Medicine as a Community of Practice: Implications for Medical Education

Community-Powered Learning: A Qualitative Analysis of Postgraduate Medical Trainee Development Through Journal Club

BACKGROUND

Journal clubs are a core feature of postgraduate medical education. They are used to teach critical appraisal skills and evidence-based medicine to postgraduate trainees. Studies have been carried out examining the purpose and goals of journal club, but with minimal input from learners. Thus, the research question was devised, 'why do postgraduate trainees find journal clubs effective for their continuous professional development and what underlying processes facilitate their learning and engagement in these settings?'

METHODS

A qualitative study was designed to capture the opinions of the learners when considering learning through journal club. Semi-structured interviews were felt to be most appropriate to allow participants to explore freely how they learn from journal club as well as the aspects of the club that support or hinder learning. Data were analysed using thematic analysis.

RESULTS

21 interviews were conducted within two departments in adjoining hospitals. There were 6 consultants, 9 registrars and 6 SHOs interviewed. The median (IQR) interview time was 23.5 (19.5-27.3) minutes. The themes identified were committed participation, with subthemes of habit formation and positive environment, and transformative participation, with subthemes of emerging leaders and shared experience.

DISCUSSION/CONCLUSION

The themes identified from our interviews align with principles of communities of practice and legitimate peripheral participation. Regular meetings in a positive learning environment are vital. Mutual engagement and role modelling contribute hugely to trainee learning from journal club, through the development of relationships between junior and senior members in the preparation, delivery and discussion of literature.

From Pages to Practice: Inviting Authors to Facilitate Medical Education Journal Club to Support Knowledge Translation

BACKGROUND

Medical educators must advance their knowledge to promote educational innovation grounded in best practices.

AIM

We developed a virtual medical education journal club to enhance pedagogical practice, foster an environment for collaboration, and enhance knowledge of research methodologies.

SETTING

The Knowledge Information Collaborative Scholarship (KICS) monthly virtual medical education journal club.

PARTICIPANTS

Faculty, trainees, and staff in medicine. Average monthly attendance was 36 individuals, representing 37 institutions across the USA, and one international participant.

PROGRAM DESCRIPTION

Innovating the traditional model, the authors are invited to present. The authors begin with a brief description of the paper and lessons learned followed by group discussion.

PROGRAM EVALUATION

We surveyed participants from 2023 to 2024. The survey had a 25.8% response rate (n=51). Participants indicated that journal club increased their familiarity with the literature, 91.8% (n=45) and that they had applied knowledge learned in journal club to their work, 71.4% (n=35). Content analysis yielded two themes: (1) Practical application of knowledge and (2) The value of participating in a community for professional growth.

DISCUSSION

The KICS journal club has demonstrated success with engagement and geographic reach. Participants indicate acquisition and application of knowledge. Moving forward, we aim to promote scholarly productivity through collaboration among participants.

Barriers and facilitators to the cultivation of communities of practice for faculty development in medical education: A scoping review

BACKGROUND

Communities of practice (CoPs) have been promoted as a strategy to foster the professional development of faculty. In recent years, there have been a rising number of publications in the field of medical education that report on the impact of CoPs in faculty development (FD), as well as the factors that influence their cultivation. The objective of this scoping review was to comprehensively map the reported barriers and facilitators to cultivating CoPs for FD in medical education.

METHODS

The authors searched five electronic databases on 15 January 2022, and in a final update search on 4 August 2024. The authors used the updated Consolidated Framework for Implementation Research as an a priori coding framework to guide coding. The authors applied a quasi-statistical content analysis to quantify and draw meaning from the factors that constrain and support CoP formation, implementation and sustainability.

RESULTS

The authors generated 359 codes for barriers and facilitators from 25 included empirical and non-empirical articles, of which 295 codes (82%) were relevant to forming and implementing a CoP, and 64 (18%) relevant to sustaining a CoP. The main barriers and facilitators were related to: the sufficiency of structural, cultural and resource support; the availability and fit of required stakeholders; relevance to member needs; planning; member attraction and engagement; and reflection and evaluation of the CoP.

CONCLUSIONS

This review highlights the key patterns and gaps in the emerging publications on CoP cultivation for FD in medical education, from their formation to their sustainability. There remain key unresolved problems and gaps in the evidence concerning how to create long-term participation successfully to sustain CoPs for FD in medical education. Although hybrid and virtual CoPs appear to be the way forward, there is still a need to account for individual member capabilities and needs, and the nature of the medical education context on CoP sustainability.

The impact of mentoring relationships on professional identity formation in medical education: a systematic review

BACKGROUND

The promise that enduring and personalised mentoring relationships shape how mentees think, feel and act as professionals, or their professional identity formation (PIF), and thus how they interact, care and support patients and families has garnered significant interest. However, efforts to marshall these elements have been limited due to a lack of effective understanding. To address this lacunae, a systematic scoping review was carried out to map current knowledge on mentoring relationships and its impact on PIF.

METHODS

Guided by PRISMA guidelines and the Systematic Evidence-Based Approach (SEBA) to ensure a consistent and reproducible review, independent searches and appraisals of relevant articles published between 1st January 2000 and 4th December 2024 on PubMed, Embase, ERIC and Scopus databases were performed. Data from included articles were content and thematically analysed. Related themes and categories were combined using the SEBA methodology.

RESULTS

248 articles were identified across four databases and snowballing of key articles. A total of 27 articles were included. The domains identified were: (1) the mentoring ecosystem; (2) mentoring dynamics; (3) shifts in belief systems and professional identity; and (4) complex adaptive systems.

CONCLUSIONS

The mentoring programme can be seen as a mentoring ecosystem, functioning as a community of practice and supporting the socialisation process within its boundaries and along the mentoring trajectory. The culture and structure of the mentoring ecosystem help inculcate the shared belief systems and programme identity. It also nurtures stakeholder investment and commitment, as well as their internal compass which is key to contending with the complex array of influences upon their development. Through the lens of a complex adaptive system, it is also possible to appreciate transitions between roles and responsibilities and the notion of being and becoming. These findings underline the evolving nature of practice and the need for personalised and longitudinal mentoring support.

Twelve tips for creating a works in progress conference that builds capacity for educational scholarship and creates a scholarly community

Educators have implemented various strategies to build capacity for education scholarship, and often, these strategies focus on a specific set of interested individuals. We perceived a need for a strategy to engage a health professions education community with peer support. The purpose of these 12 tips is to describe an approach in place for nearly two decades that concurrently advances education scholarship and fosters a community that welcomes novices to experts. The approach is based on principles that not only build capacity and community but also stress the importance of alignment with the institution's missions. The tips guide setting up, conducting, and sustaining such an approach.

