and Near Honors graded evaluations within the FM or IM clerkship evaluation sets. There was no significant difference in evaluation character length among the assigned grades. Among FM evaluations, "outstanding" and "excellent" were the two most common sentiment words used in both Honors and Near-Honors. Among IM evaluations, outstanding and excellent were most commonly used in Honors evaluations, while "excellent" and "good" were most common in Near-Honors. Conclusion This study outlines a novel text analysis method for analyzing narrative evaluation association with assigned grade that other institutions can utilize. Sentiment word choices are not significantly different among Honors and Near Honors clerkship narrative evaluations. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01654-2.
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Affiliation(s)
- Douglas R. Rice
- Department of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239 USA
| | - Gregory N. Rice
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Charles Baugh
- Department of Family Medicine, Adventist Health 260 Hospital Drive, Suite 103, Ukiah, CA 95482 USA
| | - Robert L. Cloutier
- Department of Emergency Medicine and Pediatrics, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239 USA
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Abstract
Surgeons are famously decisive, assertive, and confident. Unfortunately, we also often have a reputation for being blunt, harsh, and unprofessional. Unprofessional behaviors are unacceptable, and we believe that they are a symptom of surgeon distress and burnout. Unprofessional behaviors should be prevented, but equally importantly, so should the stressors that drive them. This is critically important for the future of our profession.
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Veríssimo AC, Conrado GAM, Barbosa J, Gomes SF, Severo M, Oliveira P, Ribeiro L. Machiavellian Medical Students Report More Academic Misconduct: A Cocktail Fuelled by Psychological and Contextual Factors. Psychol Res Behav Manag 2022; 15:2097-2105. [PMID: 35983023 PMCID: PMC9380600 DOI: 10.2147/prbm.s370402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Maladaptive personality traits and some psychological functioning indicators have been linked to academic misbehaviour; yet their role is still poorly explored in medical students. This study aims to assess associations of academic misconduct with dark personality traits and psychological well-being. Methods Five hundred and ninety-one medical students attending the first, third and fifth-year at one Portuguese medical school replied to the Dark Triad Dirty Dozen, Ryff’s Psychological Well-Being Scales and an original Academic Misconduct Questionnaire, using a cross-sectional design. Multiple linear regression was performed to assess associations. Results Fifth-year medical students who scored higher in Machiavellianism and psychological well-being and perceived greater peer fraud and lower penalty for cheating reported more academic misconduct. The explanatory power of the model was 16.6%. Machiavellianism showed the strongest associations with cheating, while sex and age were not significant predictors. Conclusion This study offers relevant insights into how maladaptive personalities influence academic misconduct in medical students, and how this relationship is moulded by psychological and contextual factors. These findings can help guide institutional actions to foster academic integrity in future physicians.
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Affiliation(s)
- Ana Cristina Veríssimo
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - George A M Conrado
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,University of Pernambuco, Pernambuco, Brazil
| | - Joselina Barbosa
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra F Gomes
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Milton Severo
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto, Porto, Portugal
| | - Pedro Oliveira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto, Porto, Portugal
| | - Laura Ribeiro
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,I3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Smith BK, Hamstra SJ, Yamazaki K, Tekian A, Brooke BS, Holmboe E, Mitchell EL, Park YS. Expert Consensus on the Conceptual Alignment of ACGME Competencies with Patient Outcomes After Common Vascular Surgical Procedures. J Vasc Surg 2022; 76:1388-1397. [DOI: 10.1016/j.jvs.2022.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 10/31/2022]
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Findyartini A, Greviana N, Felaza E, Faruqi M, Zahratul Afifah T, Auliya Firdausy M. Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture. BMC MEDICAL EDUCATION 2022; 22:443. [PMID: 35676696 PMCID: PMC9175156 DOI: 10.1186/s12909-022-03393-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 04/19/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Professional identity formation (PIF) has been recognized as an integral part of professional development in medical education. PIF is dynamic: it occurs longitudinally and requires immersion in the socialization process. Consequently, in the medical education context, it is vital to foster a nurturing learning environment that facilitates PIF. AIM This study assesses PIF among medical students in various stages of study and explores their perceptions of PIF, with its contributing and inhibiting factors. METHOD This mixed-methods study uses a sequential explanatory approach with undergraduate (years 2, 4, and 6) and postgraduate medical students in Indonesia. We examine the subjects by administering an adapted questionnaire on PIF. We completed a series of FGDs following questionnaire administration. Quantitative and thematic analyses were conducted sequentially. RESULTS & DISCUSSION A total of 433 respondents completed the questionnaire. There were statistically significant differences among subjects on the subscales "Recognition and internalization of professional roles" and "Self-control in professional behavior"; the more senior students had higher scores. We conducted 6 FGDs in total. The results characterize PIF as a complex, dynamic, and longitudinal journey to becoming a medical doctor that is closely related to a student's motivation. The FGDs also highlight the importance of both internal factors (students' values, attributes, and personal circumstances) and external factors (curriculum, the learning environment, workplace-based learning, and external expectations) for PIF in medical education. CONCLUSION Higher-level students show higher scores in some aspects of PIF, which further validates the potential use of the questionnaire to monitor PIF, a dynamic process influenced by internal and external factors. Generating awareness among medical students and encouraging reflection on their PIF stage may be crucial for PIF processes.
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Affiliation(s)
- Ardi Findyartini
- Medical Education Center, Faculty of Medicine, Indonesia Medical Education and Research Institute, Universitas Indonesia, Jakarta, Indonesia.
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Nadia Greviana
- Medical Education Center, Faculty of Medicine, Indonesia Medical Education and Research Institute, Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Estivana Felaza
- Medical Education Center, Faculty of Medicine, Indonesia Medical Education and Research Institute, Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad Faruqi
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Undergraduate Medical Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Taris Zahratul Afifah
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Undergraduate Medical Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mutiara Auliya Firdausy
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Undergraduate Medical Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Barber C, Burgess R, Mountjoy M, Whyte R, Vanstone M, Grierson L. Associations between admissions factors and the need for remediation. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:475-489. [PMID: 35171399 DOI: 10.1007/s10459-022-10097-8] [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: 07/26/2021] [Accepted: 01/23/2022] [Indexed: 06/14/2023]
Abstract
This study examines the way in which student characteristics and pre-admissions measures are statistically associated with the likelihood a student will require remediation for academic and professionalism offenses. We anchor our inquiry within Irby and Hamstra's (2016) conceptual framework of constructs of professionalism. Data from five graduating cohorts (2014-2018) from McMaster University (Hamilton, Canada) (N = 1,021) were retroactively collected and analyzed using traditional and multinominal logistic regression analyses. The relationship among student characteristics, pre-admissions variables, and referral for potential remediation both by occurrence (yes/no) as well as type (academic/professional/no referral) were examined separately. Findings indicate that gender (OR = 0.519, 95% CI 0.326-0.827, p < 0.01) and undergraduate grade point average (GPA) (OR = 0.245, 95% CI 0.070-0.855, p < 0.05) were significantly associated with instances of referral for potential professionalism and academic remediation, respectively. Women were less likely than men to require remediation for professionalism (OR = 0.332, 95% CI 0.174-0.602, p < 0.001). Undergraduate GPAs (OR = 0.826, 95% CI 0.021-0.539, p < 0.01) were significantly associated with remediation for academic reasons. Lower undergraduate GPAs were associated with a higher likelihood of remediation. These findings point to the admissions variables that are associated with instances that prompt referral for potential remediation. Where associations are not significant, we consider the application of different conceptualizations of professionalism across periods of admissions and training. We encourage those involved in applicant selection and student remediation to emphasize the importance of the interactions that occur between personal and contextual factors to influence learner behaviour and professional identity formation.
