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Gupta S, Howden S, Moffat M, Pope L, Kennedy C. Placement or displacement: An ethnographic study of space in the clinical learning environment. MEDICAL TEACHER 2024; 46:672-681. [PMID: 37910032 DOI: 10.1080/0142159x.2023.2273783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE This paper aims to examine the spatial attributes in the hospital ward environment and their impact on medical students' learning and experience of the clinical workplace. MATERIALS AND METHODS An ethnographic study was conducted in a Scottish teaching hospital, combining observations and interviews over a period of 10 months. Two teaching wards served as the field-sites where approximately 120 h of non-participant observations took place sequentially. In addition, 34 individual interviews were conducted with identified key informants that included medical students, junior doctors, postgraduate trainees, consultant supervisors, ward nurses and hospital pharmacist. A combination of Actor-network Theory (ANT) and Social cognitive theory (SCT) was applied to analyse data pertaining to spatial attributes and their relevance to clinical teaching and learning. RESULTS Analysis of the observational and interview data led to generation of the following themes: spatial attributes in the clinical workplace can enable or constrain teaching and learning opportunities, inadequate spaces impact students' and junior doctors' sense of value, short clinical rotations influence a sense of ownership of doctors' spaces, and contested nature of space in the clinical environment. Several illustrations of the field-sites help to contextualise the themes and aid in understanding the participants' experiences and perceptions. CONCLUSIONS Our findings suggest a complex entanglement of space with medical students learning and wellbeing in the clinical workplace. Provision of suitable spaces needs to be a core consideration to realise the full potential of work-based learning in medicine.
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Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, UK
| | - Stella Howden
- Learning and Teaching Academy, Herriot-Watt University, Edinburgh, UK
| | - Mandy Moffat
- School of Medicine, University of Dundee, Dundee, UK
| | - Lindsey Pope
- School of Medicine Dentistry and Nursing, University of Glasgow Medical School, Glasgow, UK
| | - Cate Kennedy
- School of Medicine, University of Dundee, Dundee, UK
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Gupta S, Howden S, Moffat M, Pope L, Kennedy C. Connecting the complex chemistry of space in medical education. MEDICAL EDUCATION 2023; 57:1187-1190. [PMID: 37300515 DOI: 10.1111/medu.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
In the latest Medical Education Connections piece, Gupta et al. juxtapose four recent articles to outline the complex chemistry of space in medical education.
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Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, UK
| | - Stella Howden
- Learning and Teaching Academy, Herriot-Watt University, Edinburgh, UK
| | - Mandy Moffat
- School of Medicine, University of Dundee, Dundee, UK
| | - Lindsey Pope
- University of Glasgow Medical School, Glasgow, UK
| | - Cate Kennedy
- School of Medicine, University of Dundee, Dundee, UK
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [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: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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Dodsworth A, Munro K, Alberti H, Hirsh DA, Paes P, Illing J. Patient outcomes in a Longitudinal Integrated Clerkship: A systematic literature review. MEDICAL EDUCATION 2023; 57:820-832. [PMID: 36573064 DOI: 10.1111/medu.15013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
CONTEXT Patient-student relationships are at the heart of Longitudinal Integrated Clerkships (LICs). Outcomes for students and preceptors are beneficial, but patient outcomes remain unclear. This systematic literature review explored the current evidence base of patient outcomes in an LIC. Patient outcomes were defined as issues related to patient safety, clinical effectiveness or patient experience. METHODS Seven bibliographic databases were searched. A wider search strategy included a hand search of three medical education journals' previous issues and backward/forward citation searching of included studies and of a relevant systematic review. Included studies were quality appraised and assessed for their strength and level of evidence. A qualitative data synthesis was performed. RESULTS Databases searches identified 7237 titles. Following the removal of duplicates, titles and abstracts were reviewed against the inclusion criteria. Forty-eight studies had a full-text review. Nineteen met the inclusion criteria. Seven studies were included from the wider search strategy. From the 26 included studies, two major themes were identified. (1) 'A trusting patient-student relationship' contains the sub-themes: 'care and compassion', 'patient education and empowerment' and 'the loss of the student as 'my' doctor'. (2) 'The student acts as an agent of change for the patient' contains the sub-themes: 'patient advocacy', 'supporting the patient to navigate the healthcare system', 'communication between patient and healthcare professional' and 'enhancement of preceptors' care, healthcare services and communities'. CONCLUSIONS LICs provide educational continuity allowing the creation of a trusting patient-student relationship. This relationship leads to students becoming agents of change for patients by enhancing patient outcomes. This review provides further evidence on the benefits of having an LIC as part of the medical education curricula and implications for its successful delivery. Further research is needed to explore educationally induced benefits for patients and look at objective assessments of patient health outcomes.
