The Distinctions Between Theory, Theoretical Framework, and Conceptual Framework

Measuring self-efficacy in patient-centeredness of physicians in oncology - translation, adaptation and evaluation of psychometric properties of the SEPCQ-27 German version (SEPCQ-24-GER)

INTRODUCTION

Providers' self-efficacy in patient-centeredness, defined as their confidence in their ability to communicate in a patient-centered manner, is linked to their patient-centered attitudes and behaviors. The SEPCQ-27 is a validated instrument to measure medical students' and physicians' self-efficacy in patient-centered communication. The aim of this study was to produce a German adaptation of the SEPCQ-27 and evaluate its psychometric properties in a sample of physicians in oncology.

MATERIALS AND METHODS

The SEPCQ-27 was professionally translated and adapted into German. Descriptive analyses, exploratory and confirmatory factor analyses, and internal consistency, convergent, discriminant and construct validity were conducted using data from a sample of n = 258 physicians collected during the three-arm cluster-randomized intervention trial 'KommRhein Interpro' conducted from 2019-2023.

RESULTS

Exploratory factor analysis led to a modified three-dimensional German version with 24 items (SEPCQ-24-GER), which showed acceptable fit in confirmatory factor analysis (χ2/df = 1.8, CFI = 0.92, TLI = 0.91, SRMR = 0.05, RMSEA = 0.06). The SEPCQ-24-GER demonstrated good internal consistency (Cronbach's alpha > 0.7 for all three dimensions) and acceptable convergent (CR for all dimensions is > 0.7), discriminant (√AVE is higher than the factor intercorrelations for all but one factor), and construct validity (regarding occupational group (F = 4.741, p < .001), occupational experience (r =.240, p < .001) and between factor 3 and sex (t = 2.575, p = .011)).

DISCUSSION

The SEPCQ-24-GER demonstrated satisfactory psychometric properties. Future research should focus on further measures of reliability, sensitivity to change and validation within different samples.

TRIAL REGISTRATION

DRKS (German Clinical Trials Register) - ID: DRKS00022563, registered 29/07/2020.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

How the prospect of a clinical trial impacts decision-making for predictive genetic testing in ALS

Objective: Genetic testing practices are rapidly evolving for people living with, or at-risk for, amyotrophic lateral sclerosis (ALS), due to emerging genotype-driven therapies. This study explored how individuals at-risk for familial ALS (fALS) perceive the opportunity to participate in a clinical trial, and to better understand how that may influence the decision-making process for predictive genetic testing. Methods: This study used both quantitative and qualitative data analyses. Data were collected through an online questionnaire, followed by semi-structured interviews conducted with twelve (n = 12) individuals at-risk for either SOD1- or C9orf72-ALS who had predictive testing prior to study participation. Interview data were analyzed using reflexive thematic analysis. Results: Three overarching themes were conceptualized from the data: i) the psychosocial impact of fALS; ii) perspectives of at-risk individuals on research involvement; and iii) predictive genetic counseling and testing considerations. These results contribute perspectives of the lived experience to inform predictive genetic counseling and testing practices for individuals at-risk for fALS. Conclusion: Individuals at-risk for fALS view potential participation in a presymptomatic clinical trial as an actionable measure that may increase their desire for predictive genetic testing. Genetic counseling was identified as a critical component of the predictive testing process given the life-changing implications associated with a positive result. Increased access to predictive genetic counseling, and in a timely manner, is a significant need in the ALS population given potential access to gene-specific therapies in the presymptomatic stage.

"It's OK for Me to Cry": Client and Therapist Perspectives on Change Processes in SPEAKS Therapy for Anorexia Nervosa

INTRODUCTION AND AIMS

Existing therapies for Anorexia Nervosa (AN) have limited effectiveness, necessitating the development of novel therapies and interventions. Hypothesizing and targeting clear mechanisms of change within treatment offer potential opportunities to improve them. The SPEAKS program aimed to develop, trial, and evaluate a therapy which targets key emotional and social factors known to be relevant in the development and maintenance of AN. The aim of the present study is to explore therapist and client experiences of change processes during the SPEAKS intervention, and what supported or inhibited these.

METHOD

Semi-structured interviews were conducted with sixteen female clients (in age range of 18-49) and six therapists; topic guides explored perceptions of client change processes. Thematic analysis was conducted on the data by two researchers.

RESULTS

Two themes and six sub-themes were developed from the data. These were: "the impact on the eating disorder," "change processes" ("emotional change" and "changing the self"), and "facilitators of and barriers to change processes" ("therapeutic relationship," "clients' emotional engagement," "online delivery," and "therapist lacking flexibility"). "Emotional change" involved an enhanced capacity for clients to tune-in more, acknowledge, listen to, and express how they felt, and "Changing the self" represented a shift in how clients related to themselves, particularly the more vulnerable parts of themselves.

DISCUSSION

The findings of the present study provide support for the hypothesized mechanisms of change inherent within the SPEAKS therapy approach. This supports the robustness and validity of the intervention and lends support for further investigation of its effectiveness.

CLINICAL TRIAL REGISTRATION

The study was registered according to the guidelines of the International Standard Randomized Controlled Trial Number Register (ISRCTN No. 11778891).