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Affiliation(s)
- Cassandra Barber
- McMaster Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Raquel Burgess
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, USA
- MD Undergraduate Program, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Margo Mountjoy
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- MD Undergraduate Program, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Rob Whyte
- MD Undergraduate Program, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meredith Vanstone
- McMaster Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada
- MD Undergraduate Program, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Lawrence Grierson
- McMaster Program for Education Research, Innovation, and Theory (MERIT), Faculty of Health Sciences, McMaster University, Hamilton, Canada.
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W., Hamilton, ON, L8P 1H6, Canada.
- MD Undergraduate Program, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Soemantri D, Findyartini A, Yolanda S, Morley E, Patterson F. Evaluation of Situational Judgment Tests in student selection in Indonesia and the impact on diversity issues. BMC MEDICAL EDUCATION 2022; 22:239. [PMID: 35366862 PMCID: PMC8976983 DOI: 10.1186/s12909-022-03247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Internationally, medical selection relies heavily on prior academic attainment which has an adverse impact on the diversity of selected students. Since non-academic attributes are also important, this study aims to evaluate the use of a Situational Judgment Test (SJT) for selection and the impact on student diversity relating to gender, ethnicity and socio-economic status. Previous SJT research has almost entirely originated from a Western context and this study focuses on new evidence in a South East Asian context with a different demographic profile. METHODS Thirty faculty members developed 112 SJT scenarios assessing professionalism, communication and self-awareness domains. The scenarios underwent a concordance stage where stakeholder input was sought on the content appropriateness, to define the item scoring key, followed by an initial psychometric evaluation with first and second year medical students (N = 436). Based on these results, 30 scenarios, consisting of 128 nested items, were selected for pilot testing and evaluation regarding diversity issues with two cohorts of applicants in 2017 (N = 446) and 2018 (N = 508). RESULTS The SJT demonstrated good internal consistency (Cronbach's alpha of 0.80 and 0.81 respectively). There were significant differences in SJT scores based on gender in both years, where females consistently outperformed males (p = .0001). However, no significant differences were found based on high school origin, parental educational background or ethnicity. CONCLUSIONS This is the first study to evaluate the use of an SJT in Indonesia, which has a unique diversity profile compared to Western countries. Largely, the preliminary results replicate previous studies of the potential diversity benefits of using an SJT as a tool for medical student selection and has the potential to level the playing field regarding socio-economic status and ethnicity. Further studies exploring more variables representing diversity are warranted to confirm the early results in this study.
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Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sophie Yolanda
- Department of Physiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Fiona Patterson
- Work Psychology Group, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
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Kirtchuk D, Wells G, Levett T, Castledine C, de Visser R. Understanding the impact of academic difficulties among medical students: A scoping review. MEDICAL EDUCATION 2022; 56:262-269. [PMID: 34449921 DOI: 10.1111/medu.14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Many medical students may encounter a range of academic and personal challenges during their course of study, but very little is known about their experiences. Our aim was to review the literature to inform future scholarship and to inform policy change. METHODS A scoping review was conducted searching PubMed, MEDLINE, EMBASE, PsycInfo, British Education Index, Web of Science and ERIC for English language primary research with no date limits. This retrieved 822 papers of which eight met the requirements for inclusion in the review. Data were independently reviewed by two researchers and underwent thematic analysis by the research team. RESULTS Three major themes emerged. Theme 1: 'Identity preservation' addressed students' aim to preserve their sense of self in the face of academic difficulty and their tendency to seek support. This connected the apprehension many students expressed about their educational institutions to Theme 2: 'The dual role of the medical school'-medical schools are required to support struggling students but are predominantly seen as a punitive structure acting as the gatekeeper to a successful career in medicine. Students' apprehension and attempts to protect their identities within this complex landscape often resulted in 'maladaptive coping strategies' (Theme 3). CONCLUSION Understanding and exploring the academic challenges faced by medical students through their own experiences highlight the need for the development of more individualised remediation strategies. Educators may need to do more to bridge the gap between students and institutions. There is a need to build trust and to work with students to enhance their sense of self and remediate approaches to engagement with learning, rather than focusing efforts on success in assessments and progression.
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Affiliation(s)
- David Kirtchuk
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Geoffrey Wells
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Tom Levett
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Clare Castledine
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | - Richard de Visser
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
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Moniz T, Melro CM, Warren A, Watling C. Dual and duelling purposes: An exploration of educators' perspectives on the use of reflective writing to remediate professionalism in residency. MEDICAL EDUCATION 2022; 56:176-185. [PMID: 34437727 PMCID: PMC9297876 DOI: 10.1111/medu.14625] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging-and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism. METHOD In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them. RESULTS Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners-one that enables the genuine reflection required for insight development-while meeting requirements of remediation. CONCLUSIONS Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.
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Affiliation(s)
- Tracy Moniz
- Department of Communication StudiesMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | | | - Andrew Warren
- Department of Pediatrics, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Chris Watling
- Departments of Oncology and Clinical Neurological Sciences, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
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Barnhoorn PC, Nierkens V, Mak-van der Vossen MC, Numans ME, van Mook WNKA, Kramer AWM. Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty. BMC FAMILY PRACTICE 2021; 22:249. [PMID: 34930146 PMCID: PMC8686537 DOI: 10.1186/s12875-021-01609-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. METHODS We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. RESULTS Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. CONCLUSIONS The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Parthiban N, Boland F, Fadil Azim DH, Pawlikowska T, O’Shea MT, Jaafar MH, Morgan K. Asian medical students' attitudes towards professionalism. MEDICAL EDUCATION ONLINE 2021; 26:1927466. [PMID: 33999787 PMCID: PMC8143598 DOI: 10.1080/10872981.2021.1927466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between pre-clinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, IrelandMethods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used.Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students.Conclusion: Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.
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Affiliation(s)
| | - Fiona Boland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Mohamad Hasif Jaafar
- Perdana University - Royal College of Surgeons in Ireland, Perdana University, Malaysia
| | - Karen Morgan
- Perdana University - Royal College of Surgeons in Ireland, Perdana University, Malaysia
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Habib SR, Sattar K, Ahmad T, Barakah RM, Alshehri AM, Andejani AF, Almansour AA. An insightful evaluation of professionalism among dentistry students. Saudi Dent J 2021; 33:753-760. [PMID: 34803330 PMCID: PMC8589603 DOI: 10.1016/j.sdentj.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose The objective of this study was to explore the ambience of professionalism related to academic integrity among undergraduate dental students. Methodology “Dundee Polyprofessionalism Inventory I: Academic Integrity” was used to collect responses from first-year to fifth-year dental students of the College of Dentistry, King Saud University (Response rate = 78%). The participants’ responses (for 34 professionalism lapses) were recorded by using the Dundee Polyprofessionalism Inventory. Statistical analysis included descriptive statistics, Chi-square, and T-tests (P < 0.05). Results The “Ignore” sanction was not opted for any of the 34 professionalism behaviors, and there was unanimous agreement between the participants in considering all 34 behavior statements to be “wrong”. Male and female participants were found to opt for a similar sanction as the median for 16 statements (47%), whereas, for 18 statements (53%), their responses differed with a range of levels 0.5 to 1.5. Preclinical- and clinical-year student responses also showed similarities in their 11 statements (32.3%), and they did differ for 20 statements (58.8%). Interestingly, clinical year respondents were overall on the stricter side of recommending sanctions. Conclusions For the majority of the dental students tested, there was a good understanding of the significance of some lapses of professionalism associated with academic integrity. Some of the disclosures in this study were substantially appreciable because none of the students selected “ignore” sanction for any of the survey statements. We found that using the Dundee Polyprofessionalism Inventory for learning and understanding academic professionalism among dental students is useful.
