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Bransen J, Poeze M, Mak-van der Vossen MC, Könings KD, van Mook WNKA. 'Role Model Moments' and 'Troll Model Moments' in Surgical Residency: How Do They Influence Professional Identity Formation? PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:313-323. [PMID: 38800716 PMCID: PMC11122703 DOI: 10.5334/pme.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
Introduction Role models are powerful contributors to residents' professional identity formation (PIF) by exhibiting the values and attributes of the community. While substantial knowledge on different attributes of role models exists, little is known about their influence on residents' PIF. The aim of this study was to explore surgical residents' experiences with role models and to understand how these contribute to residents' PIF. Methods Adopting a social constructivist paradigm, the authors used a grounded theory approach to develop an explanatory model for residents' experiences with role models regarding PIF. Fourteen surgical residents participated in individual interviews. The authors iteratively performed data collection and analysis, and applied constant comparison to identify relevant themes. Results Role model behavior is highly situation dependent. Therefore, residents learn through specific 'role model moments'. These moments arise when residents (1) feel positive about a moment, e.g. "inspiration", (2) have a sense of involvement, and (3) identify with their role model. Negative role model moments ('troll model moments') are dominated by negative emotions and residents reject the modeled behavior. Residents learn through observation, reflection and adapting modeled behavior. As a result, residents negotiate their values, strengthen attributes, and learn to make choices on the individual path of becoming a surgeon. Discussion The authors suggest a nuance in the discussion on role modelling: from 'learning from role models' to 'learning from role model moments'. It is expected that residents' PIF will benefit from this approach since contextual factors and individual needs are emphasized. Residents need to develop antennae for both role model moments and troll model moments and acquire the skills to learn from them. Role model moments and troll model moments are strong catalysts of PIF as residents follow in the footsteps of their role models, yet learn to go their own way.
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Affiliation(s)
- Jeroen Bransen
- Department of Trauma Surgery, Maastricht University Medical Center+, The Netherlands
- School of Health Professions Educations, Maastricht University, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center+, The Netherlands
| | - Marianne C. Mak-van der Vossen
- Assistant professor in medical education, Amsterdam UMC, Department of General Practice, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Karen D. Könings
- School of Health Professions Educations, Maastricht University, The Netherlands
- School of Health Sciences, University of East Anglia, UK
| | - Walther N. K. A. van Mook
- School of Health Professions Educations, Maastricht University, The Netherlands
- Department of Intensive Care Medicine, and postgraduate dean, Academy for Postgraduate Training, Maastricht University Medical Center+, Maastricht, The Netherlands
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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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Balasanova AA, Kennedy KG. What Is the Value of the Psychiatrist in Resident Psychotherapy Supervision? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:183-187. [PMID: 38337079 DOI: 10.1007/s40596-024-01944-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
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Bibler TM, Nelson RH, Moore B, Malek J, Majumder MA. Building Effective Mentoring Relationships During Clinical Ethics Fellowships: Pedagogy, Programs, and People. HEC Forum 2024; 36:1-29. [PMID: 35218454 DOI: 10.1007/s10730-022-09473-z] [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] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
How should clinical ethicists be trained? Scholars have stated that clinical ethics fellowships create well-trained, competent ethicists. While this appears intuitive, few features of fellowship programs have been publicly discussed, let alone debated. In this paper, we examine how fellowships can foster effective mentoring relationships. These relationships provide the foundation for the fellow's transition from novice to competent professional. In this essay, we begin by discussing our pedagogical commitments. Next, we describe the structures our program has created to assist our fellows in becoming competent ethicists. We then outline the kinds of knowledge, skills, and professional attributes mentors should possess. Following this, we focus on the knowledge, skills, and professional attributes that fellows develop as they co-create effective mentoring relationships. We will not prescribe a single approach to fellowship training; instead, our perspective will, we hope, become a catalyst for further conversation on training and mentoring clinical ethics fellows.
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Affiliation(s)
- Trevor M Bibler
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Ryan H Nelson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Bryanna Moore
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, TX, USA
| | - Janet Malek
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
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Bashir A, McTaggart IJ, Tufail S, Mustafa N, Rauf A. Negative faculty role modelling - is it a reflection of deteriorating societal values? MEDICAL TEACHER 2024:1-7. [PMID: 38306677 DOI: 10.1080/0142159x.2024.2306844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Negative faculty role modelling is an area of growing concern especially due to its implications on medical professionalism. The study aims to explore the impacts of negative role modelling on professionalism of medical students in the context of Pakistan. METHODS This qualitative study is part of a larger study exploring impacts of role modelling on professionalism of students. It is based on Constructivist Grounded Theory involving six semi-structured interviews with clinical faculty and three focus group discussions with 22 students. Initial, focused, selective coding and thematic analysis was used to find the core category. RESULTS Three overarching categories were developed: traits observed with negative role models; impact of negative role modelling; factors promoting negative role modelling. Subcategories of impacts included negative impact on professionalism, emotional impact, and its paradoxical positive impact. Negative role modelling, a manifestation of declining professionalism, was attributed to deteriorating societal values; further compounded by the lack of required mechanisms by institutions and the regulatory authority at their respective levels. CONCLUSIONS In the absence of a strong moral platform at societal level, the burden of responsibility rests with the faculty and more importantly with institutions and regulatory bodies to discourage negative role modelling and educate students to recognize, reflect on and avoid negative behaviours and adopt strong professional values.
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Affiliation(s)
- Adeela Bashir
- Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan
| | | | - Shazia Tufail
- Department of Obstetrics & Gynaecology, CMH Lahore Medical College, National University of Medical Sciences, Lahore, Pakistan
| | - Nilofar Mustafa
- Department of Obstetrics & Gynaecology, CMH Lahore Medical College, National University of Medical Sciences, Lahore, Pakistan
| | - Ayesha Rauf
- Department of Health Professions Education, National University of Medical Sciences, Rawalpindi, Pakistan
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George RE, Sidhu MS. Promoting inclusivity in health professions education. CLINICAL TEACHER 2023; 20:e13606. [PMID: 37475641 DOI: 10.1111/tct.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Riya E George
- Clinical Communication Skills & Diversity Education, Institute of Health Sciences Education, Queen Mary University of London, London, UK
| | - Manbinder S Sidhu
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Kyi K, Gilmore N, Kadambi S, Loh KP, Magnuson A. Stigmatizing language in caring for older adults with cancer: Common patterns of use and mechanisms to change the culture. J Geriatr Oncol 2023; 14:101593. [PMID: 37524648 PMCID: PMC10823037 DOI: 10.1016/j.jgo.2023.101593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Kaitlin Kyi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester, Medical Center, Rochester, NY, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA
| | - Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester, New York, USA.