Navigating identity dissonance: subjectification to balance socialization

One of the main goals of medical education is to facilitate the development of a professional identity. As part of this effort, trainees are exposed to the values and cultures of the profession in a process known as socialization. Learners must then negotiate incongruent aspects between their preexisting identities and nascent professional identities. Individuals from historically underrepresented ethnic groups often undergo more significant changes due to their values and culture not being as prevalent within the dominant ideology of medicine. This transformative process can lead to identity dissonance and manifest as an internal discomfort resulting from perceived contradictions between one's existing identity and the required professional identity. Identity dissonance may be traumatic and pose a threat to the academic performance and professional integration of trainees. These detrimental effects harm the medical workforce by depriving it of a group crucial in addressing health inequities. Educators tasked with facilitating the professional development of learners must consider their implicit expectations about professionalism, explore the distinct challenges experienced by individuals from underrepresented backgrounds in their professional development, and work to develop strategies to help trainees navigate identity dissonance. Subjectification, an education philosophy that focuses on compelling individuals to explore the new possibilities and responsibilities imparted to them by their education, provides a theoretical framework to help educators guide learners through identity dissonance.

An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171

There is a long and impressive scholarly history evidencing why it is important to address professional identity formation (PIF) in medical curricula. In this AMEE Guide, the authors present an evidence-informed pedagogical approach to assist educators in developing educational practices to foster a healthy PIF in medical students. The authors first describe the theoretical framework that underpin this approach. At the core of this framework is the recognition that, for a healthy PIF, students need to become aware that they have the autonomy, but also responsibility, to form their professional identity in a way that fits both their personality and their (future) professional role. In other words, students need to learn to navigate the interplay between socialization and subjectification. Next, the authors outline the six-step structure of their pedagogical approach, designed to help students: (1) undergo a PIF-related experience, (2) observe their responses to the experience, (3) externalize their reflections, (4) share their reflections, (5) broaden their perspective, and (6) explore their freedom of choice through experimentation. The authors also describe six conducive conditions to facilitate the implementation of the pedagogical approach. These conditions include (1) creating a setting that enables students to slow down, (2) adopting a longitudinal approach, (3) making it part of the formal curriculum, (4) refraining from grading, (5) establishing an interdisciplinary expert team, and (6) providing teacher training. The authors conclude that the theoretical framework leads to a coherent and consistent pedagogical approach that, when implemented according to the conducive conditions, enables students to gradually internalize the reflective process and help them to cultivate a reflective attitude towards their PIF.

Teaching excellence, the hidden curriculum and complexity: an international comparative case study of two medical schools

The perception held by clinical teachers of health professionals that their teaching efforts are under-valued by their education institutions persists despite intensive research and subsequent interventions to address this global problem. The purpose of this multi-site study is to examine how clinical teaching activities are organised, in order to reveal if there are underlying systemic factors that may contribute to this wicked problem. This study employed a cross-comparative case study design of one Singaporean and one Canadian medical school. Semi-structured interviews were conducted with organisational leaders (n = 23) who manage clinical teaching activities and/or have insights on their local assessment, support and recognition systems. Public records were also collected from each site (n = 24). A theory-driven content analysis using a complexity science interpretation of the concept of the Hidden Curriculum was conducted with both sets of data. The two sites were at different stages of maturation in respect of clinical teaching evaluation and feedback, support, and recognition and reward systems. Despite this, the interviews identified shared structure, process and culture-oriented challenges: low prioritisation of teaching, faculty demotivation and dissatisfaction across both research sites. Our findings suggest that a continued focus on structure and process-oriented reforms to elicit change is insufficient. Instead, further examination of site-specific, multiple intersecting academic and clinical cultures is needed. Future efforts to improve the value and drive the pursuit of teaching excellence will require multi-faceted structure, process and culture change approaches. We argue that Hafferty and Castellani's (The hidden curriculum: A theory of medical education, Routledge, 2009) re-conceptualisation of hidden curriculum through a complexity science lens should be used as a heuristic device to address future research and reform in local medical education contexts.

Proposing the Community Triad Model to action social accountability in medical schools

This article is the third in a series exploring drivers of social accountability (SA) in medical schools across Canada. Findings from the two previous articles have highlighted a central relationship between community, students, and faculty at medical schools, and led to the emergence of a new social accountability model- the Community Triad Model (CTM). The CTM proposes an interconnectedness between community, students, faculty, and the broader institution, and the pathways through which community-based learning directly and indirectly influences decision-making in medical institutions. This article explores the relationships between the three arms of the CTM by examining the literature on community engagement and SA, as well as by revisiting popular models and foundational SA reports to garner insights into authentic community engagement in health professions education. While there is an abundance of literature demonstrating the impact of community placements on students, there are limited studies describing the influence of communities on faculty and the broader institution either directly, or indirectly via students. The authors recommend that institutions be more intentional in engaging students and faculty, and learn from their experiences with community to shape curriculum, practices, policies, and culture of the broader institution. This study offers an operational model of SA that is easy to adopt and implement. It intends to demonstrate how the components of the triad (students, faculty/leadership, community) function together in the community engagement and social accountability of medical schools.

Navigating Digital Medical Education in the Current Era: Process Over Platform

With the dawn of advanced technological and digital resources, medical education has changed. Learners are now able to learn, share, and communicate medical knowledge through online discussion forums, blogs, videos, podcasts, infographics, virtual communities, social media platforms, and collaborative author groups. Navigating these digital education modalities can be challenging, with each platform presenting unique challenges and opportunities. Digital educators need to learn how to navigate this uncertain territory, equipped with a skillset applicable to all digital spaces. This article explores the key components of a digital educator's skillset by examining the core foundations of learning theory, creation of digital education materials, and virtual communities of practice.

From Learner to Provider: Navigating Role Tensions in Postgraduate Medical Training Through Activity Theory

Introduction

The transition from medical school to residency, especially during the postgraduate year (PGY) internship, poses unique challenges as graduates navigate clinical practice complexities. Understanding PGYs' experiences is crucial for developing effective support strategies to promote their professional growth and well-being.

Methods

This qualitative, longitudinal study followed ten PGYs from August 2021 to July 2023, using biannual audio diary based on open-ended questions to capture their experiences. Data analysis, guided by Activity Theory, focused on role conflicts and contradictions as PGYs transitioned from learners to practicing physicians.

Results

The analysis revealed prevalent role conflicts and contradictions, primarily due to the tension between the PGYs' roles as learner and healthcare provider. Differences in objectives between PGYs and practicing doctors further exacerbated these conflicts, leading to clashes in priorities and care approaches. Consequently, PGYs experienced reality shock, lack of confidence, and feelings of incompetence, compounded by heavy workloads and exhaustion. These findings underscored the need for support and resources to help PGYs navigate these challenges and succeed in their healthcare roles.