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Affiliation(s)
- Syed Rashid Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Kamran Sattar
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Saudi Arabia
| | - Rana M Barakah
- Intern, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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García-Estañ J, Cabrera-Maqueda JM, González-Lozano E, Fernández-Pardo J, Atucha NM. Perception of Medical Professionalism among Medical Residents in Spain. Healthcare (Basel) 2021; 9:1580. [PMID: 34828626 PMCID: PMC8623659 DOI: 10.3390/healthcare9111580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. RESULTS A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). CONCLUSIONS The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.
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Affiliation(s)
- Joaquín García-Estañ
- Centro de Estudios en Educación Médica, Universidad de Murcia, 30120 Murcia, Spain;
| | - Jose María Cabrera-Maqueda
- Servicio de Docencia y Formación, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.C.-M.); (E.G.-L.)
| | - Eduardo González-Lozano
- Servicio de Docencia y Formación, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.C.-M.); (E.G.-L.)
| | | | - Noemí M. Atucha
- Centro de Estudios en Educación Médica, Universidad de Murcia, 30120 Murcia, Spain;
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Bertolami CN, Opazo C, Janal MN. The ultimatum bargaining game: An adaptation for teaching ethics. J Dent Educ 2021; 86:437-442. [PMID: 34726272 DOI: 10.1002/jdd.12815] [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: 05/22/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE The ultimatum bargaining game has been devised by economists to measure fairness and generosity during negotiations. This study sought to adapt the game to classroom application with the intent of (a) determining whether the known outcomes would be replicated given modifications needed to make the game suitable as an educational tool and (b) sharing the resulting self-appraisal with students themselves. METHODS A total of 452 first-year dental students participated in this adaptation as part of a classroom exercise. Students, identified as donors, were allocated an imaginary stake of $100 and asked to share some amount of it with a recipient classmate by making a nonnegotiable, one-time offer. If the offer is accepted, the donor student retains any residual amount. If the offer is rejected, neither the donor nor recipient receives anything. The question being tested is whether student fairness and/or generosity change when the preferred donor status is assigned at random versus on the basis of an earned property entitlement represented here by a higher-class rank. RESULTS AND CONCLUSION When status as Group A donors was established at random, the majority of students offered their fictitious Group B counterpart the fairest possible amount of $50 (70.4% in 2020 and 61% in 2018). However, when students were told that their status as Group A donors would be established based on their ranking in the upper half of the class, the percentage offering the fairest amount declined to 49.5% in 2020 and to 51.8% in 2018. This outcome was available for immediate disclosure to students during the classroom session; it was consistent with results previously reported for the ultimatum bargaining game; and it showed that when a property entitlement is perceived as having been earned (manifested by a higher-class rank), fairness and generosity decline.
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Affiliation(s)
- Charles N Bertolami
- Office of the Dean and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, New York, USA
| | - Cristián Opazo
- Office of Academic Affairs, Educational Technology, New York University College of Dentistry, New York, New York, USA
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York, USA
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Bajwa NM, Nendaz MR, Posfay-Barbe KM, Yudkowsky R, Park YS. A Meaningful and Actionable Professionalism Assessment: Validity Evidence for the Professionalism Mini-Evaluation Exercise (P-MEX) Across 8 Years. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S151-S157. [PMID: 34348372 DOI: 10.1097/acm.0000000000004286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE With the growing importance of professionalism in medical education, it is imperative to develop professionalism assessments that demonstrate robust validity evidence. The Professionalism Mini-Evaluation Exercise (P-MEX) is an assessment that has demonstrated validity evidence in the authentic clinical setting. Identifying the factorial structure of professionalism assessments determines professionalism constructs that can be used to provide diagnostic and actionable feedback. This study examines validity evidence for the P-MEX, a focused and standardized assessment of professionalism, in a simulated patient setting. METHOD The P-MEX was administered to 275 pediatric residency applicants as part of a 3-station standardized patient encounter, pooling data over an 8-year period (2012 to 2019 residency admission years). Reliability and construct validity for the P-MEX were evaluated using Cronbach's alpha, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). RESULTS Cronbach's alpha for the P-MEX was 0.91. The EFA yielded 4 factors: doctor-patient relationship skills, interprofessional skills, professional demeanor, and reflective skills. The CFA demonstrated good model fit with a root-mean-square error of approximation of .058 and a comparative fit index of .92, confirming the reproducibility of the 4-factor structure of professionalism. CONCLUSIONS The P-MEX demonstrates construct validity as an assessment of professionalism, with 4 underlying subdomains in doctor-patient relationship skills, interprofessional skills, professional demeanor, and reflective skills. These results yield new confidence in providing diagnostic and actionable subscores within the P-MEX assessment. Educators may wish to integrate the P-MEX assessment into their professionalism curricula.
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Affiliation(s)
- Nadia M Bajwa
- N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, and faculty member, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-1445-4594
| | - Mathieu R Nendaz
- M.R. Nendaz is professor and director, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, and attending physician, Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0003-3795-3254
| | - Klara M Posfay-Barbe
- K.M. Posfay-Barbe is professor and chairperson, Department of General Pediatrics, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland; ORCID: https://orcid.org/0000-0001-9464-5704
| | - Rachel Yudkowsky
- R. Yudkowsky is professor, Department of Medical Education, College of Medicine at the University of Illinois at Chicago, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-2145-7582
| | - Yoon Soo Park
- Y.S. Park is associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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Johnson GJ, Kilpatrick CC, Zaritsky E, Woodbury E, Boller M, Burton M, Asfaw T, Ratan BM. Training the Next Generation of Obstetrics and Gynecology Leaders, A Multi-Institutional Needs Assessment. JOURNAL OF SURGICAL EDUCATION 2021; 78:1965-1972. [PMID: 34294573 DOI: 10.1016/j.jsurg.2021.06.010] [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: 03/10/2021] [Revised: 06/10/2021] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess resident and faculty interest in, as well as content and preferred format for, a leadership curriculum during obstetrics and gynecology residency DESIGN: From June to July 2019, a needs assessment survey on leadership training was distributed to residents and academic faculty at 3 United States obstetrics and gynecology residency programs. Descriptive and bivariate analyses were performed. Open ended questions were analyzed for themes. SETTING Three ob/gyn residency programs across the United States: Kaiser Permanente East Bay in Oakland, California, Baylor College of Medicine in Houston, Texas, and Weill Cornell Medicine in New York, New York. PARTICIPANTS Surveys were distributed to all residents (n = 111) and affiliated academic faculty (n = 124) at each of the 3 participating sites. RESULTS Resident response rate was 71% (79/111) and faculty rate was 63% (78/124). Postgraduate year (PGY) 1 residents were more likely to believe there was sufficient leadership training during residency (17/23, 74%) compared to PGY 2-4s (16/56, 29%) and faculty (20/76, 26%; p < 0.01). Most residents (66/79, 84%) and faculty (74/78, 82%) expressed that residents would benefit from a leadership curriculum. Both deemed small group exercises and leadership case studies taught by physicians were the preferred format for this curriculum. Residents and faculty agreed on 3 of the top 4 topics for a leadership curriculum - effective communication, team management, and time management - while residents chose self-awareness and faculty chose professionalism as the fourth of their top domains. Open-ended survey questions revealed that leadership demands in obstetrics and gynecology are similar to other specialties but differ in emphasis on crisis management, situational awareness, and advocacy training. CONCLUSIONS Given unique aspects of leadership within the specialty, obstetrics and gynecology residents and faculty see benefit for specialty-specific formalized leadership training.