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Affiliation(s)
- Alastair Dodsworth
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northumbria General Practice Training Programme, Health Education England North East and Cumbria, Newcastle upon Tyne, UK
| | - Katie Munro
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - David A Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Paul Paes
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Illing
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- RCSI University of Medicine Health Sciences, Dublin, Ireland
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Liu X, Du J, Liu X, Tang N. Application of Nursing Intervention Based on Nel Noddings Care Theory for School-Aged Asthmatic Children. Am J Health Behav 2023; 47:130-138. [PMID: 36945093 DOI: 10.5993/ajhb.47.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: The objective of this study was to examine the effect of nursing intervention based on Nel Noddings care theory on self-management behavior and symptomatic improvement in school-age asthmatic children in China. Methods: In this study, a sample of 100 school-aged children suffering from asthma was chosen, and divided into two groups: observation group and control group. Both groups received routine nursing but the observation group was combined with nursing intervention based on Nel Noddings theory.Results:The total scores of social psychologies, daily life, disease medicine and self-management in the observation group before intervention were similar to those in the control group. The self-management scores of the observation group after intervention were higher than those of the control group. The improvement time of wheezing and cough in the observation group was shorter than that in the control group. The total number of complete compliance and partial compliance in the observation group was higher than that in the control group. Conclusion: The application of nursing intervention based on Nel Noddings care theory to the nursing of school-age asthmatic children can improve the self-management ability of children, promote the recovery of cough, wheezing and other symptoms, and is of great significance to improve the compliance and nursing effect of children, with high popularization and application value.
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Affiliation(s)
- Xuelian Liu
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Junying Du
- Child Health Clinic, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaoyan Liu
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China; lxy1234567202204@163. com
| | - Na Tang
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China;,
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Shagrin BS, Gheihman G, Sullivan AM, Li H, Hirsh DA. Faculty perspectives on facilitating medical students' longitudinal learning: A mixed-methods study. MEDICAL EDUCATION 2022; 56:1002-1016. [PMID: 35599241 DOI: 10.1111/medu.14842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Medical students' longitudinal care of patients supports clinical learning and promotes patient-centredness. The literature presents little empirically derived guidance for faculty to facilitate students' longitudinal learning and care. Informed by the conceptual framework of relational learning, this study investigated faculty perspectives about longitudinal teaching, their strategies for facilitating students' longitudinal learning and perceived barriers and enablers. METHODS Using a convergent mixed-methods approach at a single academic medical centre, the authors conducted a survey and two focus groups in 2018-2019 with faculty members teaching in three longitudinal clinical courses. Quantitative analyses included descriptive statistics and chi-square tests. Qualitative content analysis described deductive categories and identified inductive themes. RESULTS Forty-three eligible faculty (69%) completed the survey. Ninety-one percent (n = 39) reported that teaching in a longitudinal model enhanced their experience as preceptors. Faculty described activities students performed to provide longitudinal care: spending time with patients independently (n = 38, 88%), making follow-up phone calls (n = 35; 81%) and participating in home- and community-based visits (n = 20, 47%), among others. Twelve faculty participated in two focus groups. Deductive analysis characterised strategies for facilitating students' longitudinal learning and barriers and enablers. Strategies included "encouraging students to follow patients," "faculty adaptability," "offering guidance and setting expectations," and "careful patient selection." Barriers included scheduling limitations, and enablers included student initiative. Inductive analysis identified two themes: faculty goals for students and faculty benefits from teaching. Goals included meaningful engagement with patients and their illness over time. Benefits from teaching included personal gratification, mentorship, and holistic student assessment. DISCUSSION Our survey and focus group findings demonstrated positive faculty attitudes and experiences, characterised faculty goals and approaches, and identified elements of the educational context that hindered or facilitated longitudinal teaching and learning. This study's faculty perspectives build upon prior investigations of students' and patients' perspectives, offer teaching strategies, and may guide faculty development.