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Tan E, Tan D, Cleland J. The Value of Role Modeling in Value Conscious Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1238. [PMID: 37556823 DOI: 10.1097/acm.0000000000005431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Emmanuel Tan
- Assistant dean of student wellbeing, and lecturer of medical education, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; ; ORCID: https://orcid.org/0000-0002-0204-0079
| | - Daniel Tan
- Medical officer, public health care system, and a former graduate, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jennifer Cleland
- Professor of medical education research, president's chair in medical education, vice-dean (education), and director, Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; ORCID: http://orcid.org/0000-0003-1433-9323
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Lewthwaite NAB, Gray EA, Skinner MA. Exploring clinical learning experiences of novice physiotherapy students in a hospital setting. Physiother Theory Pract 2023; 39:2131-2143. [PMID: 35475779 DOI: 10.1080/09593985.2022.2069617] [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: 04/07/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Exposure to clinical practice experiences ensures undergraduate physiotherapy students meet the clinical competencies required to graduate as autonomous practitioners. Much of the research literature has investigated the clinical experiences of medical students. While recent studies have explored physiotherapy students' experiences with simulation, few have explored their perspectives of a clinical placement in a hospital setting at the early learning stage of a four-year programme. OBJECTIVE To explore the perspectives of novice undergraduate physiotherapy students on a clinical placement in a real hospital setting. METHODS Fifteen Year 3 undergraduate physiotherapy students participated in semi-structured interviews midway through a three-week tertiary care clinical placement. Interviews were transcribed, coded and analyzed using thematic analysis. RESULTS Three main themes emerged: 1) student attributes affecting placement experience; 2) impact of the educator on student experience; and 3) effects of the clinical environment on student experiences. CONCLUSION The real clinical environment promotes a rich learning experience for students, while the clinical educator is pivotal to guiding student learning through provision of resources and feedback. Provision of early orientation and timely clarification of expectations is important to alleviate anxiety and allow students to prepare themselves.
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Affiliation(s)
- Natasha A B Lewthwaite
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Emily A Gray
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Margot A Skinner
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Kaplan KB, Tenam-Zemach M, Reeves J. Improving cultural humility in physical therapy students: What is faculty's role? Physiother Theory Pract 2023:1-18. [PMID: 37647271 DOI: 10.1080/09593985.2023.2252053] [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: 04/17/2023] [Revised: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Clinician bias contributes to health disparities; therefore, educational standards and professional expectations incorporate cultural humility. Vague standards and numerous pedagogical methods make implementing an effective and uniform curriculum challenging. Classroom and clinical faculty's attitudes and behaviors are pivotal; however, evidence on roles beyond instruction is lacking. PURPOSE This study explored physical therapy (PT) students' perceptions of faculty's role in improving their cultural humility. METHODS This study was rooted in a phenomenological approach that incorporated elements of both descriptive and interpretive phenomenology. Thirteen first-year PT students participated in one-on-one interviews which underwent reflexive thematic analysis. RESULTS Reflexive thematic analysis generated two hundred-ninety codes, six categories, and one overarching theme. Dissonance emerged between students' perceptions of faculty's role and the explicit and implicit curriculum. CONCLUSION Explicit messaging from classroom instruction and implicit messaging from clinical encounters and unspoken attitudes, values, and behaviors were disparate. Faculty role modeling, diversity, cultural awareness, and perceived comfort interacting with a diverse patient population improved students' self-confidence and cultural humility. Professional development including field experience with a cognitive apprenticeship approach, and standardized, discipline-specific cultural humility competencies may provide uniform and clear guidelines.
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Affiliation(s)
- Kelby B Kaplan
- Department of Physical Therapy and Rehabilitation Science, University of Maryland Baltimore, Baltimore, MD, United States
| | - Michelle Tenam-Zemach
- Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Jennifer Reeves
- Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States
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Li C, Ye X, Yu C, Wu H. The effect of an information intervention on the career commitment of medical students: evidence from a randomized experiment. Front Med (Lausanne) 2023; 10:1101993. [PMID: 37283628 PMCID: PMC10239797 DOI: 10.3389/fmed.2023.1101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction The needs-based shortage of healthcare workers is severe worldwide and it would be exacerbated if many medical students switch to other careers after graduation. Maintaining and improving the career commitment of medical students, which could be a feasible, effective, and scalable way to reduce the attrition rate, is essential in medical education. We designed a randomized experiment to test whether an information intervention based on role modeling could enhance medical students' career commitment. Methods In the randomized experiment, the sample (N = 36,482) was divided into the treatment group (N = 18,070) and the control group (N = 18,412). The intervention information consisted of image-text messages on Zhong Nanshan, who is an inspiring role model for he went to the frontline of COVID-19 in the most critical circumstances and received praise and affirmation from the public. Α difference-in-differences model was employed to identify the effect of the information intervention. Heterogeneous treatment effects were identified using sub-sample analyses. Results The results showed that the information intervention statistically significantly reduced medical students' dropout intention by 2.7 percentage points (95% CI: -0.037 to -0.016, t = -4.95, p < 0.001), equivalent to 14.6% of the control group mean. This estimate indicates that the information intervention could significantly increase the career commitment of medical students. Finally, male and senior students were influenced more than their female and junior counterparts, which can be explained by their relatively high dropout intention. Conclusion Role model-based information intervention improves the career commitment of medical students. The underlying behavioral model is that, when students use a role model as their reference point, they consider dropout as a substantial welfare loss. Role modeling is an effective way to improve the career commitment of medical students, especially for males and senior students.
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Affiliation(s)
- Chunqing Li
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Xiaoyang Ye
- Annenberg Institute for School Reform, Brown University, Providence, RI, United States
| | - Chen Yu
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China
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Pieterse AH, Gulbrandsen P, Ofstad EH, Menichetti J. What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care. PATIENT EDUCATION AND COUNSELING 2023; 114:107801. [PMID: 37230040 DOI: 10.1016/j.pec.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training. DISCUSSION Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients. CONCLUSIONS We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, 0316 Oslo, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
| | - Eirik H Ofstad
- The Medical Clinic, Nordland Hospital Trust, 8005 Bodø, Norway
| | - Julia Menichetti
- Health Services Research Unit (HØKH), Akershus University Hospital, 1478 Lørenskog, Norway
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Kim DT, Applewhite MK, Shelton W. Professional Identity Formation in Medical Education: Some Virtue-Based Insights. TEACHING AND LEARNING IN MEDICINE 2023:1-11. [PMID: 37140086 DOI: 10.1080/10401334.2023.2209067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Issue: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well. However, in its conceptual formulations, the literature risks underappreciating the pedagogical significance of the moral basis of identity formation-that is, the developing moral agencies and aspirations of learners to be good physicians. Evidence: Our conceptual analysis and argument build on a critical review of the medical education literature on PIF and draw on relevant insights from virtue ethics to deepen the conceptualization of PIF in moral, and not just psychosocial, terms. We show that a narrowly psychosocial view risks perpetuating institutional perceptions that can conceive professionalism norms primarily as standards of discipline or social control. By drawing on the conceptual resources of virtue ethics, we highlight not just the psychosocial development of medical learners but also their self-reflective, critical development as particular moral agents aspiring to embody the excellences of a good physician and, ultimately, to exhibit those traits and behaviors in the practice of medicine. Implications: We consider the pedagogical relevance of this insight. We show that drawing on virtue theory can more adequately orient medical pedagogy to socialize learners into the medical community in ways that nurture their personal growth as moral agents-in terms of their particular, restless aspirations to be a good physician and to flourish as such.