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Affiliation(s)
- Grace J Johnson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Charlie C Kilpatrick
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Eve Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California East Bay- Oakland, Oakland, California
| | - Emily Woodbury
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Marie Boller
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California East Bay- Oakland, Oakland, California
| | - Madreya Burton
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California East Bay- Oakland, Oakland, California
| | - Tirsit Asfaw
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York
| | - Bani M Ratan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
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Gerritse FL, Duvivier RJ. Disciplinary complaints concerning transgressive behaviour by healthcare professionals: an analysis of 5 years jurisprudence in the Netherlands. BMJ Open 2021; 11:e053401. [PMID: 34642199 PMCID: PMC8513272 DOI: 10.1136/bmjopen-2021-053401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To study the frequency of observed cases of disciplinary law complaints concerning transgressive behaviour in Dutch healthcare by analysing disciplinary cases handled in Dutch disciplinary law. DESIGN Retrospective review of complaints in the Dutch disciplinary law tribunals from the period 1 January 2015 to 1 January 2020. SETTING Dutch healthcare. METHOD Descriptive retrospective study. All judgements at regional disciplinary tribunals in the first instance from the period 1 January 2015 to 1 January 2020 concerning transgressive behaviour were investigated. The following was studied: year of judgement, number and nature of complaints, type of complainants, profession of defendant. RESULTS Over the study period, 139 complaints about transgressive behaviour were handled, 90 of which involved sexual behaviour. 66/139 complaints were submitted by patients themselves (47.5%). Most complaints were directed against physicians (44.6%; n=62), followed by nurses (30.2%; n=42), psychologists (11.5%; n=16) and physiotherapists (7.9%; n=11). 80.6% of the complaints were directed against a male healthcare professional (OR 4.25; 95% CI 1.7590 to 10.2685; p=0.0013). 104/139 of the complaints originated from an outpatient work setting and about half of the complaints originated from mental healthcare. Of the 90 disciplinary cases in which the complaint was related to sexually transgressive behaviour, 83.3% (n=75) were ruled to be substantiated (5 of which partially) with a measure imposed in all cases: 6 formal warnings (8%), 11 reprimands (14.7%), 10 denials (partial suspension) (13.3%), 26 temporary suspensions (34.7%) and 22 cancellations of the licence to practice (29.3%). CONCLUSION This study describes jurisprudence of disciplinary cases about transgressive behaviour of healthcare professionals in the Netherlands. The results of this study can be used to monitor trends in observed cases of transgressive behaviour.
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Affiliation(s)
| | - Robbert J Duvivier
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, Groningen, The Netherlands
- Parnassia Academy, The Hague, The Netherlands
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Pronk SA, Gorter SL, van Luijk SJ, Barnhoorn PC, Binkhorst B, van Mook WNKA. Perception of social media behaviour among medical students, residents and medical specialists. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:215-221. [PMID: 33826108 PMCID: PMC8368941 DOI: 10.1007/s40037-021-00660-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Behaviour is visible in real-life events, but also on social media. While some national medical organizations have published social media guidelines, the number of studies on professional social media use in medical education is limited. This study aims to explore social media use among medical students, residents and medical specialists. METHODS An anonymous, online survey was sent to 3844 medical students at two Dutch medical schools, 828 residents and 426 medical specialists. Quantitative, descriptive data analysis regarding demographic data, yes/no questions and Likert scale questions were performed using SPSS. Qualitative data analysis was performed iteratively, independently by two researchers applying the principles of constant comparison, open and axial coding until consensus was reached. RESULTS Overall response rate was 24.8%. Facebook was most popular among medical students and residents; LinkedIn was most popular among medical specialists. Personal pictures and/or information about themselves on social media that were perceived as unprofessional were reported by 31.3% of students, 19.7% of residents and 4.1% of medical specialists. Information and pictures related to alcohol abuse, partying, clinical work or of a sexually suggestive character were considered inappropriate. Addressing colleagues about their unprofessional posts was perceived to be mainly dependent on the nature and hierarchy of the interprofessional relation. DISCUSSION There is a widespread perception that the presence of unprofessional information on social media among the participants and their colleagues is a common occurrence. Medical educators should create awareness of the risks of unprofessional (online) behaviour among healthcare professionals, as well as the necessity and ways of addressing colleagues in case of such lapses.
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Affiliation(s)
- Sebastiaan A Pronk
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Simone L Gorter
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Scheltus J van Luijk
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Beer Binkhorst
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Ashcroft J, Warren P, Weatherby T, Barclay S, Kemp L, Davies RJ, Hook CE, Fistein E, Soilleux E. Using a Scenario-Based Approach to Teaching Professionalism to Medical Students: Course Description and Evaluation. JMIR MEDICAL EDUCATION 2021; 7:e26667. [PMID: 34185007 PMCID: PMC8277325 DOI: 10.2196/26667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Doctors play a key role in individuals' lives undergoing a holistic integration into local communities. To maintain public trust, it is essential that professional values are upheld by both doctors and medical students. We aimed to ensure that students appreciated these professional obligations during the 3-year science-based, preclinical course with limited patient contact. OBJECTIVE We developed a short scenario-based approach to teaching professionalism to first-year students undertaking a medical course with a 3-year science-based, preclinical component. We aimed to evaluate, both quantitatively and qualitatively, student perceptions of the experience and impact of the course. METHODS An interactive professionalism course entitled Entry to the Profession was designed for preclinical first-year medical students. Two scenario-based sessions were created and evaluated using established professionalism guidance and expert consensus. Quantitative and qualitative feedback on course implementation and development of professionalism were gathered using Likert-type 5-point scales and debrief following course completion. RESULTS A total of 70 students completed the Entry to the Profession course over a 2-year period. Feedback regarding session materials and logistics ranged from 4.16 (SD 0.93; appropriateness of scenarios) to 4.66 (SD 0.61; environment of sessions). Feedback pertaining to professionalism knowledge and behaviors ranged from 3.11 (SD 0.99; need for professionalism) to 4.78 (SD 0.42; relevance of professionalism). Qualitative feedback revealed that a small group format in a relaxed, open environment facilitated discussion of the major concepts of professionalism. CONCLUSIONS Entry to the Profession employed an innovative approach to introducing first-year medical students to complex professionalism concepts. Future longitudinal investigations should aim to explore its impact at various stages of preclinical, clinical, and postgraduate training.