Discussions

Using Activity Theory to analyze the inherent challenges and contradictions within the PGY experience, this study offers insights for enhancing PGY preparedness, fostering both professional development and well-being. Drawing on recommendations supported by existing literature, which are stratified by tools, rules, and division of labor, we propose targeted strategies to address specific facets of the PGY role, thereby improving the overall training environment. This research highlights the need for tailored interventions to support PGYs through the challenging transition into clinical practice.

Scaling and spreading age-friendly care: Early lessons from the VA National Age-Friendly Action Community

BACKGROUND

The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings.

METHODS

The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings. The VA Action Community included online synchronous webinars, Community of Practice coaching calls, and office hours. A learner experience questionnaire was administered at the completion of the Action Community.

RESULTS

Totally 186 care teams enrolled in the VA Action Community, representing 78/171 (45.6%) VA medical centers (VAMCs), across 36 US states and 20 types of care settings. Participants reported high rates of satisfaction and confidence in their ability to apply the knowledge and skills learned. Overall, 58 Action Community teams earned Level 1, Participant recognition, and 43 teams also earned Level 2, Committed to Care Excellence recognition from the Institute for Healthcare Improvement.

CONCLUSIONS

The VA Action Community facilitated learning about the 4Ms, supported interprofessional teams in earning AFHS recognition, and offers a promising model for spreading AFHS in other large health systems. Further work is underway to evaluate the impact of this educational experience on clinical process and outcomes measures.

Characteristics of Engagement and Persistence of Teachers in an Innovative Master's Program Focused on the "One Health" Concept: A Qualitative Study

We aimed to describe the characteristics of teachers' engagement and persistence in an innovative multidisciplinary health program. Participants in this descriptive and comprehensive study consisted of teachers in higher education (veterinary medicine, human medicine, pharmacy, engineers in husbandry) who were involved in the conception and the implementation of an international master's program called MAN-IMAL. This program was characterized by interculturality, multidisciplinarity, using technology, active teaching, and learning. We conducted two focus groups, each of which included six participants. A thematic analysis was performed. The constitution of a community of practice through a process of socialization involving teachers, students, and faculty developers around the "One Health" concept had a positive influence on engagement and persistence. On the contrary, a lack of leadership sharing in the program and a lack of recognition by institutional leaders had a negative effect on persistence. Also, the characteristics of the program had different impacts on stress perceived by the teachers and, therefore, could have both a negative and/or a positive influence on persistence. Our results suggest that the development of a community of practice in an innovative multidisciplinary health program around a unifying concept like One Health can have a positive influence on teachers' engagement and persistence, even in a challenging context.

Setting Up and Running Online Communities of Practice (CoPs) for Veterinary Educators

Communities of practice (CoPs) are social systems consisting of individuals who come together to share knowledge and solve problems around a common interest. For educators, membership in a CoP can facilitate access to expertise and professional development activities and generate new collaborations. This teaching tip focuses on online CoPs and provides tips for setting up and running such communities. The initial planning phase involves establishing the purpose of the CoP, recruiting an administrative team, designing the structure of the online environment, and choosing a platform. Once the online platform is launched, running the CoP involves building the membership, encouraging engagement (primarily in discussion forums), finding ways to create and share useful resources, and sustaining the community as an active and effective CoP. We also describe a specific example of an online CoP for veterinary educators involved in clinical skills teaching. The membership has grown to represent an international community who engage in a range of activities including sharing knowledge, tips and ideas, asking questions, discussing challenges, and promoting collaborative activities.

Building Global Partnerships: A Qualitative Exploration of In-Person Training for HealthCare Simulation Educators Working in Low-Resource Settings

INTRODUCTION

Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills. The purpose of this study was to explore how the VAST SIMposium influenced perceived development of skills, confidence, and engagement in a community of practice for simulation educators working in low-resource settings.

METHODS

This qualitative study involved in-depth interviews with a purposive sample of 16 VAST SIMposium attendees. Transcripts of audio recordings were analyzed using inductive thematic analysis.

RESULTS

Six themes were identified during data analysis: 1) Diversity with shared passion for medical education; 2) Supportive in-person learning environment; 3) Simulation-based education relevant to low-resource settings; 4) Camaraderie; 5) Building knowledge, skills, and confidence; and 6) Being part of a community of practice.

CONCLUSION

The SIMposium rejuvenated passion, knowledge, skills, and, most importantly, strengthened global connections and partnerships. These collaborations will benefit areas that are underrepresented in simulation and will ultimately improve patient outcomes. A SIMposium of this format is an efficient and effective way to foster sustainable global dissemination of simulation-based global health education.

Challenges of Contemporary Practice: Internists Maintaining Competency in Multiple Specialties

INTRODUCTION

Despite increasing physician specialization, high-quality continuing professional development is needed for continual mastery learning, especially focused on multiple specialties. Board certification is considered a surrogate for competency, and some stakeholders consider it suboptimally aligned with its primary purpose. We set to explore the motivation for continued education and competence in physicians who are board certified in multiple specialties.

METHODS

We performed a qualitative study using thematic analysis. Semistructured interviews were performed virtually. Landscapes of practice, an extension of communities of practice within sociocultural learning theory, was used as a theoretical framework.

RESULTS

Fifteen internists and their related subspecialties performing continual board certification completed the study. We identified six themes describing the underlying motivation for why physicians maintain competency in multiple medical specialties: Social responsibility, Promise of expertise, Enhanced job opportunities, Widened expertise, Professional requirements, and Personal fulfillment.

DISCUSSION

The landscape of medicine continues to evolve in how it is practiced. How a physician navigates this process, maintaining their competency, is a continuous lifelong learning process, and there are multiple ways. A portion of internal medicine physicians are motivated to practice in multiple specialties, recognizing the opportunities and challenges involved. The practical application of this study would include organizational-based education focused on hybrid learning (education explicitly focusing on overlapping or cross-discipline fields). Despite a plethora of educational opportunities, there is very little with the focus on cross-discipline education and training.

Seeing Ourselves in Others: Understanding and Addressing Biases in Medical School Admissions Processes

Purpose

Medical school admissions is a vital area for advancing diversity, equity, and inclusion (DEI). Integrating bias recognition and management (BRM) within the context of admissions is critical in advancing DEI. However, there is a dearth of empirically informed literature on BRM in the admissions context. Therefore, this study sought to explore how individuals involved in admissions decisions process and integrate bias related feedback.