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Affiliation(s)
- Daniel T Kim
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
| | - Megan K Applewhite
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
| | - Wayne Shelton
- Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
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Emilia O, Suhoyo Y, Utomo PS. Teacher as role model in developing professional behavior of medical students: a qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2023; 14:55-62. [PMID: 37146184 PMCID: PMC10693392 DOI: 10.5116/ijme.6443.ae49] [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: 07/11/2022] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
Objectives This study aimed to explore students' perspectives on the attributes of medical teachers as role models to students' professional behaviour in the educational process. Methods A phenomenological study was conducted to obtain participants' perceptions concerning the professional attributes of medical teachers. The participants were 21 final-year medical students in the School of Medicine, Universitas Gadjah Mada, who had completed and passed the national examination. The participants were recruited purposively to represent genders and performance (i.e., high-performing and average-performing students). The participants were divided into two focus groups based on their performance, each facilitated by non-teaching faculty members to avoid bias. Thematic analysis was conducted to analyze focus group transcripts by two independent coders. Codes were synthesized into themes related to the study aims. Results Seven themes were identified related to observed role model attributes, for instance, passionate lecturers, caring and empathetic, supportive and involving, objectivity, incompetence and compromising, poor communication and conflict, and time management. Subsequently, five themes were identified in participants' responses towards the observed role model, for instance, exemplary models, respect and motivating, confusion and inconvenience, avoiding and hate, and value collision and harmonization. Conclusions This study revealed a range of role model attributes and responded positively and negatively during learning encounters. As negative attributes are also prominent and observed by students, there is a need for medical schools to perform faculty development for the professional enhancement of medical teachers. Further study should be conducted to investigate the impact of role modelling on learning achievement and future medical practice.
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Affiliation(s)
- Ova Emilia
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Yoyo Suhoyo
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
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Gölcü BM, Ünsal Adaca A, Yerlikaya N, Özen D, Başağaç Gül RT. A Mixed-Methods Survey of Veterinary Ethics Teaching in Turkey. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20220077. [PMID: 37015026 DOI: 10.3138/jvme-2022-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
With the growth of interest in veterinary ethics, the teaching of ethics to veterinary students has become more important. This study collects comprehensive data about ethics education at veterinary faculties in Turkey to contribute to the international literature. A cross-sectional descriptive survey design is used to collect data via questionnaire. Of the 31 faculty members actively teaching ethics at 24 of the 29 veterinary faculties in Turkey (as of the end of 2021), 30 responded to the survey. By the end of 2021, ethics courses in 24 veterinary faculties in Turkey were conducted between the 7th and 10th semesters with similar content across the examined institutions. Of the 31 faculty members responsible for ethics education, 22 were ethicists. Theoretical lectures and multiple-choice tests were the most preferred methods for teaching and assessment. The most preferred learning outcome to be gained by students was ethical awareness. Integrity by ethicists and morality by faculty members from other departments were considered the most important virtues. The collected qualitative data regarding the strengths of ethics education and areas for improvement were varied and controversial. Ethics training should be an ongoing process throughout veterinary education. Applied ethics education should be comprehensively included in the curricula and carried out with the cooperation of faculty members working in clinical fields.
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Affiliation(s)
- Berfin Melikoğlu Gölcü
- Department of Veterinary History and Deontology, Ondokuz Mayıs University, Samsun, Türkiye
| | - Aytaç Ünsal Adaca
- Department of Veterinary History and Deontology, Ankara University Faculty of Veterinary Medicine, Ankara University, Ankara, Türkiye
| | - Nigar Yerlikaya
- Department of Veterinary History and Deontology, Ankara University Faculty of Veterinary Medicine, Ankara University, Ankara, Türkiye
| | - Doğukan Özen
- Department of Biostatistics, Ankara University Faculty of Veterinary Medicine, Ankara University, Ankara, Türkiye
| | - R Tamay Başağaç Gül
- Department of Veterinary History and Deontology, Ankara University Facuty of Veterinary Medicine, Ankara University, Ankara, Türkiye
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Stelwagen M, Westmaas A, Van Kempen A, Scheele F. In-hospital education of parents of newborns may benefit from competency-based education: A qualitative focus group and interview study among health professionals. J Clin Nurs 2023; 32:1076-1088. [PMID: 35460132 DOI: 10.1111/jocn.16334] [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: 11/09/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
AIMS/OBJECTIVES The aim of this study was to appraise health professionals' self-reported practices in educating parents of hospitalised newborns from the perspective of competency-based education and to identify areas for improvement of parental learning. BACKGROUND Patient education is essential to achieve autonomy in parents of hospitalised newborns. The literature provides descriptions of the use of various components of competency-based education in patient education. This suggests that competency-based education is a valuable concept for patient education. DESIGN A case-based qualitative study. METHODS Three focus group discussions were conducted and 28 semi-structured interviews with 45 health professionals who practice in a hospital setting that is designed to empower parents. The data were analysed with a framework analysis approach, using a framework of competency-based education themes for a combined inductive and deductive content data analysis. The recommendations of the Standards for Reporting Qualitative Research checklist were followed. FINDINGS Two themes of competency-based education emerged as evidently operationalised: (1) 'Learning climate' and (2) 'Role modeling'. Five themes emerged as incompletely operationalised: (1) 'Parent curriculum based on inter-professional consensus'; (2) 'Transparency about the competencies needed'; (3) 'Access to teaching'; (4) 'Assessing and reporting results'; and (5) 'Proficiency statements based on autonomy expectations'. Two themes did not emerge: (1) 'Empowering parents to be active learners' and (2) 'Evaluation and improvement of the education program'. CONCLUSIONS Parent education is at risk of being merely on a master-apprentice model and may be more effective if it is designed on competency-based education principles. Identified areas for improvement are empowering parents to be 'active learners' and by involving them in the evaluation and improvement of the educational program. Parent education in neonatal health care may benefit from an appraisal based on competency-based education themes. RELEVANCE TO CLINICAL PRACTICE Appraising parent education based on competency-based education principles is feasible for improving the learning process towards parent autonomy.
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Affiliation(s)
- Mireille Stelwagen
- Department of Teaching and Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Alvin Westmaas
- Department of Social Psychology, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Anne Van Kempen
- Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Gynecology and Department Teaching at OLVG Hospital, Health systems innovation and education at the VU University Amsterdam and Amsterdam University Medical Center, Amsterdam, The Netherlands
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Koh EYH, Koh KK, Renganathan Y, Krishna L. Role modelling in professional identity formation: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:194. [PMID: 36991373 PMCID: PMC10052869 DOI: 10.1186/s12909-023-04144-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). METHODS A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. RESULTS 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. CONCLUSION Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.
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Affiliation(s)
- Eugene Yong Hian Koh
- Singapore Armed Forces, 303 Gombak Drive, Singapore, 669645, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Kai Kee Koh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Yaazhini Renganathan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Dr, Singapore, 169610, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK.
- Cancer Research Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- Duke-NUS Medical School, National University of Singapore, College Rd, Singapore, 169857, Singapore.
- Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore.
- The Palliative Care Centre for Excellence in Research and Education, PalC, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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Lowe E, Kogan AC, Feldman CT, Ma SB, Lie DA. Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study. BMC MEDICAL EDUCATION 2022; 22:867. [PMID: 36517790 PMCID: PMC9749622 DOI: 10.1186/s12909-022-03922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
STUDY AIM Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies. METHODS Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach. RESULTS Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained). CONCLUSIONS Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.