Making Medical Education Courses Visible: Theory-Based Development of a National Database

Background

Medical education has undergone professionalization during the last decades, and internationally, educators are trained in specific medical education courses also known as "train the trainer" courses. As these courses have developed organically based on local needs, the lack of a general structure and terminology can confuse and hinder educators' information and development. The first aim of this study was to conduct a national search, analyze the findings, and provide a presentation of medical education courses based on international theoretical frameworks to support Swiss course providers and educators searching for courses. The second aim was to provide a blueprint for such a procedure to be used by the international audience.

Objective

In this study, we devised a scholarly approach to sorting and presenting medical education courses to make their content accessible to medical educators. This approach is presented in detailed steps and our openly available exemplary database to make it serve as a blueprint for other settings.

Methods

Following our constructivist paradigm, we examined content from medical education courses using a theory-informed inductive data approach. Switzerland served as an example, covering 4 languages and different approaches to medical education. Data were gathered through an online search and a nationwide survey with course providers. The acquired data and a concurrently developed keyword system to standardize course terminology are presented using Obsidian, a software that shows data networks.

Results

Our iterative search included several strategies (web search, survey, provider enquiry, and snowballing) and yielded 69 courses in 4 languages, with varying terminology, target audiences, and providers. The database of courses is interactive and openly accessible. An open-access template database structure is also available.

Conclusions

This study proposes a novel method for sorting and visualizing medical education courses and the competencies they cover to provide an easy-to-use database, helping medical educators' practical and scholarly development. Notably, our analysis identified a specific emphasis on undergraduate teaching settings, potentially indicating a gap in postgraduate educational offerings. This aspect could be pivotal for future curriculum development and resource allocation. Our method might guide other countries and health care professions, offering a straightforward means of cataloging and making information about medical education courses widely available and promotable.

Digital Ergonomics of NavegApp, a Novel Serious Game for Spatial Cognition Assessment: Content Validity and Usability Study

BACKGROUND

Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD.

OBJECTIVE

This study aimed to determine the content validity and usability perception of NavegApp across multiple groups of interest.

METHODS

A multistep process integrating methodologies from software engineering, psychometrics, and health measurement was implemented to validate the software. Our approach was structured into 3 stages, guided by the software life cycle for health and the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations for evaluating the psychometric quality of health instruments. To assess content validity, a panel of 8 experts evaluated the relevance and representativeness of tasks included in the app. In addition, 212 participants, categorized into 5 groups based on their clinical status and risk level for AD, were recruited to evaluate the app's digital ergonomics and usability at various stages of development. Complementary analyses were performed to identify group differences and to explore the association between task difficulty and user agreeableness.

RESULTS

NavegApp was validated as a highly usable tool by both experts and users. The expert panel confirmed that the tasks included in the game were representative (Aiken V=0.96-1.00) and relevant (Aiken V=0.96-1.00) for measuring SC components. Both experts and nonexperts rated NavegApp's digital ergonomics positively, with minimal differences between groups (rrb 0.08-0.29). Differences in usability perceptions were observed among participants with sporadic mild cognitive impairment compared to cognitively healthy individuals (rrb 0.26-0.29). A moderate association was also identified between task difficulty and user agreeableness (Cramér V=0.37, 95% CI 0.28-0.54).

CONCLUSIONS

NavegApp is a valid and user-friendly SG designed for SC assessment, developed by integrating software engineering and psychometric evaluation methodologies. While the results are promising, further studies are warranted to evaluate its diagnostic accuracy and construct validity. This work outlines a comprehensive framework for SG development in cognitive assessment, emphasizing the importance of incorporating psychometric validity measures from the outset of the design process.

Applying theories, models, and frameworks to help genetic counselors and students achieve clinical and professional goals

Some genetic counselors (GCs) may find theories, models, and frameworks (TMFs) useful in clinical skills selection and when reflecting on or evaluating genetic counseling practice. This paper aims to demonstrate how TMFs can be used to postulate how different skills may impact patients'/clients' decisions, behaviors, and outcomes and consider how multiple TMFs can inform the use of various skills or strategies to achieve different goals. Additionally, we provide examples of TMFs that may help GCs in nonclinical aspects of their work, such as implementing and evaluating new interventions or service delivery models. To guide the selection of appropriate TMFs, we provide a set of questions to consider and include examples of skills and approaches that align with different TMFs. While TMFs provide a structured approach and valuable guidance that may help advance genetic counseling practice, they have certain limitations. Additional research is necessary to determine the effectiveness of using TMFs to guide clinical practice and improve patient/client outcomes.

Return to practice for allied health professionals with protected characteristics: a mixed-methods study

INTRODUCTION

Return to practice is one mechanism for recruiting and retaining allied health professionals (AHPs) within the health and care workforce in England. It is not known how this affects persons with protected characteristics.

AIM

To understand experiences of AHPs with protected characteristics of returning to the workforce through a return to practice programme.

METHOD

A QUAL (semistructured interviews) + qual (focus group interviews) mixed-methods study. 12 online semistructured interviews with return to practice AHPs, followed by 2 online focus groups.

RESULTS

Our research identifies a new type of returners who have to use the return to practice programme as a vehicle to step into health and social care as they have not been able to find employment. A main driver to return to practice was financial reason.

CONCLUSION

To date there, is little evidence of leaders understanding the complexities of AHPs in a return to practice programme, the considerable contribution they can make to the workplace and the current inequities that exist.

Interventions to enhance the core competencies of clinical nursing preceptors: A systematic review

Aim This systematic review aimed to identify intervention studies on core competencies of clinical nursing preceptors, evaluate their quality using quantitative indicators, and summarize the effectiveness of the intervention programs and limitations of included studies.