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Affiliation(s)
- Bianca S Shagrin
- Cambridge Integrated Clerkship, Harvard Medical School/Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Galina Gheihman
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy M Sullivan
- Shapiro Institute for Education and Research, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - David A Hirsh
- Cambridge Integrated Clerkship, Harvard Medical School/Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Chow CJ, Hirshfield LE, Wyatt TR. Sharpening Our Tools: Conducting Medical Education Research Using Critical Theory. TEACHING AND LEARNING IN MEDICINE 2022; 34:285-294. [PMID: 34282701 DOI: 10.1080/10401334.2021.1946401] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Issue: As medical education continues to grapple with issues of systemic racism and oppression within its institutions, educational researchers will undoubtedly turn to critical theory to help illuminate these issues. Critical theory refers both to a "school of thought" and a process of critique that reveals the dynamic forces impacting minoritized groups and individuals. Critical theory can be helpful when researchers want to examine or expose social structures for their asymmetrical power differentials, and subsequently act upon them to create change. Evidence: However, despite the repeated calls for more critical work in medical education, merely describing critical theory's school of thought has not forwarded researchers' engagement with these theories. Presently, critical analyses remain rare in medical education. One potential reason for the lack of critical analyses is that there is little guidance for how researchers might engage with their data and approach their findings. Implications: In this paper, we go beyond merely describing critical theory and demonstrate how critical theory can be used as an analytic approach to interrogate the experiences of minoritized individuals in medical education. Using three critical theories: critical race theory, feminist theory, and postcolonial theory, we provide an illustration of how researchers might approach their data using one of three critical theories. In doing so, we hope to assist researchers in better understanding the utility of critical analyses to illuminate sociohistorical forces at work within medical education.
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Affiliation(s)
- Candace J Chow
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Laura E Hirshfield
- Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Balmer DF, Richards BF. Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:277-288. [PMID: 34460054 DOI: 10.1007/s10459-021-10068-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA, 19104, USA.
| | - Boyd F Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Gheihman G, Callahan DG, Onyango J, Gooding HC, Hirsh DA. Coproducing clinical curricula in undergraduate medical education: Student and faculty experiences in longitudinal integrated clerkships. MEDICAL TEACHER 2021; 43:1267-1277. [PMID: 34129424 DOI: 10.1080/0142159x.2021.1935825] [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] [Indexed: 06/12/2023]
Abstract
PURPOSE Educational coproduction, in which learners partner with educators to create and improve their educational experiences, can facilitate student-centered medical education. Empirical descriptions of best practices for involving students in clinical curricular coproduction are needed. We aimed to understand faculty and student perspectives on methods, perceived benefits, and common barriers and solutions to clinical curricular coproduction. METHODS We conducted an international mixed-methods study of clinical curricular coproduction in undergraduate medical education and longitudinal integrated clerkships specifically. Faculty and students identified through an international listserv received an electronic survey to identify methods, benefits, and challenges of clinical curricular coproduction. We conducted semi-structured interviews with a subset of survey participants. We present descriptive statistics for survey data and themes derived from inductive qualitative analysis. RESULTS Two hundred forty-seven individuals (104 faculty; 143 students) representing 52 medical schools in eight countries completed the survey. Methods for clinical curricular coproduction ranged from informal, low-intensity learner involvement (e.g. verbal feedback) to formal, high-intensity learner involvement (e.g. committee membership). Perceived benefits included improvements in student-faculty relationships, program culture and design, and student development. Structural issues (e.g. scheduling) were the most common perceived barriers. CONCLUSIONS Clinical curricular coproduction among faculty and students is perceived to enhance collaboration, enable curriculum change, and support students' professional development. Our study offers empirical guidance for involving students as partners in clinical curricular coproduction.