Methods

The authors conducted a qualitative exploratory study using constructivist grounded theory. 21 semi-structured interviews were conducted with various participants in the admissions process at a North American medical school who had participated in bias related training. Participants included medical school faculty, senior medical students, and community volunteers.

Results

Overall, participants expressed diverse perspectives on their personal biases and how these biases impact admissions decisions. Their reflections were shaped by their identities, values, and priorities, which varied based on whether they were faculty members, students, or community members. Participants also highlighted that their biases influenced their perceptions of the ideal admissions candidate, thus influencing their decision-making process. They emphasized the need for more opportunities to engage in dialogue with peers to openly share and discuss how to recognize and manage their biases.

Conclusion

Our study suggests that fostering critical reflection about identity tensions, building and sustaining a community of practice, and facilitating sustained dialogue may provide admissions committees with an evidence-informed, meaningful, and sustained approach to advancing DEI through bias recognition and management.

Preparing physiotherapists for the future: the development and evaluation of an innovative curriculum

BACKGROUND

Educational innovation in health professional education is needed to keep up with rapidly changing healthcare systems and societal needs. This study evaluates the implementation of PACE, an innovative curriculum designed by the physiotherapy department of the HAN University of Applied Sciences in The Netherlands. The PACE concept features an integrated approach to learning and assessment based on pre-set learning outcomes, personalized learning goals, flexible learning routes, and programmatic assessment. PACE distinguishes itself from traditional education because of the flexible learning routes, vertical organization in learning communities, absence of pre-defined learning activities and class schedules, and a culture of continuous learning and development. PACE is based on three guiding principles: 1) flexible and varied, 2) self-directed and collaborative, 3) future-oriented. PACE was implemented in 2021 for first-year students. This study evaluates the implementation to inform future curriculum development.

METHODS

A sequential explanatory mixed methods design was used to evaluate the implementation of PACE using a questionnaire, focus groups, in-depth interviews, and a national progress test allowing for benchmarking results. Participants were undergraduate physiotherapy students of cohort 2021-2022, the first group who experienced PACE and teachers involved with this cohort. Questionnaire data were analyzed using descriptive statistics. To compare mean total scores of the national progress test between four different universities a one-way ANOVA was conducted including a post-hoc analysis. Reflexive thematic analysis guidelines were applied to analyze the interview data.

RESULTS

In total 82 first year students (44,6%) of cohort 2021-2022 and 36 teachers (60%) completed the questionnaire. Results show that the guiding principles were implemented as intended. Results of the national progress test on knowledge and clinical reasoning showed that students of the HAN University performed well compared to other universities. Thematic analysis of interviews and focus groups resulted in three themes and nine subthemes: 1) navigating a personalized curriculum, 2) caring and sharing, and 3) shaping professional identity. PACE contributed positively to students' intrinsic motivation, learning joy, identity development, and life-long learning skills. Areas for improvement were self-directed learning support, and teaching strategies to prompt deep learning.

CONCLUSION

The evaluation showed that the guiding principles of PACE were implemented as intended and that the innovation positively contributed to student learning.

Assessing Program Culture in Virtual Fellowship Interviews: Insights From Pulmonary and Critical Care Fellows

BACKGROUND

Virtual interviewing for fellowship training programs has been widely adopted since the COVID-19 pandemic. However, whether fellowship candidates can adequately evaluate training program culture through virtual interviews is unclear.

OBJECTIVE

Our aim was to explore how pulmonary and critical care fellows ascertained program culture during virtual and in-person fellowship program recruitment interviews, with the overall goal of improving our virtual recruiting interview processes.

METHODS

Exploratory semi-structured one-on-one interviews (study-interviews) following a constructivist approach were done during the fall of 2022 with a convenience sample of current fellows within the pulmonary critical care medicine fellowship program in an urban tertiary care hospital. Questions probed fellows' perspectives on program culture, what features of program culture they valued, and how they evaluated program culture during their initial fellowship interviews (recruitment-interviews). Study-interviews were framed to explore four deductive themes, and transcripts were analyzed with inductive thematic analysis.

RESULTS

Of the 11 fellows interviewed, two had completed in-person and nine had completed virtual recruitment-interviews. There was an overall favorable perception of program culture during all recruitment-interviews, regardless of format. Elements of program culture that fellows valued included training program quality, an academic focus, complexity in cases, workplace diversity, a positive socioemotional environment, and a collaborative/supportive working/learning environment.

CONCLUSIONS

This study suggests that important elements of program culture can be evaluated by fellowship candidates through virtual interviews when applicants are allowed ample opportunity for high-quality interactions with faculty and current trainees.

The Academic Catalyst Group: A Tactical Framework for Working Groups to Enhance Clinician-Educator Academic Career Development

ABSTRACT

Working groups have tremendous potential to contribute to the academic career development of early-career clinician-educators. These individuals may find themselves engaged in many different working spaces, including working groups or committees such as those found within specialty societies or professional organizations. Such working groups may be underrecognized opportunities for academic skill building and professional growth because they are often characterized as primarily service-oriented, citizenship, or administrative work. Working groups can use their natural cross-institutional collaborations for mentorship and externalization-2 key building blocks for academic success that frequently represent challenges for early-career clinician-educators. In this article, the authors review common challenges that early-career clinician-educators may encounter during their academic development and propose a 3-step tactical framework, the academic catalyst group, that working group leaders can apply to groups to purposefully enhance professional development for clinician-educators. The framework urges working group leaders and members to conceptualize and develop academic catalyst groups as communities of practice by (1) assembling with intention, (2) mining the mission, and (3) finding an easy win. This framework can inspire working group leaders to align their work with academic career development and ultimately foster career growth for all group members.

Latin American framework for faculty development in health education

PURPOSE

This study aims to develop and establish a comprehensive framework for faculty development in health sciences in Latin America. This initiative enhances teaching methodologies and elevates the quality of learning experiences.

MATERIALS AND METHODS

The methodology included a qualitative approach using an initial questionnaire, interviews, and group discussions. 1836 professionals from 16 Latin American countries participated, providing a broad and diverse perspective.

RESULTS

Five key dimensions were defined: learning facilitation, evaluation and feedback, innovation and research, managing educational processes, and empathetic and socioemotional pedagogical relationships. The framework identifies seven progressive levels of teacher development, emphasizing 'catalytic performances' as critical drivers for continuous improvement and reciprocal influence within the educational system.

CONCLUSIONS

The Latin American framework offers a detailed structure adapted to the region's particularities, highlighting the importance of advanced pedagogical competencies and teacher-student relationships. Its holistic and progressive approach is relevant and applicable in the Latin American context, providing a guide for professional development in health sciences.