DESIGN

This review was reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist.

DATA SOURCES

Between May 1, 2024 and May 30, 2024, we searched PubMed, Web of Science, CINAHL, Medline, EMBASE and ProQuest (Health & Medical Collection) to get relevant literature published between January 2010 and May 2024. The main search concepts were core competence; preceptor; intervention; nurse. References in all eligible literature were also searched to prevent omissions.

REVIEW METHODS

Articles were screened and then evaluated by two researchers independently. The narrative table was used to summarize the characteristics of the included studies and the details of interventions. The modified Educational Interventions Critical Appraisal Tool was used to evaluate the quality of studies; the Kirkpatrick Model was used to assess the interventions. The content analysis method was used to synthesize data.

RESULTS

A total of 27 articles were included in this review. Six studies were rated as high quality. The remaining 21 studies were all rated as moderate quality and no studies were rated as low quality. Eight studies achieved the Kirkpatrick level 1, all the studies achieved the Kirkpatrick level 2, six studies achieved the Kirkpatrick level 3, Only one study achieved the Kirkpatrick level 4.

CONCLUSIONS

Interventions that covered key content themes, used face-to-face training method, and had shorter intervals may be more effective. Future studies could be improved by involving more representative samples, developing interventions based on theories, evaluating the long-term effects of the interventions. This review provided implications for developing more effective and sustainable educational programs for clinical nursing preceptors.

On concepts, constructs, measures, metrics, and the variable necessity of definitions

This commentary is a response to both Merkebu et al., (2024) and Ellaway and Patocka (2024) on the place and importance of definitions of key notions in health professions education (HPE). The author argues that definitions of key notions in HPE research, teaching, and assessment are both variably possible and variably useful. By differentiating across concepts, constructs, measures, and metrics, the author contextualizes the variable utility and necessity of definitions according to their intended use. While many conceptualizations of key notions peacefully co-exist in the current HPE literature, conflation across concepts, constructs, measures, and metrics lead to a fragmented literature base and problematic assumptions, operationalizations, and misattributions of some of our most closely held concepts.

Impact of patient sex on selection for abdominal aortic aneurysm repair: a discrete choice experiment

OBJECTIVES

Women with an abdominal aortic aneurysm (AAA) are less likely to receive elective repair than men. This study explored the effect of patient sex and other attributes on vascular surgeons' decision-making for infrarenal AAA repair.

DESIGN

Discrete choice experiment.

SETTING

Simulated environment using case scenarios with varying patient attributes.

PARTICIPANTS

Vascular surgeons.

INTERVENTIONS

Surgical decision-making.

MAIN OUTCOME MEASURES

AAA repair versus no repair and endovascular versus open repair.

RESULTS

182 surgeons completed 2987 scenarios. When all other attributes were equal, a woman was more likely to be offered an AAA repair (marginal rate of substitution (MRS) 3.86 (95% CI 2.93, 4.79)), while very high anaesthetic risk (MRS -4.33 (95% CI -5.63, -3.03)) and hostile anatomy (MRS -3.28 (95% CI -4.55, -2.01)) were deterrents. Increasing age did not adversely affect the likelihood of offering repair to men but decreased the likelihood for women, which negated women's selection advantage from the age of 83 years. Women were also more likely to be offered endovascular repair (MRS 2.57 (95% CI 1.30, 3.84)).

CONCLUSIONS

Patient sex alone did not account for real-world disparity observed in selection for surgery. Rather, being a woman was associated with a higher likelihood of being offered AAA repair but also a higher likelihood of being offered less invasive endovascular repair. Increased age decreased the likelihood of surgical selection for women but not men. Preference for less invasive repair, combined with inferior rates of anatomical suitability, and the comparably older age of women at the time of AAA repair selection may account for lower rates of repair for women observed.

Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Scoping Review

BACKGROUND

Critical thinking is a crucial skill in the nursing profession and must be fostered through nursing education. Simulation-based learning (SBL) with technological modalities is a pedagogical approach to enhance critical thinking skills for nursing students. The use of technology in SBL to achieve critical thinking skills is diverse. No previous scoping review has systematically mapped studies on SBL supported by technology to enhance critical thinking in nursing students.

OBJECTIVE

This scoping review aimed to systematically map research on the use of SBL supported by technology to enhance critical thinking in nursing students.

METHODS

This scoping review was conducted according to the framework by Arksey and O'Malley and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, Embase, PsycINFO, and Web of Science databases in 2021 and repeated in 2023 and 2024. Pairs of authors independently assessed titles, abstracts, and full-text papers and extracted data from the included studies. The data underwent summative and thematic analysis and were categorized according to the findings.

RESULTS

In total, 4 main categories of technology applied in SBL were identified: computer-based simulations, human-patient simulators, virtual reality or immersive virtual reality, and others. The findings revealed a shift across time in the technology used for SBL to enhance critical thinking, from human patient simulators to computer-based simulations. A dominant part of the included studies published after 2018 (21/44, 48%) incorporated a combination of asynchronous and synchronous learning activities. The theoretical foundation of the studies revealed a range of scientific theories and conceptual frameworks and models. Enablers of or barriers to the enhancement of critical thinking skills in nursing students were identified within the following themes: affinity for and availability of technology, realism, accessibility, engagement and motivation, validation, return on investment, and enhanced critical thinking through SBL using technology.