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Affiliation(s)
- Galina Gheihman
- Departments of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA, USA
| | - Dana G Callahan
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | | | - David A Hirsh
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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Brown MEL, Proudfoot A, Mayat NY, Finn GM. A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1229-1253. [PMID: 33847851 PMCID: PMC8452574 DOI: 10.1007/s10459-021-10046-x] [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: 07/20/2020] [Accepted: 03/22/2021] [Indexed: 06/02/2023]
Abstract
Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK.
| | - Amy Proudfoot
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Nabilah Y Mayat
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Brown MEL, Whybrow P, Kirwan G, Finn GM. Professional identity formation within longitudinal integrated clerkships: A scoping review. MEDICAL EDUCATION 2021; 55:912-924. [PMID: 33529395 DOI: 10.1111/medu.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Although the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research. METHOD In 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis. RESULTS 849 articles were identified following an extensive search. 131 articles were selected for full-text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity. CONCLUSIONS This scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co-providers of patient care. There are suggestions that LICs encourage the development of an 'ethic of caring'. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Paul Whybrow
- Academy for Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | | | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Lefkowitz A, Meitar D, Kuper A. Can doctors be taught virtue? J Eval Clin Pract 2021; 27:543-548. [PMID: 32323428 DOI: 10.1111/jep.13398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/30/2022]
Abstract
Medical schools and residency programs have become very adept at teaching medical students and residents an enormous amount of information. However, it is much less clear whether they are effective at fostering virtuous qualities like empathy or professionalism in trainees. This would come as no surprise to Plato, who famously argued in the Meno that virtue cannot be taught. This pedagogical challenge threatens to stymie medical educators, who increasingly recognize the importance of professionalism, compassion, and empathy in the practice of good medicine. As medical educators, we are motivated to demonstrate that virtue is teachable and to find a way to do so, as this is how we will be able to improve the conduct of physicians and the quality of their care of patients. As such, we address the question of the teachability of virtue in the realm of medicine, analysing Plato's contradictory analyses in the Meno and Protagoras, and drawing upon modern neuroscience to turn an empirical lens on the question. We explore the ways in which Noddings' Ethic of Care may offer a way forward for medical educators keen to foster virtue in trainees. We conclude by demonstrating how, by harnessing the power of caring relationships, the principles of Noddings' Ethic of Care have already been applied to medical education at a university in Israel.
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Affiliation(s)
- Ariel Lefkowitz
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dafna Meitar
- Department of Medical Education, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Delston JB. The Ethics and Politics of Microaffirmations. PHILOSOPHY OF MANAGEMENT 2021. [DOI: 10.1007/s40926-021-00169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A Qualitative Approach to Understanding the Effects of a Caring Relationship Between the Sonographer and Patient. J Med Imaging Radiat Sci 2020; 51:S53-S58. [PMID: 32747199 DOI: 10.1016/j.jmir.2020.07.005] [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: 05/13/2020] [Revised: 06/20/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The concept of caring is rapidly becoming an area of interest in healthcare research, especially in medical imaging. While patients, academic institutions, hospitals and policy makers have an expectation for healthcare professionals to be caring, the effects of such a relationship between patient and professional is equally important to understand. Within sonography, a discipline of radiography, there is limited literature on this concept. PURPOSE The purpose of the main study was to explore and describe the sonographers' experiences of being caring professionals within private practices in the province of Gauteng, South Africa. This paper focuses on one essential theme that emerged from the study: the effects of a caring relationship between sonographer and patient. Guidelines to enhance caring relationships are also provided. MATERIALS AND METHODS A qualitative, exploratory, descriptive, contextual, phenomenology research design was utilised. Four focus group interviews (n = 14) were conducted with qualified sonographers working in the private sector, in Gauteng. Data collection took place until data saturation was reached. RESULTS Sonographers described caring for their patients as having both positive and negative effects on themselves. Sonographers explained having developed protective mechanisms to help them when caring for tenacious patients. There was also a sense of emotional and psychological strain identified. Despite this, sonographers displayed a sense of professional pride for their careers. CONCLUSION Guidelines were developed to alleviate the emotional and psychological strains sonographers are burdened with. These guidelines included; the facilitation of a supportive and healing environment through reflective practice, availability of a psychologist, and having a tea garden at work.