The doctor's presence created a safe space - a mixed methods study of students' learning outcomes from an elective course in palliative medicine

BACKGROUND

Competence in palliative medicine is required in clinical practice. Based on a literature review, we developed a two-week elective course in palliative medicine for 5th and 6th year medical students. We wanted to study learning outcomes from the course, especially related to knowledge, confidence, and reflections on the doctor's role in palliative care.

METHODS

A multiple-choice questionnaire (MCQ) assessed knowledge in palliative care pre and post course. The Thanatophobia Scale (TS) and the Self-efficacy in Palliative Care Scale (SEPC) measured confidence in communication with patients close to death and in providing palliative care, respectively. Reflection notes were analysed using Systematic Text Condensation, a cross-case thematic analysis. Lave & Wenger's theory about situated learning was used to support interpretations.

RESULTS

From 2018 to 2022 we ran four courses for a total of 48 students. Test results improved over the course in all four groups. On average, MCQ scores increased by 22% (range 13-33), TS scores were reduced by 28% (24-32), and SEPC scores increased by 50% (42-64), reflecting increased confidence in dealing with seriously ill and dying patients and their relatives. The participants prepared reflection notes describing their main impressions and take-home messages from the course, focusing specifically on the role of the doctor. They described the doctor's role linked to an overarching task of creating a sense of security for patients and relatives. Through the course, and especially through talking to patients and relatives and being part of the interprofessional team, the participants learned how this sense of security was built by gaining competence in the following domains: 1) Patient-centred communication about the disease, expected trajectory, and needs, establishing common ground and support; 2) Being the medical expert in symptom relief and decision-making, providing guidance and reassurance in difficult situations; 3) Professionalism rooted in a holistic and relational approach; and 4) Being a good team player, aware of their function and limitations.

CONCLUSIONS

A two-week student-selected course in palliative medicine improved knowledge and skills and increased confidence in providing palliative care. The comprehensive understanding of the doctor's role obtained in this course may also be relevant to other clinical specialties.

TRIAL REGISTRATION

Not applicable (no clinical trial).

Contribution of Basic Science Education to the Professional Identity Development of Medical Learners: A Critical Scoping Review

PURPOSE

Professional identity development (PID) has become an important focus of medical education. To date, contributions of basic science education to physician PID have not been broadly explored. This review explores the literature surrounding the contribution of basic science education to the PID of medical learners and interprets findings critically in terms of the landscapes of practice (LoP) framework.

METHOD

In this critical scoping review, the authors searched 12 different databases and professional organization websites from January 1988 to October 2022 for references relating to how, if at all, the basic science component of medical education contributes to the PID of medical learners. The LoP learning theory was chosen as a framework for critically interpreting the identified articles.

RESULTS

Of the 6,674 identified references, 257 met the inclusion criteria. After data extraction, content analysis of recorded key findings was used to ensure all findings were incorporated into the synthesis. Findings aligned with and were critically interpreted in relation to the 3 LoP modes of identification: engagement (engaging in the work of a physician), imagination (imagining oneself becoming a "good doctor"), and alignment (aligning with the practices and expectations of a medical community or specialty). Within each mode of identification, it was possible to see how basic science may support, or catalyze, PID and how basic science may serve as a barrier, or an inhibitor, to PID or contribute to the development of negative aspects of identity development.

CONCLUSIONS

The LoP learning theory suggests that the effect of basic science on physicians' PID is most effective if educators view themselves as guides through interfaces between their scientific disciplines and medicine. Learners need opportunities to be engaged, to imagine how their current learning activities and developing skills will be useful as future physicians, and to feel alignment with medical specialties.

Novice clinician educator professional identity formation through a longitudinal mentorship: a qualitative study

BACKGROUND

The professional identity of doctors is evolving with physicians now required to be 'scholars', facilitating the education of students and healthcare teammates as educators. Mentoring is widely practiced and is postulated to facilitate professional identity formation (PIF) through socialization. Preliminary literature review suggested few studies looking into how formal mentoring programmes affect PIF of novice clinician educators, particularly an Asian context. I hope to understand the perceived professional identity of such educators, and what changes in professional identity are observed after longitudinal mentorship, using the social cognitive career theory (SCCT) as an underpinning framework.

METHODS

A qualitative study explored perspectives of mentees with less than two years teaching experience and participating in a formal mentoring programme. Semi-structured interviews were conducted at the beginning and end of the programme. Thematic analysis and coding of these taped and transcribed interviews was performed and triangulated with an elite interview. Mind maps were constructed to appreciate the inter-relatedness of themes and evaluated using the SCCT framework. Methodology was anchored to the Consolidated Criteria for Reporting Qualitative Research checklist.

RESULTS

Seven mentees were recruited. All were Chinese except for two Indians. All had less than six months experience with educational activities. None had formal training in medical education. Median duration postgraduate was six years. One was from a surgical discipline, others were from a range of medical disciplines. Themes identified included background influences, learning experiences and outcome expectations which affected self-efficacy, leading to mentees attaining goals and performing actions which effected their professional identity development, which was in-turn affected by contextual influences. Most perceived themselves as clinicians rather than medical educators. Concepts underpinning PIF included socialisation (role modelling and mentorship, communities of practice, sense of belonging), experiential learning, the hidden curriculum and reflective practice.

CONCLUSIONS

Novice clinician educators mostly have a hierarchical identity. Role modelling and mentorship, active participation in communities of practice, promotion of a sense-of-belonging, experiential learning combined with reflective practice are important components for socialisation, synergistically facilitating PIF in novice clinician educators. Overcoming contextual barriers, being cognisant of cultural practices and addressing concerns in the hidden curriculum can assist educators in development of their professional identity.

Praxis-Informed Pointers: A Student Guide for Optimizing Clinical Learning in a Resource-Constrained Setting

Issue: Health professions education (HPE) is intimately linked with teaching and learning in the clinical environment. While the value of authentic clinical experiences is acknowledged, whether learning actually occurs is to a large extent dependent on students' behaviors and attitudes. The kinds of student behaviors and attitudes that are necessary to optimize learning in the clinical environment thus becomes relevant. Evidence: Tips and recommendations to maximize clinical learning in a variety of settings have been well documented. There is, however, a dearth of literature which takes a narrative-based praxis approach focused on resource-constrained environments. We developed this praxis-orientated article as a means to translate the available literature and theory into a simple, practical guide, focused on optimizing clinical learning from a student perspective, remaining cognizant of the particular challenges present in a resource-constrained setting. Implications: Based on the resource-constrained environments our students are exposed to, we outline the following six key aspects: student-driven learning, integration into the community of practice, student engagement, empathy, interprofessional learning opportunities, and feedback for learning. These aspects provide useful pointers for students in general. Furthermore, exploration into what strategies students may utilize in resource-constrained clinical contexts is addressed.