CONCLUSIONS

There has been a noticeable shift in the technology and use of technology in SBL. Descriptions of the applied technology and pedagogical considerations are pivotal for comparing or synthesizing research results. There has been a trend toward a blended educational approach combining synchronous and asynchronous learning activities. User technological proficiency and the perceived quality of the technology are imperative in the development of critical thinking. Realism, engagement, and motivation play pivotal roles in the enhancement of critical thinking in technologically supported SBL. The establishment of robust theoretical foundations of research and standardized research practices will strengthen the evidence obtained from the research conducted.

Senior Year Clinical Trainees' Perceptions of a Clinical Entrustment Scale in an Academic Veterinary Medical Center

Researchers explored senior/clinical year veterinary trainees' perceptions of the Goal Oriented Learner Driven-Entrustment (GOLD-E) scale. Researchers recruited trainees from on-campus clinical service rotations to explore the following questions: 1) How do trainees regard the feedback the GOLD-E tool provides? 2) How do trainees enter into the clinical feedback relationship? 3) How does the GOLD-E tool create opportunities for trainees to engage authentically with themselves and with clinical coaches (i.e., clinicians, technicians, interns, and house officers)? Clinical year trainees completed the GOLD-E form with clinical coaches during the 2018-2019 academic year. Data collection included both quantitative and qualitative methods using bi-weekly surveys and focus groups. Findings point to the need for: Thoughtful integration of feedback and coaching when assessing practice using EPAs; better understanding of the role coaches play in the everyday expectations and practices of learning to become a practicing veterinarian; and realization of trainees' uncertainty concerning their role in the coaching relationship, the learning process, and when asking for feedback. These findings connect with the first paper in this series and further emphasize that culture change requires significant time and effort. Moreover, there needs to be careful consideration of organizational structures to effectively implement change.

Navigation as a system approach: A qualitative descriptive study to inform a statewide cancer navigation approach in Australia

PURPOSE

This study aimed to identify challenges and facilitators in accessing cancer care in South Australia, from the perspectives of cancer survivors and caregivers, to inform responsive cancer navigation approaches.

METHODS

A qualitative descriptive study was conducted using an online qualitative survey (n = 75) and video, phone, and in-person semi-structured interviews (n = 22) with cancer survivors and caregivers (herein cancer consumers). Data analysis was performed in two phases: content analysis categorised consumer challenges and facilitators, while a subjective-inductive approach guided by the supportive care framework was used to develop a statewide navigation approach.

RESULTS

Key challenges reported by consumers included perceived invalidation of medical concerns, delayed diagnoses, poor communication, inadequate information provision, fragmented care, and limited logistical, cultural, and psychological support. Inductive analysis identified four key themes: 1) cancer consumers have dynamic care needs that can evolve throughout a patient's cancer experience, 2) cancer consumers require a foundational level of information to support navigation, 3) some cancer consumers express a preference for community-based navigation services to help them manage their care, and 4) individuals with more complex care needs may require more intensive professional navigation services. A conceptual needs-based navigation approach (the Flinders Needs-Based Approach to Cancer Navigation) was developed based on these insights. This approach consists of three levels of navigation interventions: level 1 involves providing information-based navigation to all individuals affected by cancer, level 2 involves community-based navigation support offered to those requiring or wanting additional supported assistance, and level 3 offers professional navigation for individuals with complex needs.

CONCLUSION

Our study highlights the importance of tailoring cancer navigation services to meet the evolving needs of patients, emphasising the role of both community and professional support, particularly for individuals with complex care requirements. Findings will inform further co-design discussions involving consumers, health professionals, and policymakers to implement cancer navigation services across South Australia.

Methodology for promoting equity-informed research in sport and exercise medicine: recommendations from the AMSSM Collaborative Research Network

BACKGROUND

Limited guidance exists for conducting research on health disparities within the field of sport and exercise medicine (SEM). This review aimed to identify and summarise existing best practices for conducting equitable, diverse and inclusive research within SEM.

METHODS

A narrative review with evidence synthesis was conducted using electronic databases, reference lists, manual searches and relevant publications from other organisations. Search terms associated with steps of the research process were used in tandem with 'equity', 'inclusion' and 'health disparities'.

RESULTS

We developed a research roadmap for SEM researchers with methodological recommendations to develop and conduct equity-informed and equity-focused research. This roadmap serves as a tool for SEM researchers and clinicians to design, execute and disseminate research with a health disparities lens. We recommend SEM researchers should build an equitable, diverse and inclusive research team and include community members; apply a multilevel, intersectional framework; minimise and acknowledge potential biases in the study design and incorporate qualitative or mixed-methods approaches if appropriate; apply multiple inclusive strategies for recruiting and retaining diverse populations; collect accurate and representative data using inclusive data collection methods and tools with validity and reliability in the populations of interest; apply measures with evidence of validity and reliability in the populations of interest; implement a data analysis plan that reflects the conceptual and theoretical frameworks; and promote broad dissemination and interventions that ultimately address and reduce health inequities.

CONCLUSION

SEM researchers should consider these methodological recommendations to conduct equity-informed and equity-focused research to address health disparities in SEM.

Social media quality in undergraduate medical education: A reconceptualisation and taxonomy

BACKGROUND

Social Media (SoMe) as a learning tool, though ubiquitous in society and popular within medical education, is often criticised as superficial. Its limitless output has been blamed for encouraging shorter attention spans and shirking in-depth reflection. The evidence base is itself superficial and lacking rigour or meaning. We aimed to consider a theoretical basis for how 'quality' learning may happen on such platforms. Our findings then informed the construction of a taxonomy for SoMe learning.