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Robinson H, Al-Freih M, Kilgore W. Designing with care. THE INTERNATIONAL JOURNAL OF INFORMATION AND LEARNING TECHNOLOGY 2020. [DOI: 10.1108/ijilt-10-2019-0098] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this study was to explore how care theory and the ethics of care are explained by students in the online environment to clarify the factors that are more relevant in establishing and maintaining caring relations in online learning context.Design/methodology/approachUtilizing naturalistic inquiry, the researchers interviewed online students and coded transcripts using multiple coding methods within two phases of analysis. Noddings' framework for ethics of care was utilized to identify strategies and practices that enhance each of Noddings' elements in an online course experience.FindingsThe findings of this exploratory study provide evidence on how learners perceive being cared for and highlight specific instructor behaviors and course design elements that support the emergence and maintenance of a climate of care in an online learning environment. Indicators of all four elements of Noddings' framework were present in the interviews. Within the themes of each element, strategies and practices to enhance each element in an online course experience are further explained.Research limitations/implicationsEstablishing a climate of care, whether in traditional or online learning, leads to more inclusive learning experiences that are responsive to the needs of all learners. This study brought to light some of the factors that are more relevant in establishing and maintaining caring relations in online learning context.Originality/valueThe findings of this study add to the literature on the role of emotions in an online learning as viewed through the lens of care theory. The findings highlight some strategies and behaviors that promote a climate of care in an online environment from a learner's perspective.
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Bernstein J, Wood S, Latessa R, Hirsh DA. Teaching in longitudinal integrated clerkships: the seven 'C's. CLINICAL TEACHER 2018; 16:101-107. [PMID: 30192057 DOI: 10.1111/tct.12947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Joshua Bernstein
- Department of Internal Medicine, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, North Carolina, USA
| | - Sarah Wood
- Department of Pediatrics, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Robyn Latessa
- Department of Family Medicine, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, North Carolina, USA
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Shubkin CD, Garrett JR, Lantos JD. When Residents Let Conscience Be Their Guide: Professional Development and Educational Opportunity. Acad Pediatr 2018; 18:239-242. [PMID: 29269031 DOI: 10.1016/j.acap.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/05/2017] [Accepted: 12/10/2017] [Indexed: 11/26/2022]
Abstract
Residency is a time of professional identity formation. During this time, residents may first be exposed to conflicts between professional duties and personal beliefs which may lead to a request for a conscience-based exemption. Faculty, whether the supervising attending or the program director, have an important role in the professional and ethical development of residents by acknowledging and supporting residents as they encounter these potential conflicts. In this paper, we highlight three areas of unique issues that arise within the context of residency training programs when a resident makes a request to be excused from clinical duties based on personal conscience: namely, the maintenance of educational standards, the burdens that may be placed on colleagues, and the responsibility for faculty to foster the professional development of ethically sensitive pediatricians.
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Affiliation(s)
| | - Jeremy R Garrett
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, Mo
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Kansas City, Kansas City, Mo
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Balmer DF, Richards BF. Longitudinal qualitative research in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:306-310. [PMID: 28840491 PMCID: PMC5630535 DOI: 10.1007/s40037-017-0374-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Dorene F Balmer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Boyd F Richards
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1313-1319. [PMID: 28248695 DOI: 10.1097/acm.0000000000001621] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The authors explored affordances that contribute to participants' successful learning in longitudinal integrated clerkships (LICs). METHOD This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine-Asheville campus from 2009 to 2013. The survey questions asked LIC graduates to rate components of LICs that they perceived as contributing to successful learning. A research assistant interviewed a subset of study participants about their learning experiences. The authors analyzed aggregate data quantitatively and performed a qualitative content analysis on interview data. RESULTS The graduates reported multiple affordances that they perceive contributed to successful learning in their LIC. The most reported components included continuity and relationships with preceptors, patients, place, and peers, along with integration of and flexibility within the curriculum. CONCLUSIONS As LIC models grow in size and number, and their structures and processes evolve, learners' perceptions of affordances may guide curriculum planning. Further research is needed to investigate to what degree and by what means these affordances support learning in LICs and other models of clinical education.