A scoping review and theory-informed conceptual model of professional identity formation in medical education

INTRODUCTION

Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues.

METHODS

A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases.

RESULTS

A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it.

CONCLUSIONS

Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.

An Approach to Intensive Care Unit Rounds Utilizing 5, 10, and 15-Minute Strategies

Teaching medical rounds in intensive care units (ICUs) are essential for resident education. However, the ICU's high workload can hinder these rounds. We propose a new approach that is based on the constructivist theory of learning communities. This approach emphasizes active, collaborative learning through interaction. In the ICU, it encourages active learning, peer interaction, and shared responsibility among residents. Our model involves structured teaching rounds that promote active learning, collaboration, and reflection, all integrated into the ICU workflow. This new approach aims to enhance the learning experience; improve teaching round effectiveness; and, ultimately, contribute to better patient care.

How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study

BACKGROUND

This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians.

METHODS

We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation.

RESULTS

Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers.

CONCLUSION

Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.

Professional identity formation of medical students in relation to older persons' healthcare: exploring the views of older persons living in the Netherlands - a qualitative study

OBJECTIVES

Given the growing population of older persons, medical students need to develop an appropriate professional identity to comply with older persons' healthcare needs. In this study, we explored the needs and expectations of older persons regarding their doctor to gain more insight into the characteristics of this professional identity.

DESIGN

A qualitative study based on a constructivist research paradigm was conducted, based on individual semistructured, in-depth interviews using a letter as a prompt, and focus groups. Thematic analysis was applied to structure and interpret the data.

SETTING AND PARTICIPANTS

Our study population consisted of older persons, aged 65 years and above, living at home in the South-West of the Netherlands, with no apparent cognitive or hearing problems and sufficient understanding of the Dutch language to participate in writing, talking and reflecting. The in-depth interviews took place at the participant's home or the Leiden University Medical Center (LUMC), and the focus groups were held at the LUMC.

RESULTS

The older persons shared and reflected on what they need and expect from the doctor who takes care of them. Four major themes were identified: (1) personal attention, (2) equality, (3) clarity and (4) reasons why.

CONCLUSION

Increasing complexity, dependency and vulnerability that arise at an older age, make it essential that a doctor is familiar with the older person's social context, interacts respectfully and on the basis of equality, provides continuity of care and gives clarity and perspective. To this end, the doctor has to be caring, involved, patient, honest and self-aware. Participation in a community of practice that provides the context of older persons' healthcare may help medical students develop a professional identity that is appropriate for this care.

Peer mentorship and professional identity formation: an ecological systems perspective

BACKGROUND

Mentoring can help shape how medical students think, feel, and act as physicians. Yet, the mechanism in which it influences this process of professional identity formation (PIF) remains poorly understood. Through the lens of the ecological systems theory, this study explores the interconnected and dynamic system of mentoring relationships and resources that support professional development and growth within the Palliative Medicine Initiative (PMI), a structured research peer mentoring program.

METHODS

A secondary analysis of transcripts of semi-structured interviews with peer mentors and mentees and a review of their mentoring diaries was conducted to explore the impact of participation in a longitudinal peer mentoring program on both mentees and peer mentors on their personal and professional development through the lens of the mentoring ecosystem model. The Systematic Evidence-Based Approach was adapted to analyze the data via content and thematic analysis.

RESULTS

Eighteen mentees and peer mentors participated and described a supportive community of practice within the research program, with discrete micro-, meso-, and macro-environments that are dynamic, reflexive, and interconnected to form a mentoring ecosystem. Within this ecosystem, reflection is fostered, and identity work is done-ultimately shaping and refining self-concepts of personhood and identity.

CONCLUSION

This study underscores the nuances and complexities of mentorship and supports the role of the mentoring ecosystem in PIF. A deeper understanding of the multiple factors that converge to facilitate the professional development of mentees can help educators develop and implement structured peer mentorship programs that better support reflective practice and identity work.

How Preceptors Support Pharmacy Learner Professional Identity Formation

OBJECTIVE

Pharmacy preceptors play a role in helping learners form professional identities during experiential education. However, it is not clear what specific roles and precepting strategies best foster professional identity formation (PIF). The objective of this study was to explore how preceptors support pharmacy learner PIF.

METHODS

This qualitative study used an interpretative descriptive approach. Preceptors from 5 experiential education programs were recruited using purposive sampling for individual semistructured interviews. Interviews were recorded, transcribed, coded, and analyzed by thematic analysis. Team members used a reflective and iterative approach for data analysis and generation of themes.

RESULTS

A total of 22 participants were interviewed from various pharmacy practice settings and precept a range of learners, including introductory pharmacy practice experiences, advanced pharmacy practice experiences, and residents. Four main themes were identified to support pharmacy leaner PIF: making learners part of the practice and team, preparing learners to assume the role of a pharmacist, helping learners navigate emotions during practice experiences, and supporting learners in finding the right fit within the profession. Specific precepting strategies associated with each theme were identified.

CONCLUSION

Preceptors play an important role in supporting learners in thinking and acting as professionals while also helping navigate emotional experiences that may impact PIF and having conversations to help define learner's future aspirations of the pharmacist they want to become. Strategies identified can inform curricular approaches and preceptor development that intentionally supports PIF.

Development and validation of the Workplace Learning Inventory in Health Sciences Education: a multimethod study

Health sciences students face many challenges in regard to clinical practical learning. A better understanding of student learning is required to address student needs in this crucial phase. The theory of self-regulated learning provides a comprehensive view of learning and could serve as a basis for further research. There are instruments to assess self-regulated learning in preclinical academic learning. However, there are no such instruments for workplace learning. The aim of the present study is to provide a comprehensive inventory from which researchers can select those scales that are relevant to their research questions in the investigation of workplace learning. Hence, the aim is to develop and validate a set of scales to assess undergraduates' workplace learning in health sciences education in four areas (cognition, motivation, emotion, and context) on two levels (the learning process level and the metalevel). Study 1 is a qualitative multimethod study to identify indicators and develop items. It integrates the perspectives of students, teachers, and researchers and includes six steps: literature review, interviews, synthesis, item development, expert review, and cognitive pretesting. This study yields a set of scales for each area on both levels. Study 2 is a quantitative study to assess the psychometric properties. The results show acceptable values in terms of unidimensionality, reliability and validity for each of the 31 scales. The newly developed Workplace Learning Inventory is comprehensive; the scales are relevant to workplace learning and short enough that their administration is feasible in the workplace setting. The rigorous process of questionnaire development contributes to the validity of scales. By providing the Workplace Learning Inventory, we hope to encourage research on workplace learning in health sciences education from an educational psychology perspective.