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Williams BW, Welindt D, Hafferty FW, Stumps A, Flanders P, Williams MV. Adverse Childhood Experiences in Trainees and Physicians With Professionalism Lapses: Implications for Medical Education and Remediation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:736-743. [PMID: 32520753 DOI: 10.1097/acm.0000000000003532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Unprofessional behavior, which can include failure to engage, dishonest and/or disrespectful behavior, and poor self-awareness, can be demonstrated by medical trainees and practicing physicians. In the authors' experience, these types of behaviors are associated with exposure to adverse childhood experiences (ACEs). Given this overlap, the authors studied the percentage of ACEs among trainees and physicians referred for fitness-for-duty evaluations and patterns between the types of ACEs experienced and the reason for referral. METHOD A final sample of 123 cases of U.S. trainees and physicians who had been referred to a Midwestern center for assessment and/or remediation of professionalism issues from 2013 to 2018 was created. Included professionalism lapses fell within 3 categories: boundary violation, disruptive behavior, or potential substance use disorder concerns. All participants completed a psychosocial developmental interview, which includes questions about ACE exposure. Overall rate of reported ACEs and types of ACEs reported were explored. RESULTS Eighty-six (70%) participants reported at least 1 ACE, while 27 (22%) reported 4 or more. Compared with national data, these results show significantly higher occurrence rates of 1 or more ACEs and a lower occurrence rate of 0 ACEs. ACEs that predicted reasons for referral were physical or sexual abuse, feeling unwanted or unloved, witnessing abuse of their mother or stepmother, or caretaker substance use. CONCLUSIONS In this sample, ACE exposure was associated with professionalism issues. Remediating individuals with professionalism issues and exposure to ACEs can be complicated by heightened responses to stressful stimuli, difficulties with collaboration and trust, and decreased self-efficacy. Adoption of a trauma-informed medical education approach may help those that have been impacted by trauma rebuild a sense of control and empowerment. The findings of this study may be useful predictors in identifying those at risk of problematic behavior and recidivism before a sentinel event.
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Affiliation(s)
- Betsy White Williams
- B.W. Williams is clinical program director, Professional Renewal Center, Lawrence, Kansas, and clinical associate professor, University of Kansas School of Medicine, Department of Psychiatry, Kansas City, Kansas
| | - Dillon Welindt
- D. Welindt is research assistant, Wales Behavioral Assessment and Professional Renewal Center, Lawrence, Kansas
| | - Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota
| | - Anna Stumps
- A. Stumps is an intern, Spaulding Rehabilitation Hospital Neurorehabilitation Lab, Charlestown, Massachusetts
| | - Philip Flanders
- P. Flanders is clinical psychologist, Professional Renewal Center, Lawrence, Kansas
| | - Michael V Williams
- M.V. Williams is principal, Wales Behavioral Assessment, Lawrence, Kansas
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Abstract
ABSTRACT
Boundary violations by non-psychiatric physicians have received relatively little attention in available literature. In this report, the authors reviewed 100 cases of professional boundary violations identified in physicians undergoing outpatient psychiatric evaluation. They included boundary violations with a patient, boundary violations with non-patients, such as family members, employees, and co-workers, and prescribing/treating irregularities. Fifty-three of the physicians had engaged in sexual boundary violations with patients. Twenty-two had engaged in sexual boundary violations with non-patients. Eighteen of the physicians had non-sexual violations involving financial matters, social relationships, confidentiality and other transgressions. Twenty-six of the 100 were involved in some type of prescribing/treating irregularity. Fifty-two percent of the physicians sampled met criteria for an Axis II personality disorder, 17 had a substance abuse diagnosis, and 13 had a paraphilia or sexual disorder. The implications of these findings are discussed in a context relevant to ethics and regulatory bodies.
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Schnapp BH, Alvarez A, Bianchi R, Caretta‐Weyer H, Jewell C, Kalantari A, Lee E, Miller D, Quinn A. Curated collection for clinician educators: Six key papers on residency recruitment. AEM EDUCATION AND TRAINING 2021; 5:e10597. [PMID: 33969251 PMCID: PMC8086575 DOI: 10.1002/aet2.10597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 05/23/2023]
Abstract
INTRODUCTION All emergency medicine (EM) residency programs must recruit new medical school graduates each year. The process is often overwhelming, with each program receiving far more applicants than available positions. We searched for evidence-based best practices to guide residency programs in screening, interviewing, and ranking applicants to ensure a high-performing and diverse residency class. METHODS A literature search was conducted on the topic of residency recruitment, utilizing a call on social media as well as multiple databases. After identifying relevant articles, we performed a modified Delphi process in three rounds, utilizing junior educators as well as more senior faculty. RESULTS We identified 51 relevant articles on the topic of residency recruitment. The Delphi process yielded six articles that were deemed most highly relevant over the three rounds. Transparency with selection criteria, holistic application review, standardized letters of evaluation, and blinding applicant files for interviewers were among noted best practices. CONCLUSIONS Well-supported evidence-based practices exist for residency recruitment, and programs may benefit from understanding which common recruitment practices offer the most value. The articles discussed here provide a foundation for faculty looking to improve their program's recruiting practices.
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Affiliation(s)
| | - Al’ai Alvarez
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Riccardo Bianchi
- Department of Physiology and PharmacologySUNY Downstate Health Sciences UniversityNew YorkNew YorkUSA
| | | | - Corlin Jewell
- Department of Emergency MedicineUniversity of WisconsinMadisonWisconsinUSA
| | - Annahieta Kalantari
- Department of Emergency MedicineMilton S Hershey Medical CenterPenn State HealthHersheyPennsylvaniaUSA
| | - Eric Lee
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNew YorkUSA
| | - Danielle Miller
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Antonia Quinn
- SUNY Downstate Health SciencesUniversity College of MedicineNew YorkNew YorkUSA
- Department of Emergency MedicineSUNY DownstateBrooklynNew YorkUSA
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Sattar K, Akram A, Ahmad T, Bashir U. Professionalism development of undergraduate medical students: Effect of time and transition. Medicine (Baltimore) 2021; 100:e23580. [PMID: 33655905 PMCID: PMC7939229 DOI: 10.1097/md.0000000000023580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023] Open
Abstract
Changeover phases are essential and inevitable times in professional life, which let the learners adapt and grasp emerging opportunities for learning based on the past experiences with the catering of novel creativity as required in the present as well as emerging time. This study was carried out to examine the effectiveness of a professionalism course, during the transition from a non-clinical to clinical setting, within the context of undergraduate medical education.This observational study was conducted during 2019 to 2020, with pre- and post-professionalism course evaluation. We used the Dundee Poly-professionalism inventory-1: Academic Integrity, among the undergraduate medical students.Our results are based on the medical student's professional progress with the transition from 2nd year to 3rd year. During the 1st phase of the study, the participants at their Pre-Professionalism Course (PrPC) level in their 2nd medical year (only attended the introductory lectures for professionalism), showed a good understanding of professionalism. For the 2nd phase, when the same students, at their Post-Professionalism Course (PoPC) level, in their 3rd year (completed professionalism course) filled the same survey and it was found that there was no decline in their understanding of the topic, even after more than a year. They were even more aware of the significance of professionalism in their clinical settings.Despite a year gap, the understanding of professionalism among students was stable. Results helped us infer that time laps did not affect the professionalism concept learned earlier; rather during clinical settings, students become more aware of professionalism.