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Affiliation(s)
- Robyn A Latessa
- R.A. Latessa is director and assistant dean, University of North Carolina (UNC) School of Medicine-Asheville Longitudinal Integrated Clerkships Program, Asheville, North Carolina, and professor of family medicine, UNC School of Medicine, Chapel Hill, North Carolina. R.A. Swendiman is a general surgery resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. A.B. Parlier is a research project coordinator, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina. S.L. Galvin is director of research, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics/Gynecology, UNC School of Medicine, Chapel Hill, North Carolina. D.A. Hirsh is director, Harvard Medical School Cambridge Integrated Clerkship, Cambridge Health Alliance, Cambridge, Massachusetts, director, Harvard Medical School Academy Medical Education Fellowship, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts
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Structuring Medical Education for Workforce Transformation: Continuity, Symbiosis and Longitudinal Integrated Clerkships. EDUCATION SCIENCES 2017. [DOI: 10.3390/educsci7020058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Green EP, Gruppuso PA. Justice and care: decision making by medical school student promotions committees. MEDICAL EDUCATION 2017; 51:621-632. [PMID: 28488300 PMCID: PMC5431287 DOI: 10.1111/medu.13280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/24/2016] [Accepted: 01/11/2017] [Indexed: 05/30/2023]
Abstract
CONTEXT The function of medical school entities that determine student advancement or dismissal has gone largely unexplored. The decision making of 'academic progress' or student promotions committees is examined using a theoretical framework contrasting ethics of justice and care, with roots in the moral development work of theorists Kohlberg and Gilligan. OBJECTIVES To ascertain promotions committee members' conceptualisation of the role of their committee, ethical orientations used in member decision making, and student characteristics most influential in that decision making. METHODS An electronic survey was distributed to voting members of promotions committees at 143 accredited allopathic medical schools in the USA. Descriptive statistics were calculated and data were analysed by gender, role, institution type and class size. RESULTS Respondents included 241 voting members of promotions committees at 55 medical schools. Respondents endorsed various promotions committee roles, including acting in the best interest of learners' future patients and graduating highly qualified learners. Implementing policy was assigned lower importance. The overall pattern of responses did not indicate a predominant orientation toward an ethic of justice or care. Respondents indicated that committees have discretion to take individual student characteristics into consideration during deliberations, and that they do so in practice. Among the student characteristics with the greatest influence on decision making, professionalism and academic performance were paramount. Eighty-five per cent of participants indicated that they received no training. CONCLUSIONS Promotions committee members do not regard orientations of justice and care as being mutually exclusive and endorse an array of statements regarding the committee's purpose that may conflict with one another. The considerable variance in the influence of student characteristics and the general absence of committee member training indicate a need for clear delineation of the medical profession's priorities in terms of justice and care, and of the specific student characteristics that should factor into deliberations.
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Affiliation(s)
- Emily P. Green
- Section of Medical Education, The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912
| | - Philip A. Gruppuso
- Section of Medical Education, The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903
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Snow SC, Gong J, Adams JE. Faculty experience and engagement in a longitudinal integrated clerkship. MEDICAL TEACHER 2017; 39:527-534. [PMID: 28281378 DOI: 10.1080/0142159x.2017.1297528] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The authors sought to understand rewards and challenges of teaching third-year medical students in the University of Colorado School of Medicine (CUSOM) Denver Health Longitudinal Integrated Clerkship (DH-LIC) compared to teaching in rotation-based clerkships (RBCs). The authors considered implications for the recruitment and retention of faculty in clinical educational programs. Preceptors completed surveys at baseline and year-end. Of eligible faculty, 28 of 40 completed both baseline and year-end surveys. The majority (85.2%) of faculty were satisfied with the DH-LIC and 85.7% continued to teach in year-two of the program. Faculty reported increased satisfaction from teaching and improved teaching and mentoring skills. Faculty familiarity with DH-LIC students was significantly higher than with students previously taught (p = .004); 89.3% of faculty knew their DH-LIC student well enough to tailor instruction to individual learning needs. Teaching techniques utilized at baseline and end of year differed significantly; faculty reported asking questions to promote thinking, providing feedback to students, and providing students with practice in clinical reasoning more frequently in the DH-LIC. Innovative models of education such as LICs offer a strategy to recruit and retain excellent, invested faculty in outpatient settings.
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Affiliation(s)
- Sarah C Snow
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Jennifer Gong
- b Department of Family Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Jennifer E Adams
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
- c Denver Health and Hospital Authority , Denver , CO , USA
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