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Affiliation(s)
- Enya Lowe
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Alexis Coulourides Kogan
- Family Medicine and Gerontology, Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Alhambra, USA
| | - Corinne T. Feldman
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Sae Byul Ma
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Désirée A. Lie
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
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Boutin-Foster C. R.E.A.C.T: A framework for role modeling anti-racism in the clinical learning environment. MEDICAL TEACHER 2022; 44:1347-1353. [PMID: 35815705 DOI: 10.1080/0142159x.2022.2094231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE In 2020, medical schools across the U.S. were called to task by students who demanded a response to structural racism in medicine. Many medical schools made anti-racism declarations and pledged to promote more inclusive learning environments. Much of the focus was on changing the pre-clinical curriculum and less on the everyday interactions that occur in clinical settings. As medical educators, we have an obligation to reinforce statements of solidarity by role modeling behaviors that demonstrate anti-racism in clinical practice. METHODS This article proposes a framework that provides practical steps for role modeling anti-racism in the clinical learning environment. These steps are drawn from a review of the literature on role modeling, constructs from Social Cognitive Learning Theory, and anti-racism praxis. RESULTS The resulting framework uses the acronym R.E.A.C.T to describe practical steps that include Reflecting on implicit biases, Educating ourselves on historical and current forms of structural racism, Assessing the use of race in clinical practice and asking how racism is impacting a clinical interaction, Calling out behaviors that perpetuate racism, and Treating everyone with dignity and respect. CONCLUSIONS The R.E.A.C.T framework is of value to medical educators because it provides practical steps on role modeling anti-racism in the clinical learning environment. The framework calls medical educators not to merely passively 'react,' but to be introspective, proactive, and intentional in their response to racism. Examples are provided on how each step can be actualized and adapted for different learning environments.
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Affiliation(s)
- Carla Boutin-Foster
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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20
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Liu J, Li S. An ethnographic investigation of medical students' cultural competence development in clinical placements. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10179-7. [PMID: 36371573 DOI: 10.1007/s10459-022-10179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
As a result of an increased understanding of culture's impact on health and healthcare, cultural competence and diversity curricula have been incorporated into many medical programs. However, little is known about how students develop their cultural competence during their training. This ethnographic case study combined participant observation with interviews and focus group to understand students' views and experiences in developing their cultural competence during clinical placements. The results show that students' development of cultural competence is an individually varied process via four distinctive yet interrelated learning avenues. Immersion in a diverse healthcare environment contributes to students' development of cultural awareness and knowledge. Observation of culturally appropriate or inappropriate practices allows students to enhance their practical skills and critical reflection. Interaction with other clinical professionals, patients, and their family members, enables students' engagement within the busy clinical practice. Reflection helps students to actively think about culture's impact on health and internalize the importance of cultural competence. Students' learning via each avenue is interrelated and constantly interacting with their learning environment, which collectively contributes to their development. Integrating the results allowed the authors to generate a theoretical model that conceptualizes medical students' cultural competence development in clinical placements, which unearths students' cultural learning within the informal and hidden curriculum. This study provides a rare view of students' development of cultural competence in clinical placements, which may inform the pedagogic development of cultural competence and diversity education in medicine and healthcare.
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Affiliation(s)
- Jia Liu
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shuangyu Li
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- King's Cultural Competency Unit, Faculty of Arts and Humanities, King's College London, London, UK.
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Haruta J, Takayashiki A, Ozone S, Maeno T, Maeno T. How do medical students learn about SDH in the community? A qualitative study with a realist approach. MEDICAL TEACHER 2022; 44:1165-1172. [PMID: 35583394 DOI: 10.1080/0142159x.2022.2072282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. METHODS A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. RESULTS First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students' confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. CONCLUSION Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Ayumi Takayashiki
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Sachiko Ozone
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Japan
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Japan
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Johnson MW, Gheihman G, Thomas H, Schiff G, Olson APJ, Begin AS. The impact of clinical uncertainty in the graduate medical education (GME) learning environment: A mixed-methods study. MEDICAL TEACHER 2022; 44:1100-1108. [PMID: 35666840 DOI: 10.1080/0142159x.2022.2058383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Uncertainty is ubiquitous in medicine. Studies link intolerance of uncertainty to burnout, ineffective communication, cognitive bias, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical learning environment. We aimed to explore the perceptions and experiences of uncertainty among residents and attendings. METHODS We conducted a mixed-methods study including a survey, semi-structured interviews, and ethnographic observations during rounds with residents and attendings at an academic medical center. The survey included three validated instruments: Physicians' Reaction to Uncertainty Scale; Maslach Burnout Inventory 2-item; and Educational Climate Inventory. RESULTS 35/60 (58%) of eligible residents and 14/21 (67%) attendings completed the survey. Residents reported higher anxiety due to uncertainty than attendings, higher concern about bad outcomes, and greater reluctance to disclose uncertainty to patients. Residents reported increased symptoms of burnout (p < .05). Perceiving the learning environment as more competitive correlated with reluctance to disclose uncertainty (r = -0.44; p < .01). Qualitative themes included: recognizing and facing uncertainty, and consequences for the learning environment. Observations revealed senior clinicians have greater comfort acknowledging uncertainty. CONCLUSIONS Medical curricula should be developed to promote recognition and acknowledgement of uncertainty. Greater acknowledgement of uncertainty, specifically by attendings and senior residents, may positively impact the clinical learning environment.
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Affiliation(s)
- Mark W Johnson
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Galina Gheihman
- Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Horatio Thomas
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Gordon Schiff
- Division of General Internal Medicine, Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School Center for Primary Care, Hospitals and Health Care, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew P J Olson
- Development and Scholarship, Medical Education Outcomes Center, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Arabella Simpkin Begin
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Educational Innovation and Scholarship, Massachusetts General Hospital, Boston, MA, USA
- Internal Medicine Residency at Massachusetts General Hospital, Boston, MA, USA
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Virtual Immersion into a Poorly-Managed Medical Crisis Worsens Subsequent Performance: A Randomized, Controlled Trial. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ayyala MS, Hill J, Traba C, Soto-Greene M, Shiau S, DallaPiazza M. Teaching Health Equity in the Time of COVID-19: a Virtual Look Through the Lens of Structural Racism. J Gen Intern Med 2022; 37:2323-2326. [PMID: 35710672 PMCID: PMC9202964 DOI: 10.1007/s11606-022-07516-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the context of marked health disparities affecting historically marginalized communities, medical schools have an obligation to rapidly scale up COVID-19 education through the lens of structural racism. AIM To develop and implement a virtual curriculum on structural racism in a required COVID-19 course for medical students using "just-in-time" training. SETTING Academic medical institution during the height of COVID-19 in the spring of 2020. PARTICIPANTS Three hundred ninety-three 3rd and 4th-year medical students prior to re-entry into clinical care. PROGRAM DESCRIPTION Three educational sessions focused on (1) racial health disparities, (2) othering and pandemics, and (3) frameworks to address health inequity. The virtual teaching methods included narrated recorded presentations, reflections, and student-facilitated small group dialogue. PROGRAM EVALUATION In matched pre- and post-surveys, participants reported significant changes in their confidence in achieving the learning objectives and high satisfaction with small group peer facilitation. DISCUSSION The use of "just-in-time" training exploring the intersection between COVID-19 and structural racism facilitated the delivery of time-relevant and immediately clinically applicable content as students were preparing to re-enter a transformed clinical space. Similar approaches can be employed to adapt to changing healthcare landscapes as academic medical centers strive to build more equitable health systems.