METHODS

We conducted a qualitative interview study of United Kingdom (UK) medical students using a theory-informed inductive study design. The research question was: 'How do medical students conceptualise quality of learning on social media?'. We purposively sampled participants from responses to a short survey collecting demographic and SoMe usage data. Interview data were analysed using framework analysis and informed by Blooms taxonomy, connectivism and communities of practice (CoP) theories.

RESULTS

We received survey responses from 118 medical students across 25 UK medical schools. From these, 13 participants were recruited to individual semi-structured interviews. We constructed three themes through framework analysis of interview data: cognitive hacking, professional identity reflection and safety, control and capital.

DISCUSSION

Quality SoMe learning may be conceptualised as a socially connected process, built upon constantly evolving networks but inexorably influenced by fluctuating hierarchy within learner-centric CoP. Educators and institutions may support high-quality learning for students through engagement which promotes community development, and safe, listening environments which foster professional identity formation.

'We're like Spider-Man; with great power comes great responsibility': Coaches' experiences supporting struggling medical students

BACKGROUND

Medical students can experience a range of academic and non-academic struggles. Coaching is a valuable strategy to support learners, but coaches describe working with struggling learners as taxing. Transformative learning theory (TLT) provides insights into how educators grow from challenging experiences to build resilience. This study explores how coaches evolve as educators through supporting struggling students.

METHODS

This qualitative study grounded in an interpretivist paradigm used interviews of longitudinal medical student coaches at two academic institutions. Interviews, using TLT as a sensitizing concept, explored coaches' experience coaching struggling learners. We performed thematic analysis.

RESULTS

We interviewed 15 coaches. Coaches described supporting students through multi-faceted struggles which often surprised the coach. Three themes characterized coaches' experiences: personal responsibility, emotional response, and personal learning. Coaches shouldered high personal responsibility for learners' success. For some, this burden felt emotional, raised parental instincts and questions about maintaining boundaries with learners. Coaches evolved their coaching approach, challenged biases, and built skills. Coaches learned to better appreciate the learner point of view and employ resources to support students.

DISCUSSION

Through navigating learner struggles, educators can gain self-efficacy, learn to understand learners' perspectives, and evolve their coaching approach to lessen their personal emotional burden through time.

Development of a Cadaveric Breast Ultrasound Module and Analysis of Its Effectiveness Among Medical Students

Information characterizing a standardized breast ultrasound curriculum in medical education is lacking, and due to the sensitive nature of this imaging, medical schools encounter difficulties in obtaining standardized patients for practicing these skills. Therefore, a supplemental, cadaver-based, point-of-care ultrasound (POCUS) module was created to introduce preclinical medical students to breast anatomy and pathology (IRB #1950978). Participants (n = 104) completed a 16-item, pre-instruction assessment followed by an online breast ultrasound module. After, participants completed a 60-min, in-person training session using donor models to examine (1) normal breast tissue, (2) fluid-filled cysts, (3) benign and malignant solid lesions, and (4) breast implants; a 19-item, post-instruction assessment was completed. Comparison of mean scores from the multiple choice, knowledge-based items in the pre- and post-assessments demonstrated improvement in knowledge gained (pre, 5.08; post, 7.78) (p = 0.001); Cronbach's alpha, pre, 0.199 vs. post, 0.596. Participant perceptions were evaluated using a Likert survey; participants noted strong agreement (77%) or agreement (17%) with the benefit of and strong agreement (32%) or agreement (55%) regarding confidence in performing breast ultrasound (Cronbach's alpha: pre, 0.705; post = 0.755). Analysis of open responses revealed five themes: positive feedback (74.5%), appreciation/thanks (35.3%), emphasis of hands-on learning (21.6%), desire for additional sessions (19.6%), and suggestions for improvement (17.6%). Positive results from the introduction of a cadaver-based breast ultrasound module early in medical students' careers show promise and should be a consideration when discussing its integration into preclinical curriculum.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02149-y.

Inclusion in the clinic: A mixed methods study of left-handed student's perceptions of using cordless keyboards

PURPOSE/OBJECTIVES

Little is written on obstacles for left-handed students in the dental clinic. This mixed methods study evaluates the experiences of using cordless keyboards for left-handed dental students.

METHODS

Researchers purchased four Logitech K400 Plus wireless keyboards. Using Qualtrics, a survey software, a pre-survey was sent out at the beginning of the spring semester prior to introducing the cordless keyboards. A post-survey circulated at the end of the semester. Quantitative analysis statistical analysis was conducted using IBM SPSS Statistics. Researchers conducted a thematic analysis of the qualitative survey responses.

RESULTS

Twenty-three left-handed D3 and D4 dental students were asked to participate in a survey about cordless keyboards. The pre-survey had a 100% response rate, and the post-survey had a 71% response rate. The surveys indicated that left-handed students often face a range of barriers in clinical settings, including ergonomic challenges to enter data, difficulty managing time due to double entry of data on right-handed equipment, and feelings of psychological unsafety due to fear for asking for support. The most significant finding was as follows: not only did the cordless keyboard assist clinical performance, but the cordless keyboard project also helped students feel heard and validated as left-handed learners.

CONCLUSIONS

Researchers recommend that educators prioritize the inclusion of left-handed learners through various practices like making adjustments to physical spaces and creating inclusive environments where all learners feel supported.