A New Construct in Undergraduate Medical Education Health Humanities Outcomes: Humanistic Practice

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

Being, becoming, and belonging: reconceptualizing professional identity formation in medicine

Over the last decade, there has been a drive to emphasize professional identity formation in medical education. This shift has had important and positive implications for the education of physicians. However, the increasing recognition of longstanding structural inequalities within society and the profession has highlighted how conceptualizations of professional identity formation have also had unintended harmful consequences. These include experiences of identity threat and exclusion, and the promotion of norms and values that over-emphasize the preferences of culturally dominant groups. In this paper, the authors put forth a reconceptualization of the process of professional identity formation in medicine through the elaboration of 3 schematic representations. Evolutions in the understandings of professional identity formation, as described in this paper, include re-defining socialization as an active process involving critical engagement with professional norms, emphasizing the role of agency, and recognizing the importance of belonging or exclusion on one's sense of professional self. The authors have framed their analysis as an evidence-informed educational guide with the aim of supporting the development of identities which embrace diverse ways of being, becoming, and belonging within the profession, while simultaneously upholding the standards required for the profession to meet its obligations to patients and society.

Mentorship in health professions education - an AMEE guide for mentors and mentees: AMEE Guide No. 167

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.

Students' and Instructors' Perspectives on Learning and Professional Development in the Context of Interprofessional Simulation

Phenomenon: Simulation-enhanced interprofessional education is a potentially valuable pedagogical approach in health professional education. Simulation-enhanced interprofessional education merits more empirical exploration particularly in terms of experiences from different perspectives. Approach: The study aims to provide a multi-perspective in-depth understanding of students' engagement in a simulation-based interprofessional learning environment. Ninety students and thirteen facilitators participated. We analyzed data from examination sheets of medical and nursing students in a simulation-enhanced interprofessional education course and from a facilitator survey, using manifest inductive content analysis. The analysis was informed by actor network theory and Schön's reflection on action model. Findings: Students reflected on their performance in relation to (1) personal attributes, such as systemization skills; (2) other team members, such as communication skills; and (3) the surrounding environment, such as efficient employment of resources. They also reflected on the consequences of their actions and future professional growth. We observed group differences in conceptualizations of performance and knowledge enactment. Facilitators' and students' perceptions of performance were mostly aligned. Leadership enactment in the learning environment was problematic for students as well as facilitators. Insights: Students' engagement in the learning environment helped them develop a prototype of their professional identity and explore potential domains or tools for further learning and professional growth. Features of the learning environment fostered teamwork skills and allowed students to learn from each other, thus improving performance. Our findings have several implications for education, and professional practice, including the need for meticulous planning of learning environments and the importance of more intensive pedagogical efforts for soon-to-be health professionals regarding workplace dynamics and potential conflicts. It is also important to consider that an interactive learning environment can invoke reflection on action not only among students but also among facilitators and that this can contribute to the development of clinical praxis.

Thriving Together: a novel workshop to improve cohesion and class culture in medical school cohorts

Thriving Together, a workshop for first year medical students, addresses crucial aspects of class culture early into medical school. Through small group discussions, this student-led event creates a safe space for open dialogue and self-reflection. Participants gain valuable insights into classmates' perspectives and how to foster communication, empathy, and improved class cultures. These lessons are likely to transfer into future practice through enhanced conflict-resolution and relationship-building skills, contributing to higher-quality patient care. Because Thriving Together can readily be adopted elsewhere, we encourage other medical schools to conduct similar workshops to help in addressing an otherwise neglected aspect of medical education.

The ID Digital Institute: Building a digital education toolset and community

Organic digital education (ODE) includes online medical education content that can take various forms, such as blogs, social media, videos, podcasts, or infographics. Multimedia ODE platforms have unique benefits and have quickly become an essential part of medical education. Modern medical educators with competency in digital teaching modalities can leverage these for teaching as well as career development and dissemination of scientific research. The ID Digital Institute is a digital education program with a curriculum designed to equip infectious diseases (ID) professionals with the skills to appraise, create, curate, and integrate ODE into their teaching and career. We share the structure, content, and lessons learned from the ID Digital Institute program. We also illustrate how digital education skills can present unique opportunities to align with current and future transplant and immunocompromised host infectious diseases education efforts.

Extending Professional Identity Formation to develop academic faculty for a new medical school

Academic health centers have a responsibility to foster professional development approaches and engagement environments for faculty to elevate both knowledge and sense of belonging as medical educators. This new educational methods submission depicts faculty development and engagement initiatives implemented at a single institution that were created and influenced by the psychological framework of Professional Identity Formation. The authors suggest ways that academic medical centers can draw upon the formation of these programs to best serve their faculty for cultivating development and engagement for professional growth.

Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education

Introduction

In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education.

Methods

Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT.

Results

Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules.

Discussion

School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.

Mentoring as a complex adaptive system - a systematic scoping review of prevailing mentoring theories in medical education

BACKGROUND

Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring's personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS).

METHODS

A systematic scoping review using Krishna's Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion.

RESULTS

Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring's CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes.

CONCLUSION

Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.

Perceptions of Communities of Practice and Sense of Belonging: Focus Groups of Academic Pediatric Faculty

BACKGROUND

Providing the opportunity for collaboration around a central purpose to improve skills and exchange knowledge, the Community of Practice model can be useful for faculty development. A sense of belonging enhances the engagement in communities. Yet, the barriers and contributors to academic medicine faculty's sense of belonging in communities are not as well explored.

METHODS

Through focus groups with 21 academic pediatric faculty conducted between January and March 2023, this qualitative study examined knowledge of Communities of Practice and the factors that affect sense of belonging and engagement. The authors iteratively coded transcripts to generate themes.

RESULTS

Community accessibility; opportunities for active engagement; working under a clear, shared purpose; and personal interactions enhanced faculty sense of belonging. Barriers to engagement included competing demands, process challenges, and uncertainty.

DISCUSSION

Study results suggest strategies for the promotion of faculty sense of belonging and engagement in Communities of Practice. Consideration of contributors to a sense of belonging may enhance efforts to design and improve engaging faculty development programs.

Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study

OBJECTIVE

Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates.

METHODS

In July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness.

RESULTS

We interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates' PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency.

CONCLUSIONS

Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.