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Affiliation(s)
- Manasa S Ayyala
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - James Hill
- Office of Student Affairs, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christin Traba
- Office of Education, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Maria Soto-Greene
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle DallaPiazza
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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den Bakker CR, Hendriks RA, Houtlosser M, Dekker FW, Norbart AF. Twelve tips for fostering the next generation of medical teachers. MEDICAL TEACHER 2022; 44:725-729. [PMID: 33886424 DOI: 10.1080/0142159x.2021.1912311] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Medical professionals with a special interest in and focus on education are essential to provide good quality education. Despite high numbers of students expressing an interest in teaching, concerns are rising regarding the supply of medical teachers, with few junior educators on the career ladder. To date, only some medical schools offer in-depth courses to students wanting to explore or aspire a career as a specialised medical teacher. We propose twelve tips for an elective course to foster the next generation of medical teachers. This course aims to enhance theoretical foundations and educational practices to cultivate the next generation of medical teachers.
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Affiliation(s)
- Charlotte R den Bakker
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Renée A Hendriks
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirjam Houtlosser
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriaan F Norbart
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
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Santivasi WL, Nordhues HC, Hafferty FW, Vaa Stelling BE, Ratelle JT, Beckman TJ, Sawatsky AP. Reframing professional identity through navigating tensions during residency: A qualitative study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:93-100. [PMID: 35301685 PMCID: PMC8941044 DOI: 10.1007/s40037-022-00709-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Professional identity formation (PIF) is the internalization of characteristics, values, and norms of the medical profession. An individual's identity formation has both psychological and sociological influences. Social psychology may be useful to explore the interactions between the psychological and sociological aspects of PIF. In this study, we explored how resident physicians navigated tensions between professional ideals and the reality of medical practice to characterize PIF during residency training. METHODS Using constructivist grounded theory, the authors conducted 23 semi-structured interviews with internal medicine residents. Interview transcripts were processed through open coding and analytic memo writing. During data gathering and analysis, the authors utilized Social Cognitive Theory, specifically the bidirectional influence between person, behavior, and context, to analyze relationships among themes. Theoretical insights were refined through group discussion and constant comparison with newly collected data. RESULTS Residents described tensions experienced during residency between pre-existing ideals of "a good doctor" and the realities of medical practice, often challenging residents to reframe their ideals. The authors provide evidence for the presence of dynamic, bidirectional influences between identity (person), behavior, and environment (context), and demonstrate how PIF is informed by a complex interplay between these elements. The authors present two examples to demonstrate how residents reframed their ideals during residency training. DISCUSSION The complex bidirectional influences between person, behavior, and context, informed by SCT, helps illuminate the process of PIF in residency training. This study highlights the effects of the context of residency training on the development of residents' professional identities.
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Affiliation(s)
- Wil L Santivasi
- Center for Palliative Care, Duke University School of Medicine, Durham, NC, USA
| | - Hannah C Nordhues
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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Cheema B, Li M, Ho D, Amari E, Buckley H, Canfield C, Cuncic C, Nimmon L, Van Enk A, Veerapen K, Wisener KM, Holmes CL. Patient-present teaching in the clinic: Effect on agency and professional behaviour. MEDICAL EDUCATION 2022; 56:270-279. [PMID: 34433224 PMCID: PMC9292717 DOI: 10.1111/medu.14623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/16/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND/PURPOSE Although much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient-centred and respectful behaviours in a patient-present learning environment. METHODS We conducted this study in an ambulatory internal medicine clinic using 'patient-present' clinic visits. All case presentations occurred in examination rooms with the patient. We invited participants (attending physicians, undergraduate and postgraduate learners, patients and family members) to participate in semistructured interviews after each clinic visit to explore the impact of the patient-present learning environment. We recruited 34 participants in the study; 10 attending physicians, 12 learners, 10 patients and 2 family members. We analysed the data deductively using a conceptual framework of agency. SUMMARY/RESULTS We identified three major insights: (1) Patients felt engaged and valued opportunities to be heard; (2) Attending physicians and learners reported a more respectful learning environment and a positive though challenging teaching and learning experience; and (3) A hidden curriculum emerged in a performance-based view of professional behaviour. CONCLUSIONS Patient-present teaching engaged patients and enhanced their agency by recasting the patient as the central focus within the healthcare encounter. We identified a tension between performing and learning. This study adds new insights to the concept of patient centredness and professionalism from the perspectives of all participants in the medical teaching and learning environment.
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Affiliation(s)
- Bavenjit Cheema
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Meredith Li
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Daniel Ho
- Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erica Amari
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Heather Buckley
- Department of Family Practice, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Carolyn Canfield
- Department of Family PracticeUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cary Cuncic
- Division of General Internal Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Laura Nimmon
- Centre for Health Education Scholarship and Department of Occupational Science and Occupational TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anneke Van Enk
- Department for Innovation in Medical EducationUniversity of OttawaOttawaOntarioCanada
| | - Kiran Veerapen
- Office of Faculty Development and Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Katherine M. Wisener
- Office of Faculty Development, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Lynn Holmes
- Undergraduate Medical Education and the Division of Critical Care, Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Shaw S, Chawla N, Singhal A. Role modeling: A powerful tool to imbibe professionalism in medical practice. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Moonaghi H, Abbaspour H, Kareshki H, Esmaeili H. Positive consequences of the hidden curriculum in undergraduate nursing education: An integrative review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2022; 27:169-180. [PMID: 36237954 PMCID: PMC9552589 DOI: 10.4103/ijnmr.ijnmr_325_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022]
Abstract
Background: Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education. Materials and Methods: A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology. Results: Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity. Conclusions: Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.
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van Ments L, Treur J. Reflections on dynamics, adaptation and control: A cognitive architecture for mental models. COGN SYST RES 2021. [DOI: 10.1016/j.cogsys.2021.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zickuhr L, Kolfenbach J, Bolster MB. Applying Educational Theory to Optimize Trainee Education in the Ambulatory Virtual Care Environment. MEDICAL SCIENCE EDUCATOR 2021; 31:1715-1722. [PMID: 34422453 PMCID: PMC8370462 DOI: 10.1007/s40670-021-01365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/10/2023]
Abstract
Virtual care (VC) encounters have become an essential part of outpatient clinical care. The theory of situated learning and legitimate peripheral participation posits that medical trainees learn best when they participate in authentic patient care experiences and engage effectively with their preceptors, members of the health care team, and the clinical learning environment. This theory can provide a framework from which to approach teaching in the VC setting, whereby preceptors may capitalize on the unique learning and assessment opportunities provided during VC encounters and optimize educational experiences for trainees as well as clinical outcomes for patients. In this monograph, we propose an approach grounded in situated learning and legitimate peripheral participation for teaching in the VC environment, particularly during real-time video visits.