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Affiliation(s)
- Kamran Sattar
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ashfaq Akram
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Computer Science and Information Technology, NIMS University, Jaipur, Rajasthan, India
| | - Ulfat Bashir
- Department of Medical Education, Riphah International University, Islamabad, Pakistan
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Raidal SL, Neutze D, Strous J. Disclosure of disability or misconduct in veterinary graduate registration: balancing confidentiality, equity and stakeholder interests. Aust Vet J 2021; 99:93-107. [PMID: 33506514 DOI: 10.1111/avj.13045] [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: 08/23/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterinary registration processes, including disclosure of disability or misconduct, vary across jurisdictions in Australasia, and there is currently no clear mechanism for the communication of registration requirements to prospective or current students. Procedures for registration of graduating students are evolving but are not necessarily responsive to conflicting imperatives for confidentiality, protection of stakeholder interests and graduate support. OBJECTIVE To obtain opinions from members of the veterinary profession in Australasia on issues relating to graduate registration, including communication between veterinary schools and registration bodies. METHOD This was an online survey. RESULTS Responses were received from 245 members of the profession, including employers, educators, current students, recent graduates and board members. Respondents agreed on the importance of the survey topic to all stakeholder groups, and responses reflected the complex, contestable and nuanced nature of inherent concepts. Responses were strongly polarised between individuals with an appetite for reform, improved discourse around disability and remediation of unprofessional conduct and those with concerns and experiences suggesting boards and educators could not responsibly manage processes that included increased disclosure of disability or prior conduct. CONCLUSION Issues related to disability and misconduct should be addressed separately in any change to registration processes. A harmonisation of registration processes across jurisdictions is desirable, but the legal implications of any potential changes require careful consideration. There is a need for improved support of disability, remediation of misconduct and a desire to promote diversity within the profession. The survey evoked strong emotions, and future discussion requires sensitivity, empathy and insight.
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Affiliation(s)
- S L Raidal
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, Australia
| | - D Neutze
- Veterinary Industry Consultant, Sydney, Australia
| | - J Strous
- Australasian Veterinary Boards Council (AVBC), Melbourne, Australia
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Margolis RD, Ku CM. The "Difficult Learner" in anesthesiology: Challenges, pitfalls, and recommendations. Paediatr Anaesth 2021; 31:92-102. [PMID: 33124073 DOI: 10.1111/pan.14059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
Struggling learners often require interventions that are time-consuming and emotionally exhausting for both the trainee and faculty. Numerous barriers, including lack of resources, faculty development, and fear of legal retribution, can impede medical educators from developing and implementing robust remediation plans. Despite the large volume of literature citing professionalism education and the "hidden curriculum" as problem areas in medical education, frontline educators lack practical tools and empowerment to address unprofessionalism in trainees. The paucity of resources in this arena has led to decreased job satisfaction, increased burnout, and an exodus from academic medicine. Department leadership acknowledgment and investment in training faculty on remediation strategies for learners in difficulty and providing tools to meet these challenging job demands will improve faculty's job satisfaction and overall well-being. The authors review salient literature and methodology for diagnosing learners in difficulty, with focus on a high-yield, pragmatic approach that can be taken by medical training programs, including those that lack a robust medical education infrastructure.
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Affiliation(s)
- Rebecca D Margolis
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Cindy M Ku
- Department of Anesthesiology, Queens Medical Center, Honolulu, Hawaii, USA
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Gondhalekar AR, Rees EL, Ntuiabane D, Janjua O, Choa G, Eboreime O, Sturrock A. Levelling the playing field: students' motivations to contribute to an amnesty of assessment materials. BMC MEDICAL EDUCATION 2020; 20:450. [PMID: 33225940 PMCID: PMC7681947 DOI: 10.1186/s12909-020-02320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND 'Exam recall' is a recognised phenomenon whereby students recall and record questions after leaving the examination hall. This poses two main problems. First, as these questions are only available to peers of the students who recall the questions, these individuals have an unfair advantage. Secondly, the distribution of these recalled questions poses a threat to the validity and defensibility of assessments. To address the first of these problems, we developed an amnesty enabling students to submit assessment material to an on-line site. This study sought to explore which factors influence students' contributions to an amnesty of assessment material. METHODS We conducted a qualitative study using semi-structured focus groups. We used convenience sampling and recruited participants from all years of our undergraduate medical programme. The focus groups were facilitated by a medical student peer to reduce the power imbalance and encourage participants to discuss candidly. The focus groups were audio recorded and transcribed verbatim. Two researchers independently analysed all transcripts using thematic analysis and the research team met regularly to discuss emergent findings. Nvivo was used to assist with thematic analysis of the transcripts. RESULTS Twenty-six individuals participated in six focus groups. Six themes were identified through the analysis, which were categorised into motivating factors and de-motivating factors. Motivating factors were a perception that this would overcome inequity, a fear of repercussions, and the perceived usefulness of resources. Factors that prevented students contributing were a culture of competition, a lack of incentives, and mistrust of the medical school. CONCLUSIONS The establishment of an amnesty was acceptable to students and they were motivated to contribute materials. The competitive nature of medical careers and the stakes of summative assessments meant that students felt that some peers might still not contribute their materials. Students felt that the school were listening to their concerns and this led to a better dialogue between students and faculty.
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Affiliation(s)
- Anjali R Gondhalekar
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - Eliot L Rees
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - Daniel Ntuiabane
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - Osman Janjua
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - George Choa
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - Oziegbe Eboreime
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England
| | - Alison Sturrock
- University College London Medical School, 74 Huntley Street, London, WC1E 6JE, England.
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Abstract
OBJECTIVES Our aim was to explore the relationship between medical student Conscientiousness Index scores and indicators of later clinical performance held in the UK Medical Education Database (UKMED). Objectives were to determine whether conscientiousness in first-year and second-year medical students predicts later performance in medical school and in early practice. Policy implications would permit targeted remediation where necessary or aid in selection. DESIGN A prospective correlational study. SETTING A single UK medical school and early years of practice, 2005-2018. PARTICIPANTS The data were obtained from the UKMED on 858 students. Full outcome data was available for variable numbers of participants, as described in the text. MAIN OUTCOME MEASURES Scores on the UK Foundation Programme Office's Situational Judgement Test (SJT) and Educational Performance Measure (EPM), the Prescribing Safety Assessment (PSA) and Annual Review of Competency Progression (ARCP) outcomes. RESULTS Linear regression analysis shows Conscientiousness Index scores significantly correlate with pregraduate and postgraduate performance variables: SJT scores (R=0.373, R2=0.139, B=0.066, p<0.001, n=539); PSA scores (R=0.249, R2=0.062, B=0.343, p<0.001, n=462); EPM decile scores for the first (lowest) decile are significantly lower than the remaining 90% (p=0.003, n=539), as are PSA scores (p<0.001, n=463), and ARCP year 2 scores (p=0.019, n=517). The OR that students in the first decile fail to achieve the optimum ARCP outcome is 1.6126 (CI: 1.1400 to 2.2809, p=0.0069, n=618). CONCLUSIONS Conscientiousness Index scores in years 1 and 2 of medical school have predictive value for later performance in knowledge, skills and clinical practice. This trait could be used either for selection or for targeted remediation to avoid potential problems in the future.