Professional identity formation of medical students in relation to the care of older persons: a review of the literature

With the growing population of older persons, medical students have to be well prepared for older persons' health care during medical school. Becoming a doctor is an interplay of building competencies and developing a professional identity. Professional identity formation of medical students is a relatively new educational concept in geriatric medical education. This review aims to explore the concept of professional identity formation of undergraduate medical students in relation to the care of older persons. Twenty-three peer-reviewed studies were included and summarized narratively. Patient-centeredness, caring and compassion, collaboration and holistic care are characteristics of the doctor's professional identity in relation to the care of older persons. Participating in the context of older persons' health care contributes to the becoming of a doctor in general. In this context, the building of relationships with older persons, participating in their lives and role models are important influencers of professional identity formation. Furthermore, the perceptions and expectations medical students have of future doctoring influence their feelings about the care of older persons. To prepare medical students for older persons' health care, professional identity formation seems to be a relevant educational concept.

Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study

PURPOSE

Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships.

METHOD

The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH, continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships.

RESULTS

Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterward. These practices strengthened learning relationships and supported students' developmental trajectories.

CONCLUSIONS

Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.

Learning to Communicate: A Photovoice Study With Intensive Care Residents During Night Shifts in the Intensive Care Unit

This study explored the learning experiences of intensive care residents in an intensive care unit (ICU) during night shifts and the development of communication skills in this community of practice. This action research qualitative study used the photovoice method in four workshops. A group of nine residents shared their learning experiences and collectively analyzed, built, and presented proposals to improve residents' communication skills in the community of practice in which they become intensivists. Participatory thematic analysis was conducted. Students concluded that night shifts in the ICU offered a perfect situational learning environment for communication with one-on-one resident-teacher relationships, less administrative work, and more resident responsibility, improving intensivist identity. Role models, reflective thinking, and teamwork are essential for fostering communication skills among intensivist community members and are all trainable. The results and student suggestions were presented to teachers and decision-makers in the clinic. These photovoice strategies developed students' abilities to share their critical views and suggestions with decision-makers for subsequent implementation, enhancing their confidence in their learning process, strengthening trust-based relationships with teachers, and improving future intensivists' practice communities.

Translating, adapting, and validating the medical student version of the patient care ownership scale for use in Japan

BACKGROUND

Patient care ownership (PCO) among medical students is a growing area in the field of medical education. While PCO has received increasing attention, there are no instruments to assess PCO in the context of Japanese undergraduate medical education. This study aimed to translate, culturally adapt, and validate the PCO Scale - Medical students (PCOS-S) in the Japanese context.

METHODS

We collected survey data from fifth- and sixth-grade medical students from five different universities varying in location and type. Structural validity, convergent validity, and internal consistency reliability were examined.

RESULTS

Data from 122 respondents were analyzed. Factor analysis of the Japanese PCOS-S revealed three factors with Cronbach's alpha values exceeding the satisfactory criterion (0.70). A positive correlation was observed between the total Japanese PCOS-S scores and the global rating scores for the clinical department as a learning environment (Pearson's correlation coefficient = 0.61).

CONCLUSIONS

We conducted the translation of the PCOS-S into Japanese and assessed its psychometric properties. The Japanese version has good reliability and validity. This instrument has potential value in assessing the development of medical students' PCO.

Motivators and barriers for rural community preceptors in teaching: A qualitative study

PURPOSE

Increasing challenges in recruiting and retaining community-based teaching physicians (e.g., community preceptors) call for a better understanding of motivators and barriers community preceptors perceive in their teaching role. Given the importance of medical school partnerships with community-based sites for student training, it is essential to understand the perspectives of community preceptors as teaching physicians in a context away from the medical school, such as rural, and the factors affecting their career choice to engage in teaching while practising medicine.

METHODS

We conducted semi-structured interviews with rural community preceptors and used open coding to conceptualise data and axial coding to connect codes into categories. We used the socio-cognitive career theory framework to organise categories into themes.

RESULTS

Eleven rural community preceptors from two medical schools participated. Specialties included family medicine, internal medicine and paediatrics; clinical practice and teaching experience ranged from 3-36 and 2-29 years, respectively. Readiness for teaching ('self-efficacy') was pivotal in community preceptors' decision to teach and derived largely from vicarious learning from teaching attendings in medical school or residency; social persuasion and encouragement from clinical partners; and their accomplishments as practising physicians. However, limited faculty development, incomplete knowledge of expectations, disengagement from the medical school and lack of current mentors hindered their self-confidence. Teaching fulfilled their aspirations ('outcome expectations') to give back to the profession, but they felt undervalued and disconnected from other clinician educators. Teaching increased job satisfaction, but clinical workload, and financial impact impeded their goals for achieving excellence ('performance').

CONCLUSIONS

Self-efficacy was a pivotal motivator in rural community preceptors' decision to teach. Role models from early training inspired them to teach. Internal awards sustained teaching efforts. Future research should explore structural barriers influencing rural community preceptors' teaching experiences to better support their career choice to become medical educators.

Around the World in 60 Minutes: How a Virtual Morning Report has Created an International Community for Clinical Reasoning and Medical Education

Problem: Traditionally, clinical reasoning is developed with purposeful exposure to clinical problems through case-based learning and clinical reasoning conferences that harvest a collaborative exchange of information in real-life settings. While virtual platforms have greatly expanded access to remote clinical learning, case-based clinical reasoning opportunities are scarce in low and middle income countries. Intervention: The Clinical Problem Solvers (CPSolvers), a nonprofit organization focused on clinical reasoning education, launched Virtual Morning Report (VMR) during the COVID-19 pandemic. VMR is an open-access, case-based clinical reasoning virtual conference on the Zoom platform modeled after an academic morning report format available to participants worldwide. The authors conducted 17 semi-structured interviews with CPSolvers' VMR participants from 10 different countries to explore the experiences of the international participants of VMR. Context: The CPSolvers was founded by US physicians and has now expanded to include international members throughout all levels of the organization. VMR is open-access to all learners. Preliminary survey data collected from VMR sessions revealed 35% of the attendees were from non-English speaking countries and 53% from non US countries. Impact: Analysis generated four themes that captured the experiences of international participants of VMR: 1) Improving clinical reasoning skills where participants had little to no access to this education or content; 2) Creating a global community from a diverse, safe, and welcoming environment made possible by the virtual platform; 3) Allowing learners to become agents of change by providing tools and skills that are directly applicable in the setting in which they practice medicine; 4) Establishing a global platform, with low barriers to entry and open-access to expertise and quality teaching and content. Study participants agreed with the themes, supporting trustworthiness. Lessons Learned: Findings suggest VMR functions as and has grown into a global community of practice for clinical reasoning. The authors propose strategies and guiding principles based on the identified themes for educators to consider when building effective global learning communities. In an interdependent world where the virtual space eliminates the physical boundaries that silo educational opportunities, emphasis on thoughtful implementation of learning communities in a global context has the potential to reduce medical education disparities in the clinical reasoning space and beyond.