Ready, or not? A qualitative study of emergency medicine senior residents' perspectives on preparing for practice

Objectives

The transition from residency to unsupervised practice challenges doctors to adapt to new environments and responsibilities. Past work has focused on how physicians acclimate to their new roles, raising questions about how residents might think proactively about transitions while still in training. This study explores senior emergency medicine (EM) residents' perspectives on preparedness for unsupervised practice and how they draw from training experiences to assess their evolving sense of preparedness.

Methods

The authors used a constructivist grounded theory approach, inviting all fourth-year EM residents from two residency programs to participate in semistructured interviews. Participants were asked to reflect on their preparedness for entering unsupervised practice and to imagine scenarios for which they felt unprepared. Two authors coded line by line using constant comparison, organizing data into codes and categories. The research team met to discuss relationships between codes, developing themes to theorize about the phenomenon of interest.

Results

Sixteen residents were interviewed. The authors identified two overarching categories of themes. First, participants described individualized conceptualizations of preparedness, constructed from past workplace experiences and those they anticipated they would have in unsupervised practice. These conceptualizations emphasized drawing confidence from experience and developing adaptability to manage the uncertainties of medical practice. The second overarching category involved participants' efforts to gauge their own preparedness. To do so, they used interactions with others to assess their readiness to manage specific problems and made holistic appraisals across multiple experiences to assess their overall preparedness for unsupervised practice.

Conclusions

Trainees draw from past experiences to forecast their abilities to manage the inevitable uncertainties of unsupervised practice. These conceptualizations of preparedness reflect a capability approach to training, with informed confidence and dynamic self-appraisal. These findings suggest potential learning goals of senior trainees and considerations for medical educators to consider when fostering trainees' capabilities for unsupervised practice.

Shattering the Shield: Embracing Complexity in Undergraduate Medical Education

BACKGROUND

Multimorbidity and patient complexity are increasing, yet undergraduate medical education curricula remain dominated by single disease frameworks, where students are often shielded from exposure to this complexity. Why this shielding continues to occur is understandable; however, this may leave graduates feeling underprepared for real-world practice. This study aimed to explore medical students' experiences of encountering, managing and dealing with complexity and to provide informed recommendations for integrating complexity into clinical teaching.

METHODOLOGY

Situated within a constructivist paradigm, this qualitative study involved focus groups (n = 4) with fourth- and fifth-year medical students (n = 17) from two Scottish Universities. Data were analysed using reflexive thematic analysis.

FINDINGS

Learners in this study recognised multimorbidity, complex communication and emotionally charged interactions in their definitions of complexity. They described varying levels of exposure to complexity and opportunities to engage meaningfully with complex patients. Students felt that supervisors who shield students from learning opportunities with complex patients, together with a failing healthcare system, were critical limiting factors in their development. Learners emphasised the powerful role of supervisors in their learning experiences, which limited their ability to experiment and learn from productive failure but felt that with guided scaffolding and supervision, teaching and learning in this space could be meaningfully enhanced.

CONCLUSION

Exposure to and engagement with complex patients offer critical learning opportunities that may allow students to explore and better develop skills in managing complexity. With appropriate scaffolding, students can be empowered to embrace complexity in the clinical learning environment, potentially equipping them to care for complex patients.

A mixed methods study investigating factors affecting adherence to Plasmodium vivax malaria primaquine radical cure regimens among migrants along the Myanmar-Thailand border

BACKGROUND

The countries within the Greater Mekong Region of Southeast Asia have pledged to eliminate malaria by 2030. Elimination of Plasmodium vivax malaria is challenging as it requires radical cure to prevent relapse. Understanding and facilitating adherence to primaquine radical cure regimens is necessary for malaria elimination.

METHODS

A convergent parallel mixed methods study was conducted to investigate the barriers to and facilitators for completing primaquine treatment of P. vivax infection among mobile migrant communities on the Myanmar-Thailand border. Quantative data were derived from routine malaria consultations. Qualitative data, informed by the social cognitive theory and health belief model, were collected through in-depth interviews with patients and focus group discussions with local health providers and community leaders.

RESULTS

Of 729 adult patients with primaquine treatment outcomes, 45% did not complete the follow-up of 28 days and were assumed to be non-adherent to primaquine treatment. Patients of Karen ethnicity (OR 1.7, 95% CI 1.2-2.3; p = 0.001) or having a previous episode of malaria from any species (OR 1.6, 95% CI 1.1-2.3; p = 0.007) were more likely to report completing the 14-day primaquine radical cure regimen. Five focus group discussions with front-line healthcare workers and community members and 16 in-depth interviews with patients who were prescribed P. vivax radical cure were conducted. Key themes related to the social cognitive theory included behavioral factors where work outweighed the choice to complete treatment; environmental factors where access to care determined primaquine treatment completion; and cognitive factors having a positive but limited influence on treatment completion. According to the health belief model, prioritizaton of work reduced seeking diagnosis and completing treatment, and often outweighed facilitating factors such as malaria literacy, health education, and social norms; and affected the perceived susceptibility and severity of P. vivax infections.

DISCUSSION

Work and productivity were identified as primary behavioral factors affecting adherence to primaquine radical cure and follow up in a migrant population. Community support and cultural cues may overcome these barriers. Understanding the rationale of patient adherence to primaquine may help guide programming for P. vivax elimination among migrant populations in resource-constrained settings.