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Affiliation(s)
- Marina Sawdon
- School of Medicine, University of Sunderland, Sunderland, UK
| | - J C McLachlan
- School of Medicine, University of Central Lancashire, Preston, UK
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Halman S, Fu AYN, Pugh D. Entrustment within an objective structured clinical examination (OSCE) progress test: Bridging the gap towards competency-based medical education. MEDICAL TEACHER 2020; 42:1283-1288. [PMID: 32805146 DOI: 10.1080/0142159x.2020.1803251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Progress testing aligns well with competency-based medical education (CBME) frameworks, which stress the importance of continuous improvement. Entrustment is a useful assessment concept in CBME models. The purpose of this study was to explore the use of an entrustability rating scale within the context of an objective structured clinical examination (OSCE) Progress Test. METHODS A 9-case OSCE Progress Test was administered to Internal Medicine residents (PGYs 1-4). Residents were assessed using a checklist (CL), global rating scale (GRS), training level rating scale (TLRS), and entrustability scale (ENT). Reliability was calculated using Cronbach's alpha. Differences in performance by training year were explored using ANOVA and effect sizes were calculated using partial eta-squared. Examiners completed a post-examination survey. RESULTS Ninety one residents and forty two examiners participated in the OSCE. Inter-station reliability was high for all instruments. There was an overall effect of training level for all instruments (p < 0.001). Effect sizes were large. 88% of examiners completed the survey. Most (62%) indicated feeling comfortable in making entrustment decisions during the OSCE. CONCLUSIONS An entrustability scale can be used in an OSCE Progress Test to generate highly reliable ratings that discriminate between learners at different levels of training.
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Affiliation(s)
- Samantha Halman
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Angel Yi Nam Fu
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
| | - Debra Pugh
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Medical Council of Canada, Ottawa, Ontario, Canada
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Aylott LME, Tiffin PA, Brown S, Finn GM. Great expectations: views and perceptions of professionalism amongst mental health services staff, patients and carers. J Ment Health 2020; 31:139-146. [PMID: 32909854 DOI: 10.1080/09638237.2020.1818195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Numerous studies have explored the concept of 'professionalism' in medicine, yet little attention has been paid to the concept in a mental health services context. AIMS This study sought to determine how the lived experience of patients, carers and healthcare professionals in mental health services align with medically defined, generic, professionalism standards. METHOD Interviews and focus groups were conducted with patients, carers, nurses, occupational therapists, psychiatrists and psychologists. A framework analysis approach was used to analyse the data, based on the 'Improving Selection to the Foundation Programmes' Professional Attributes Framework. RESULTS Fifty-six individuals participated. Data aligned to all nine attributes of the Professional Attributes Framework, however the expectations within each attribute varied from that originally cited. A tenth attribute was devised during the process of analysis; Working with Carers. This attribute acknowledges the need to liaise with, and support carers in mental health services. Situational examples included both online and offline behaviours and the topic of 'black humour' emerged. CONCLUSIONS Compared to a conventional medical definition of professionalism, additional themes and differing emphases were observed for mental health and learning disability services. These findings should be used to inform the teaching and evaluation of professionalism, especially for staff pursuing mental health service careers.
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Affiliation(s)
- Lauren M E Aylott
- Health Professions Education Unit, Hull York Medical School, University of York, York, England
| | - Paul A Tiffin
- Health Professions Education Unit, Hull York Medical School, University of York, York, England.,Department of Health Sciences, University of York, York, England
| | - Sally Brown
- Edinburgh Napier University, Edinburgh, Scotland
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, England
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Sahota GS, Taggar JS. The association between Situational Judgement Test (SJT) scores and professionalism concerns in undergraduate medical education. MEDICAL TEACHER 2020; 42:937-943. [PMID: 32538227 DOI: 10.1080/0142159x.2020.1772466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: Situational judgement tests (SJTs) are widely used in selecting medical students and doctors. Emerging evidence suggests SJTs are capable of testing an individual's ability to respond to role-relevant professionalism scenarios, however, evidence is lacking for their use in identifying students with concerning professional behaviours.This study aimed to determine the association between medical student professionalism-based SJT scores and recorded professionalism concerns during training.Methods: A cross-sectional study was conducted utilising SJT scores from second-year medical students and occurrences of student professionalism concerns. Concerns were reviewed and mapped to General Medical Council standards. Multivariate logistic regression was used to determine associations between SJT scores and professionalism concerns.Results: 247 students were included in the study. For every point increase in SJT score, students were 10% less likely to have multiple professionalism concerns [OR (95% CI) 0.90 (0.83-0.97); p = .007].Students scoring below 1 and 2 standard deviations from the mean score were 4 and 11-times more likely to have multiple concerns [OR (95% CI) 4.52 (1.12-18.25); p = .034] and [OR (95% CI) 11.45 (1.72-76.15); p = .012].Conclusion: Lower SJT scores were significantly associated with an increased risk of professionalism concerns. These findings support the potential for SJT exams to identify medical students that may require closer supervision and remediation during undergraduate education.
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Affiliation(s)
- Gurvinder S Sahota
- Division of Primary Care, Primary Care Education Unit, University of Nottingham, Nottingham, UK
| | - Jaspal S Taggar
- Division of Primary Care, Primary Care Education Unit, University of Nottingham, Nottingham, UK
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Dagnone JD, Takahashi SG, Whitehead CR, Spadafora SM. Reclaiming physician identity: It's time to integrate 'Doctor as Person' into the CanMEDS framework. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e97-e99. [PMID: 32821309 PMCID: PMC7417823 DOI: 10.36834/cmej.69182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 1996, the Royal College of Physicians & Surgeons of Canada (RCPSC) adopted the CanMEDS framework with seven key roles: medical expert, communicator, collaborator, health advocate, manager, professional, and scholar. For many years, CanMEDS has been recognized around the world for defining what patients need from their physicians. From the start, the RCPSC acknowledged that these roles should evolve over time to continue to meet patient and societal needs (updates in 2005 & 2015). We propose that an 8th role is now needed in the framework: “Doctor as Person”. Interestingly, this role was present in the foundational work through the Educating Future Physicians for Ontario (EFPO) project that the RCPSC drew upon in creating CanMEDS more than 20 years ago. Given today’s challenges of providing care in an increasingly stressed Canadian healthcare system, physicians are struggling more than ever with health and wellness, burnout, and the deterioration of the clinical environment. From the patient perspective, there is growing concern that physician-patient interactions are becoming increasingly impersonal and decreasingly patient-centered. The crack emerging in the foundation of physician identity needs to be remedied. We need to pay close attention to how we define ourselves as physicians, by better identifying the competencies required to navigate the personal and professional challenges we face. Only in so doing can we ward off the threat that exists in losing authentic human to human care interactions. Formalizing Doctor as Person as an 8th role in the CanMEDS framework will help patients and physicians create the space to have essential conversations about the humanity of medical care.