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Affiliation(s)
- Lisa Zickuhr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Jason Kolfenbach
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Marcy B. Bolster
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
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Griffith S, Gelling L. How do hospice nurses prepare to give end-of-life care? A grounded theory study of nurses in one UK hospice. Int J Palliat Nurs 2021; 27:334-350. [PMID: 34569281 DOI: 10.12968/ijpn.2021.27.7.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Literature for preparing hospice nurses to deliver end-of-life care is sparse. AIM To investigate how nurses in one UK hospice prepared to deliver end-of-life care in their role. METHODS A classic grounded theory approach was used to investigate the experiences of 22 registered nurses in one UK hospice, to discover how they prepared for their role. A total of 17 individual interviews and one focus group were conducted. Constant comparison of data and member checking were performed to establish validity. FINDINGS Findings were synthesised into five categories: the 'shared ideal', feeling good at the job, making a difference, experience/exposure to hospice work and the importance of role models. The shared ideal formed the core category, which explained how hospice nurses feel a sense of 'fit' with their work. CONCLUSION The feeling of a nurse feeling well-suited to the work and that there the work was a good 'fit' for them was identified as a core element to nurses' feelings of preparedness to provide end-of-life care.
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Affiliation(s)
- Sue Griffith
- Education Department, Farleigh Hospice, Chelmsford, Essex, UK
| | - Leslie Gelling
- Department of Nursing Science, Bournemouth University, Bournemouth, UK
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Modeling learner-controlled mental model learning processes by a second-order adaptive network model. PLoS One 2021; 16:e0255503. [PMID: 34428234 PMCID: PMC8384201 DOI: 10.1371/journal.pone.0255503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022] Open
Abstract
Learning knowledge or skills usually is considered to be based on the formation of an adequate internal mental model as a specific type of mental network. The learning process for such a mental model conceptualised as a mental network, is a form of (first-order) mental network adaptation. Such learning often integrates learning by observation and learning by instruction. For an effective learning process, an appropriate timing of these different elements is crucial. By controlling the timing of them, the mental network adaptation process becomes adaptive itself, which is called second-order mental network adaptation. In this paper, a second-order adaptive mental network model is proposed addressing this. The first-order adaptation process models the learning process of mental models and the second-order adaptation process controls the timing of the elements of this learning process. It is illustrated by a case study for the learner-controlled mental model learning in the context of driving a car. Here the learner is in control of the integration of learning by observation and learning by instruction.
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Newsome AS, Ku P, Murray B, Smith SE, Powell RM, Hawkins WA, Branan TN, Bland CM. Kindling the fire: The power of mentorship. Am J Health Syst Pharm 2021; 78:2271-2276. [PMID: 34293082 PMCID: PMC8406889 DOI: 10.1093/ajhp/zxab295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, and Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Pam Ku
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | - Brian Murray
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Rebecca Martin Powell
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - W Anthony Hawkins
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, andDepartment of Pharmacology and Toxicology, Medical College of Georgia at Augusta University, Albany, GA, USA
| | - Trisha N Branan
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA, and St. Joseph's/Candler Health System, Savannah, GA, USA
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Shikama Y, Chiba Y, Yasuda M, Stanyon M, Otani K. The use of text mining to detect key shifts in Japanese first-year medical student professional identity formation through early exposure to non-healthcare hospital staff. BMC MEDICAL EDUCATION 2021; 21:389. [PMID: 34284770 PMCID: PMC8293517 DOI: 10.1186/s12909-021-02818-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/04/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Professional identity formation is nurtured through socialization, driven by interaction with role models, and supported through early clinical exposure (ECE) programmes. Non-healthcare professionals form part of the hospital community but are external to the culture of medicine, with their potential as role models unexplored. We employed text mining of student reflective assignments to explore the impact of socialization with non-healthcare professionals during ECE. METHODS Assignments from 259 first-year medical students at Fukushima Medical University, Japan, underwent hierarchical cluster analysis. Interrelationships between the most-frequently-occurring words were analysed to create coding rules, which were applied to elucidate underlying themes. RESULTS A shift in terms describing professional characteristics was detected, from "knowledge/skill" towards "pride [in one's work]" and "responsibility". Seven themes emerged: contribution of non-healthcare professionals, diversity of occupation, pride, responsibility, teamwork, patient care and gratitude. Students mentioning 'contribution of non-healthcare professionals' spoke of altruistic dedication and strong sense of purpose. These students expressed gratitude towards non-healthcare professionals for supporting clinical work, from a doctor's perspective. CONCLUSION Socialization with non-healthcare professionals provides important insights into the hospital working environment and cultural working norms. Through role modelling altruism and responsibility, non-healthcare professionals positively influenced student professional identity formation, promoting self-conceptualisation as a doctor.
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Affiliation(s)
- Yayoi Shikama
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yasuko Chiba
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Megumi Yasuda
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Maham Stanyon
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koji Otani
- Center for Medical Education and Career Development, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Bashir A, McTaggart IJ. Importance of faculty role modelling for teaching professionalism to medical students: Individual versus institutional responsibility. J Taibah Univ Med Sci 2021; 17:112-119. [PMID: 35140573 PMCID: PMC8802861 DOI: 10.1016/j.jtumed.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Adeela Bashir
- Department of Health Professions Education, National University of Medical Sciences, Pakistan
- Corresponding address: Department of Health Professions Education, National University of Medical Sciences, The Mall, Abid Majeed Road, Rawalpindi, Punjab, 46000, Pakistan.
| | - Irene J. McTaggart
- Centre of Medical Education, Ninewells Hospital, University of Dundee, Scotland, United Kingdom
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Abstract
Perioperative medicine can pose myriad challenges to professionalism and ethical practice. Medicine is a science, but definite end points, and predictable results and outcomes do not consistently occur. There is the potential for error during all steps of a patient's assessment and treatment. Examination findings, laboratory investigations, diagnosis, plans for and outcomes of surgery and long-term outcomes can all be uncertain and/or not meet expectations. Factors including pressures in the workplace, conflicts, ego, prescribed guidelines and pathways, the need to achieve healthcare targets, desire for autonomy and need to maintain multidisciplinary involvement in patient care can lead to an environment in which it is challenging for professionalism and ethics to thrive.
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Affiliation(s)
- Bid Kumar
- Department of Obstetrics and Gynaecology, Women's Directorate, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, North Wales, UK
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Mostafavi F, Zamani-Alavijeh F, Mansourian M, Bastami F. The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:22. [PMID: 33962686 PMCID: PMC8106147 DOI: 10.1186/s41043-021-00245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students. METHODS This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran. RESULTS The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05). CONCLUSION Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack. TRIAL REGISTRATION The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.