Faculty Reflections on What Makes a Good Surgeon: "The operating Room is Often the Smallest Part of the Puzzle"

OBJECTIVE

Little research has inductively investigated the unique nontechnical qualities required of a surgeon holistic to their practice. This is problematic because there may be additional nuances, or entirely new attributes, that can only be identified in the authentic context of surgical practice. The aim of this study was to investigate the unique nontechnical qualities required of surgeons holistic to their practice.

DESIGN AND SETTING

We conducted a thematic analysis. One-hour in-depth semi-structured interviews were conducted with faculty surgeons from two academic hospitals. Surgeons responded to the question: "What makes you a good surgeon?" Interviews were transcribed and coded. Theory-informing inductive data analysis, utilizing the lens of virtues ethics, allowed for development of an overarching theme.

PARTICIPANT AND RESULTS

Twenty-seven surgeons (25.9% female) participated. Ideas presented by surgeons on what makes a good surgeon were distilled into a novel conceptual framework comprising five virtue couplets. The good surgeon is perceptive and caring; self-reflective and growth-seeking; confident and humble; driven and balance-seeking; and honest and responsible.

CONCLUSIONS

This study indicates a unique set of nontechnical virtues present in the "good surgeon." These virtues offer areas ripe for education and investigation.

Factors affecting the specialty choice among medical students of Saudi Arabia; an exploratory study

BACKGROUND

Career or specialty choice is one of the crucial steps of a medical student's life. It's a difficult yet important decision that is hard to reverse after getting into the residency program. The recent catastrophic experience of shortage and maldistribution of the health workforce among different specialties during the recent pandemic has made it critical for the authorities to look into the motivators and determinants for the specialty choice from the undergraduate medical student's perspective. Therefore, the study aimed to find out the major factors affecting career choice and the effects of the COVID-19 pandemic on the specialty choice of medical students in Saudi Arabia.

METHOD

This qualitative exploratory study was carried out to explore the factors affecting the specialty choice and effects of COVID-19 on the specialty choice of senior medical students and interns of Saudi Arabia by utilizing semi-structured audio-recoded interviews. Participants of the study were enrolled by convenient sampling after informed written consent. Data were transcribed and thematic analysis was done to extract the themes.

RESULT

A total of 28 medical students and 14 interns participated in the study. The study identified five major themes with 18 relevant subthemes. The subthemes derived from the transcribed data were arranged under the following key themes; recognizing the determinants for specialty choice, financial expectation, gender specificity/stereotype, the impact of COVID-19, and concomitant motivation factors.

CONCLUSION

The right selection of a suitable future career is pivotal and strongly associated with future job success and satisfaction for a medical graduate. The study has provided insight to the regulatory bodies about student's fears and factors affecting them to choose or avoid certain specialties to formulate a future resource management plan accordingly.

Navigating the paradox: Exploring resident experiences of vulnerability

INTRODUCTION

Learning and growth in postgraduate medical education (PGME) often require vulnerability, defined as a state of openness to uncertainty, risk, and emotional exposure. However, vulnerability can threaten a resident's credibility and professional identity. Despite this tension, studies examining vulnerability in PGME are limited. As such, this study aims to explore residents' experiences of vulnerability, including the factors that influence vulnerability in PGME.

METHODS

Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Interview transcripts were coded and analysed iteratively. Themes were identified and relationships among themes were examined to develop a theory describing vulnerability in PGME.

RESULTS

Residents characterised vulnerability as a paradox represented by two overarching themes. 'Experiencing the tensions of vulnerability' explores the polarities between being a fallible, authentic learner and an infallible, competent professional. 'Navigating the vulnerability paradox' outlines the factors influencing the experience of vulnerability and its associated outcomes at the intrapersonal, interpersonal, and systems levels. Residents described needing to have the bandwidth to face the risks and emotional labour of vulnerability. Opportunities to build connections with social agents, including clinical teachers and peers, facilitated vulnerability. The sociocultural context shaped both the experience and outcomes of vulnerability as residents faced the symbolic mask of professionalism.

CONCLUSION

Residents experience vulnerability as a paradox shaped by intrapersonal, interpersonal, and systems level factors. These findings capture the nuance and complexity of vulnerability in PGME and offer insight into creating supportive learning environments that leverage the benefits of vulnerability while acknowledging its risks. There is a need to translate this understanding into systems-based change to create supportive PGME environments, which value and celebrate vulnerability.

DPD. ReflACTION framework: A proposed model for implementation of clinical pharmacy services

The implementation of clinical pharmacy services (CPS) has grown worldwide. However, few studies have used models and/or frameworks to facilitate the implementation process, especially in a low and middle-income countries. In addition, there are limitations in the ways that implementation frameworks are used. Therefore, this discussion aimed to propose and describe an approach using the ReflACTION framework. ReflACTION emerged from several years of systematic observation and experience of the Laboratory of Teaching and Research in Social Pharmacy (LEPFS) in implementing CPS in different settings of Brazilian health system. These experiences led the research group to systematize the implementation of CPS based on three theorical references: Paulo Freire's theoretical references, the Maguerez Arc and the Apoteca framework. The ReflACTION framework proposes five steps that starts and ends in the setting, which are: observation of reality; gathering key-points; theorization; solution hypothesis; and application to reality. All steps were carried out considering the determinants of the implementation process. For the present study, we highlight the importance of the implementation team, the involvement of stakeholders as well as their dialogue and awareness. Thus, we describe the operationalization process for each step. The ReflACTION framework can be used to describe and guide the implementation process of CPS. We expect the proposed framework may add knowledge to implementation science and, ultimately, achieve desired patient outcomes.