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Fong W, Kwan YH, Yoon S, Phang JK, Thumboo J, Leung YY, Ng SC. Assessment of medical professionalism using the Professionalism Mini Evaluation Exercise (P-MEX) in a multi-ethnic society: a Delphi study. BMC MEDICAL EDUCATION 2020; 20:225. [PMID: 32664983 PMCID: PMC7362541 DOI: 10.1186/s12909-020-02147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The importance of medical professionalism and its assessment has been well documented in the literature. However, there is currently no culturally-adapted tool to assess medical professionalism in Singapore. This study sets out to find consensus on relevance of the items from the Professionalism Mini Evaluation Exercise (P-MEX) for assessing medical professionalism in Singapore. METHODS A two-round Delphi survey was completed by an expert panel consisting of program directors, associate designated institutional officials, and designated institutional official (n = 15) from residency programs in Singapore. Round 1 comprised of 23 items from the P-MEX rated on a 5-point scale (1 = Definitely include, 2 = Possibly include, 3 = Neutral, 4 = Possibly exclude, 5 = Definitely exclude). In round 2, the experts received feedback from the previous round, and were asked to re-rate the items which did not achieve consensus in the previous round. The threshold for consensus in the study was defined as 70% or greater agreement among experts. RESULTS Completed questionnaires for both rounds were received from all 15 experts. In round 1, 18 items (78%) achieved consensus to be included. In round 2, 1 (4%) item achieved consensus to be included. However, none of the remaining items achieved consensus to be removed, and they exhibited stability in responses. A list of 19 items covering four domains of medical professionalism (Doctor-patient relationship skills, Reflective skills, Time management and Inter-professional relationship skills) was obtained during the two-rounds of Delphi survey. CONCLUSIONS Nineteen items in the P-MEX had garnered consensus and is suitable for assessing medical professionalism in Singapore. The findings of this study can provide guidance for faculty and institutions who want to assess medical professionalism of their medical trainees.
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Affiliation(s)
- Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Swee Cheng Ng
- Department of Rheumatology and Immunology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Ahmad T, Sattar K, Akram A. Medical professionalism videos on YouTube: Content exploration and appraisal of user engagement. Saudi J Biol Sci 2020; 27:2287-2292. [PMID: 32884409 PMCID: PMC7451591 DOI: 10.1016/j.sjbs.2020.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/03/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background Social media has become the fastest growing platform for sharing and retrieving information and knowledge, and YouTube is one of the most popular and growing sources of health and educational information video-sharing website. But, videos on this open platform are not peer-assessed, therefore, the accessible data should be adequately assessed. Till date, no exploration and analysis for assessing the credibility and usefulness of Medical professionalism videos available on YouTube are conducted. Objective To analyze the video sources, contents and quality of YouTube videos about the topic of medical professionalism. Methods A systematic search was accomplished on YouTube videos during the period between March 1, 2020 and March 27, 2020. The phrases as significant words used throughout YouTube web search were ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, ‘Attributes of professionalism’. The basic information collected for each video included author’s/publisher’s name, total number of watchers, likes, dislikes and positive and undesirable remarks. The videos were categorized into educationally useful and useless established on the content, correctness of the knowledge and the advices. Different variables were measured and correlated for the data analysis. YouTube website was searched the using keywords ‘Professionalism in Medical Education’, Professionalism in medicine’, ‘Professionalism of medical students’, ‘Professionalism in healthcare’. ‘Teaching professionalism’, and ‘Attributes of professionalism’. Results After 2 rounds of screening by the subject experts and critical analysis of all the 137 YouTube videos, only 41 (29.92%) were identified as pertinent to the subject matter, i.e., educational type. After on expert viewing these 41 videos established upon our pre-set inclusion/exclusion criteria, only 17 (41.46%) videos were found to be academically valuable in nature. Conclusion Medical professionalism multimedia videos uploaded by the healthcare specialists or organizations on YouTube provided reliable information for medical students, healthcare workers and other professional. We conclude that YouTube is a leading and free online source of videos meant for students or other healthcare workers yet the viewers need to be aware of the source prior to using it for training learning.
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Affiliation(s)
- Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Computer Science and Information Technology, NIMS University, Jaipur, Rajasthan, India
| | - Kamran Sattar
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Medical Education, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Corresponding author at: Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ashfaq Akram
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Krupat E, Dienstag JL, Padrino SL, Mayer JE, Shore MF, Young A, Chaudhry HJ, Pelletier SR, Reis BY. Do Professionalism Lapses in Medical School Predict Problems in Residency and Clinical Practice? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:888-895. [PMID: 31895703 DOI: 10.1097/acm.0000000000003145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Recognizing that physicians must exhibit high levels of professionalism, researchers have attempted to identify the precursors of clinicians' professionalism difficulties, typically using retrospective designs that trace sanctioned physicians back to medical school. To better establish relative risk for professionalism lapses in practice, however, this relationship must also be studied prospectively. Therefore, this study investigated the sequelae of medical school professionalism lapses by following students with medical school professionalism problems into residency and practice. METHOD Beginning in 2014, 108 graduates from Harvard Medical School and Case Western Reserve University School of Medicine who appeared before their schools' review boards between 1993 and 2007 for professionalism-related reasons were identified, as well as 216 controls matched by sex, minority status, and graduation year. Prematriculation information and medical school performance data were collected for both groups. Outcomes for the groups were studied at 2 points in time: ratings by residency directors, and state medical board sanctions and malpractice suits during clinical practice. RESULTS Compared with controls, students who appeared before their schools' review boards were over 5 times more likely to undergo disciplinary review during residency (16% vs 3%, respectively) and almost 4 times more likely to require remediation or counseling (35% vs 9%, respectively). During clinical practice, 10% of those who had made review board appearances were sued or sanctioned vs 5% of controls. Logistic regression for these outcomes indicated, however, that professional lapses in medical school were not the only, or even the most important, predictor of problems in practice. CONCLUSIONS Students with professionalism lapses in medical school are significantly more likely to experience professionalism-related problems during residency and practice, although other factors may also play an important predictive role.
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Affiliation(s)
- Edward Krupat
- E. Krupat is associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. J.L. Dienstag is interim dean for faculty affairs and professor of medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. S.L. Padrino is assistant dean for clinical sciences, and assistant professor, Departments of Medicine and Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: http://orcid.org/0000-0001-5637-5870. J.E. Mayer Jr is professor of surgery, Boston Children's Hospital, Boston, Massachusetts. M.F. Shore, deceased, was professor emeritus, Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0002-5517-5874. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas; ORCID: http://orcid.org/0000-0003-3356-1106. S.R. Pelletier is senior project manager, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts. B.Y. Reis is director, Predictive Medicine Group, Harvard Medical School and Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Ong YT, Kow CS, Teo YH, Tan LHE, Abdurrahman ABHM, Quek NWS, Prakash K, Cheong CWS, Tan XH, Lim WQ, Wu J, Tan LHS, Tay KT, Chin A, Toh YP, Mason S, Radha Krishna LK. Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019. MEDICAL TEACHER 2020; 42:636-649. [PMID: 32065016 DOI: 10.1080/0142159x.2020.1724921] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.
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Affiliation(s)
- Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl Shumin Kow
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorraine Hui En Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Wei Sheng Quek
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kishore Prakash
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiu Hui Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Qiang Lim
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiaxuan Wu
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Annelissa Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Family Medicine Residency, National University Health System, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
| | - Lalit Kumar Radha Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
- Education Department, Duke-NUS Graduate Medical School, Singapore, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
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