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Affiliation(s)
- Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistic, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Bastami
- Department of Public Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
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Mohammadi E, Mirzazadeh A, Shahsavari H, Sohrabpour AA. Clinical teachers' perceptions of role modeling: a qualitative study. BMC MEDICAL EDUCATION 2021; 21:261. [PMID: 33957904 PMCID: PMC8101106 DOI: 10.1186/s12909-021-02648-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/05/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND Role modeling has been significantly considered in medical education in recent decades. In the clinical course, students learn necessary skills and accordingly their professional identity is formed by observing and working among clinical educators. Given the importance of the role modeling in medical education, in the present study, it was attempted to explore the clinical teachers' perceptions of being a role model for medical students using a qualitative method. METHODS A qualitative design, based on the content analysis approach, was used to analyze the perspectives of 15 clinical teachers. Participants were chosen by purposeful sampling. Data were collected using reflection paper writing. RESULTS During the data analysis, five main categories emerged: influencing others, developing different dimensions of student, situational self-awareness, feedback and continuous effort. CONCLUSIONS This study will be useful to form role modeling educational programs. Encouraging clinical teachers to make continuous efforts to improve role modeling and educating time management and self-control skills can help reduce the challenges of role modeling for clinical teachers.
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Affiliation(s)
- Elaheh Mohammadi
- Education Development Center, Tehran University of Medical Sciences, Tehran, Iran
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azim Mirzazadeh
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Medical-Surgical Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Sohrabpour
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Rozental L, Meitar D, Karnieli-Miller O. Medical students' experiences and needs from written reflective journal feedback. MEDICAL EDUCATION 2021; 55:505-517. [PMID: 33141960 DOI: 10.1111/medu.14406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Reflective ability is an important skill for enhancing professionalism and developing communication skills. To improve reflective ability, medical educators encourage use of written reflective journals, for which feedback is important. It is difficult for educators to anticipate how their feedback will be perceived. Therefore, this study examined students' experiences with educators' written feedback on reflective journals. METHODS A qualitative, immersion/crystallization analysis of 60 written feedback texts to 15 medical students (30 identified by students as meaningful and 30 as less meaningful) and in-depth semi-structured interviews with these students. We did not define 'meaningful', to leave room for students' own interpretations. We analysed the feedback to identify what it includes (its components) and analysed the interviews to learn about students' experiences of receiving the feedback and the specific components. RESULTS Students experienced five components as meaningful: supportive and encouraging statements; legitimisation of their emotions; educators sharing personal-professional experiences; asking questions to enhance reflection; and focusing on the students' main concern. These components enhanced students' willingness to read and learn from the feedback. Three components were experienced as less meaningful: detached, impersonal feedback; negative tone (criticism); and technical issues, for example brevity. These disappointing and hurtful components led students to pay less attention to the feedback or to invest less effort in future written assignments. CONCLUSIONS The present study identified components in written reflective journal feedback texts and the experience and needs of students who received them. It showed the complexity of writing reflective feedback because of the need to support students through it, help them deal with emotions, identify and focus on personal content that matters to them, and provide opportunities to develop and enhance their reflective ability, while being mindful of their emotional state. To help educators in this challenging task, a self-assessment mnemonic ('FEEDBACK') for use before sending the initial feedback was developed.
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Affiliation(s)
- Lior Rozental
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Meitar
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Karnieli-Miller
- Department of Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mohammadi E, Mortaz Hejri S, Sohrabpour AA, Mirzazadeh A, Shahsavari H. Exploring clinical educators' perceptions of role modeling after participating in a role modeling educational program. MEDICAL TEACHER 2021; 43:397-403. [PMID: 33226884 DOI: 10.1080/0142159x.2020.1849590] [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] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Role modeling significantly affects medical students' values, attitudes, and professional behaviors. Role modeling is a complex and multidimensional process that necessitates accurate perception and adequate knowledge and skills. However, most clinical educators do not have adequate awareness and knowledge about the positive and negative effects of role modeling. We aimed to explore clinical educators' perceptions of role modeling after participating in a role modeling educational program. METHODS This qualitative study was conducted on eighteen clinical educators who were voluntarily participated in a three-month role modeling educational program. Data were collected using reflection paper writing and were analyzed through conventional content analysis. RESULTS Data analysis resulted in the development of three main categories, namely closer attention to role modeling and effort for its promotion, deliberate effort to display role modeling, and creating a positive environment to increase the effectiveness of role modeling. CONCLUSIONS Clinical educators have limited role modeling knowledge and skills, and hence, educational programs are required to improve their role modeling knowledge, attitudes, and skills. Role modeling educational programs should aim at developing educators' awareness and knowledge about role modeling, develop their reflection and self-control abilities, and sensitize them to the importance of deliberate use of role modeling.
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Affiliation(s)
- Elaheh Mohammadi
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Mortaz Hejri
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Sohrabpour
- Liver and Pancreatobiliary Diseases Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azim Mirzazadeh
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Medical-Surgical Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Randa MB. An Exploration of Absenteeism among Nursing Students in the context of a South African University. Open Nurs J 2020. [DOI: 10.2174/1874434602014010285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Absenteeism among university and college students is a global challenge. Not only does absenteeism result in inadequate learning, but it also disrupts the way in which classes are conducted.
Objective:
The study sought to explore and understand the reasons for absenteeism from the perspectives of the nursing students in the context of a South African University.
Methods:
The study used an explorative qualitative design to conduct four focus group discussions with undergraduate nursing students. Tesch’s method of data analysis was followed.
Results:
One theme and four sub-themes emerged, such as the negative attitudes of lecturers, poor guidance and lack of prompt feedback from lecturers, lack of commitment from lecturers and classes starting late, and inability of the students to cope with the workload.
Conclusion:
The study revealed that the main reasons for the students’ absenteeism from scheduled learning experiences were related to the lecturers’ behaviour and practices. The poor lecturer-student relationship discouraged the students from attending classes.
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Le‐Bucklin K, Youm J, Wiechmann W, McRae D, Boysen‐Osborn M, Vega C, Park S. #
MD
sToo: A student mistreatment prevention curriculum for faculty members and residents. CLINICAL TEACHER 2020; 17:700-704. [DOI: 10.1111/tct.13211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Julie Youm
- University of California Irvine School of Medicine Irvine California USA
| | - Warren Wiechmann
- University of California Irvine School of Medicine Irvine California USA
| | - Deena McRae
- University of California Irvine School of Medicine Irvine California USA
| | | | - Charles Vega
- University of California Irvine School of Medicine Irvine California USA
| | - Sharon Park
- Sharon Park Johns Hopkins University School of Education Baltimore Maryland USA
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Oliver TL, Shenkman R, Diewald LK, Dowdell EB. Nursing students' perspectives on observed weight bias in healthcare settings: A qualitative study. Nurs Forum 2020; 56:58-65. [PMID: 33155694 DOI: 10.1111/nuf.12522] [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] [Received: 09/18/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Weight bias continues to be problematic within the healthcare setting among practicing healthcare providers (HCPs). These HCPs serve as influential role models for nursing students when immersed in the clinical environment. However, if HCPs are demonstrating bias toward patients with obesity, this may influence nursing students' beliefs and practices. AIMS This study aimed to explore nursing students' reflections of observed weight bias within the healthcare setting. MATERIALS & METHODS A descriptive qualitative study design was used involving reflective journaling and qualitative content analysis. Two cohorts of third-year baccalaureate nursing students (n = 197) participated in weight sensitivity training and submitted reflective journals over one academic semester. RESULTS Reports of weight bias were categorized into three themes-(1) Direct Impact: Observed Implicit and Explicit Provider Weight Bias; (2) Indirect Impact: Weight Bias Due to Skills, Equipment, or Staffing/Environmental Deficits; and (3) Reactions toward HCP Weight Bias: Conflict Between Weight Bias Training and Real-World Healthcare Experiences. DISCUSSION Weight bias was observed in some HCPs within the healthcare setting. Student reflections explored weight bias and the opposing messages between weight sensitivity training and real-world practices. CONCLUSION Preventing bias through continuing education for HCPs is crucial to provide compassionate care and instill ethical values in the next generation nurses.
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Affiliation(s)
- Tracy L Oliver
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Rebecca Shenkman
- MacDonald Center for Obesity Prevention and Education, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Lisa K Diewald
- MacDonald Center for Obesity Prevention and Education, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Elizabeth B Dowdell
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
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Midwifery students’ perspectives on how role models contribute to becoming a midwife: A qualitative study. Women Birth 2020; 33:433-439. [DOI: 10.1016/j.wombi.2019.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022]
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47
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Crowther LL, Robertson N, Anderson ES. Mindfulness for undergraduate health and social care professional students: Findings from a qualitative scoping review using the 3P model. MEDICAL EDUCATION 2020; 54:796-810. [PMID: 32163615 DOI: 10.1111/medu.14150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT With many health and social care schools offering mindfulness training (MT) there is a need for deeper understanding about pedagogical issues. Despite encouraging findings showing relationships between MT and student stress reduction, there is little qualitative synthesis of the literature about best principles for teaching and learning. METHODS We report on a qualitative scoping review using the stages of Arksey and O'Malley's framework. The search identified papers from MEDLINE, PsychINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and SCOPUS over 15 years. The included papers were synthesised using the 3P model of teaching and learning to explore current MT for presage (teaching set-up), process (teaching delivery) and product (outcomes) factors. RESULTS A total of 16 articles were included in the review. There was a lack of consensus on definition of MT, facilitator training and the intervention used. The majority of studies involved small self-selected, mainly female cohorts. For the set-up (presage factors), the majority of curricula included MT for stress management and well-being, delivered in the early years. Providing appropriate facilitators was a concern, whereas process factors revealed enormous variability in delivery. Few studies had formal assessment, although many had outcome evaluation measures (product factors). CONCLUSIONS The qualitative review has highlighted additional benefits from MT aside from stress reduction; most noticeably, student self-awareness, peer cohesion and group support, ability to attend to patients, and student insights into health and social education culture. Seeking presage, process and product factors has illuminated variability in how MT is being adapted within health and social care curricula. This review highlights the next steps and recommendations for the future.
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Leahy E, Chipchase L, Calo M, Blackstock FC. Which Learning Activities Enhance Physical Therapist Practice? Part 2: Systematic Review of Qualitative Studies and Thematic Synthesis. Phys Ther 2020; 100:1484-1501. [PMID: 32529234 DOI: 10.1093/ptj/pzaa108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Post-professional physical therapy expertise requires career-long participation in learning activities. Understanding physical therapists' lived experience of learning activities provides novel insight into how best to enhance physical therapist practice from the perspective of the learner. The purpose of this study was to explore qualified physical therapists' experiences, beliefs, and perspectives with regard to learning activities and professional development. METHODS Eight databases were searched for studies published from inception through December 2018. Study selection included mixed-methods and qualitative studies exploring physical therapists' experiences, perspectives, beliefs, and attitudes. Thematic synthesis was performed, and the GRADE-Confidence in the Evidence from Reviews of Qualitative research was used to assess the level of confidence in the findings. A total 41 studies with 719 participants were included. RESULTS The key findings include physical therapists' perceptions that worthwhile post-professional learning requires more than attendance at professional development courses. Physical therapists perceived that worthwhile learning requires connection with others and being "taken out of one's comfort zone." Sufficient time and accessible, trustworthy resources were also valued. CONCLUSIONS Moderate- to low-level evidence suggests that the choice of professional development activities and education design for qualified physical therapists should consider the inclusion of connected activities, activities that take participants out of comfort zones, time to practice, and trustworthy resources that are easily accessible. Future research should evaluate the effectiveness of learning activities encompassing these factors, prioritizing those that minimize the barriers of time and distance. IMPACT This study adds to the profession's understanding of physical therapists' lived experience of learning activities, providing novel insight into how best to enhance physical therapist practice from the perspective of the learner.
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Affiliation(s)
- Edmund Leahy
- BPhysio, MPhty(Musc),, Department of Physiotherapy, School of Science and Health, Western Sydney University, Campbelltown, New South Wales, Australia; Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and Physiotherapy Department, Northern Health, Epping, Victoria, Australia
| | - Lucy Chipchase
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Marlena Calo
- B.Physiotherapy, PGCErt (PFPhysio), Department of Physiotherapy, School of Science and Health, Western Sydney University; and Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, La Trobe University
| | - Felicity C Blackstock
- Department of Physiotherapy, School of Science and Health, Western Sydney University
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Leyland R, Heath M, Neve H, Maynard V. Structured reflection on shared decision making. CLINICAL TEACHER 2020; 18:55-61. [PMID: 32815256 DOI: 10.1111/tct.13233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shared decision making (SDM), whereby patients and clinicians work collaboratively to make health care decisions, brings multiple benefits. It has, however, been slow to integrate into clinical practice. There are some examples of SDM being embedded and evaluated within medical undergraduate curricula but, despite role models being important in promoting students' patient-centred attitudes, these examples do not involve students reflecting on clinicians' use of SDM in practice. METHODS We undertook a qualitative evaluation of a small group educational intervention. A key element was the students' use of a structured reflective template, drawing on the SHARE (seek, help, assess, reach, evaluate) SDM tool, to analyse examples of clinicians using SDM in practice critically. We undertook a thematic analysis of students' completed templates and evaluated their engagement with the SHARE tool. FINDINGS A total of 44 templates were analysed. Four main themes were identified, including new learning about SDM, noticing and deconstructing SDM, participants' responses to SDM and struggles in learning. Students were positive about SHARE and used it to critique experiences and suggest specific ways that clinicians could have improved SDM. DISCUSSION A structured training intervention that promotes critical reflection on clinical role models can help to shift undergraduate medical students' understanding of, and attitudes towards, SDM. The ethical arguments for SDM, evidence for its benefits and the alignment of SDM with participants' own core values appeared to help achieve student 'buy in'. Students struggled with notions of power, risk and time constraints, and empathised with both patients and clinicians. They highlighted the scarcity of SDM in practice.
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Affiliation(s)
- Rachel Leyland
- Plymouth University Schools of Medicine and Dentistry, Plymouth, Devon, UK
| | - Miranda Heath
- Plymouth University Schools of Medicine and Dentistry, Plymouth, Devon, UK
| | - Hilary Neve
- Plymouth University Schools of Medicine and Dentistry, Plymouth, Devon, UK
| | - Veronica Maynard
- Plymouth University Schools of Medicine and Dentistry, Plymouth, Devon, UK
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Ricotta DN, Freed JA, Hale AJ. Things We Do for No Reason™: Card Flipping Rounds. J Hosp Med 2020; 15:498-501. [PMID: 32118567 DOI: 10.12788/jhm.3374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022]
Abstract
Inspired by the ABIM Foundation's Choosing Wisely® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.
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Affiliation(s)
- Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts
| | - Jason A Freed
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Andrew J Hale
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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