The impact of using ChatGPT on academic writing among medical undergraduates

BACKGROUND

ChatGPT is widely used for writing tasks, yet its effects on medical students' academic writing remain underexplored. This study aims to elucidate ChatGPT's impact on academic writing efficiency and quality among medical students, while also evaluating students' attitudes towards its use in academic writing.

METHODS

We collected systematic reviews from 130 third-year medical students and administered a questionnaire to assess ChatGPT usage and student attitudes. Three independent reviewers graded the papers using EASE guidelines, and statistical analysis compared articles generated with or without ChatGPT assistance across various parameters, with rigorous quality control ensuring survey reliability and validity.

RESULTS

In this study, 33 students (25.8%) utilized ChatGPT for writing (ChatGPT group) and 95 (74.2%) did not (Control group). The ChatGPT group exhibited significantly higher daily technology use and prior experience with ChatGPT (p < 0.05). Writing time was significantly reduced in the ChatGPT group (p = 0.04), with 69.7% completing tasks within 2-3 days compared to 48.4% in the control group. They also achieved higher article quality scores (p < 0.0001) with improvements in completeness, credibility, and scientific content. Self-assessment indicated enhanced writing skills (p < 0.01), confidence (p < 0.001), satisfaction (p < 0.001) and a positive attitude toward its future use in the ChatGPT group.

CONCLUSIONS

Integrating ChatGPT in medical academic writing, with proper guidance, improves efficiency and quality, illustrating artificial intelligence's potential in shaping medical education methodologies.

Safety management within the scope of teaching practical clinical skills: framing errors for cardiopulmonary resuscitation training - a multi-arm randomized controlled equivalence trial

INTRODUCTION

Cardiopulmonary resuscitation (CPR) is among the most important skills in clinical practice. Errors can happen here, just like everywhere, and potentially have severe consequences. Two common error handling strategies known from practice are Error Management (EM) and Error Avoidance (EA). However, its effects on medical performance outcomes remain unclear. This study aimed to examine the role of error framing in basic life support (BLS) training for future healthcare professionals.

MATERIALS AND METHODS

In an equivalence trial (N = 430), first-year medical, dentistry, physiotherapy, and midwifery students underwent BLS training. In the three study arms, participants received either (1) instructions framing errors positively (EM), (2) instructions framing errors to be avoided (EA), or (3) no further instructions (Control). CPR performance was assessed using a resuscitation manikin measuring compression depth (CD) and compression rate (CR). The self-confidence ratings were assessed using a questionnaire. Equivalence margins for the outcome parameters and sample size calculations were based on previous standard BLS studies, using two-sided 95% confidence intervals to determine significance of equivalence.

RESULTS

The results regarding CD revealed equivalence with a trend toward superiority of EM over EA (proportional difference 23.3%-points; 95% CI 11.4%-34.2%) and EM over control (proportional difference 23.4%-points; 95% CI 11.5%-34.2%.) and significant equivalence of EA and control (proportional difference 0.1%-points; 95% CI -11.6%-11.7%). Significant equivalence was determined for all study arms with respect to CR and self-confidence.

CONCLUSION

Our study revealed that EM was not detrimental to learners' CPR performance. Given existing research on long-term beneficial effects of EM on patient safety, coupled with the proven equivalence of EM and EA concerning short-term performance, we argue that EM is a promising approach for future medical education purposes. Raising awareness of error framing and teaching error-handling strategies is expected to benefit ongoing safety management efforts in medical education and beyond.

Laying train tracks en route: How institutional education leaders navigate complexity during mandated curriculum change

INTRODUCTION

Institutional education leaders serve key roles in leading major curricular change within residency education, yet little is known about how they accomplish these goals on the ground. Change management principles have predominantly been developed and described in the hierarchical context of management science and corporate settings. However, the non-hierarchical, complex and adaptive features of health professions education may render these traditional change management models inadequate. We explored how institutional educational leaders navigate the complex residency education system in implementing a major curricular change.

METHODS

Using constructivist grounded theory, we conducted and iteratively analysed semi-structured interviews with 11 institutional education leaders from across Canada who were responsible for leading the nationally mandated curricular change to competency-based residency education. Thematic analysis was performed iteratively using constant comparison.

RESULTS

Leaders managing the change process focused on two priorities: steering the direction of the change process as it evolved and maintaining the momentum amongst stakeholders to move forward steadily. Four common threats and opportunities impacted the focus on direction and momentum: multiplicity of contexts, innovation, resistance and distractions. In response, leaders utilised various tactics and harnessed diverse leadership styles to manage these challenges accordingly.

CONCLUSIONS

We identified a change framework that offers a more contextually nuanced understanding of curricular change in residency education that has not been described in the change management literature generated by the management sector. Institutional education leaders focused on maintaining the direction and momentum, while constantly assessing and adapting to evolving, uncertain and complex conditions. Our findings provide a simple and practical foundation to support leadership education in curricular change as well as researchers in developing further change theories in complex adaptive health professions education systems.

A mixed method approach to analysing patterns and drivers of antibiotic use and resistance in beef farms in Argentina

Introduction

Antimicrobial resistance is a challenge to be faced by all livestock sectors; within beef farming, antibiotic use patterns vary by country and management practices. Argentina is a country with high beef production & consumption but limited information surrounding antibiotic use. The aims of this project was to understand how antibiotics are being used across the beef industry in Argentina and exploring drivers of usage.

Methods

Quantitative and qualitative data was collected by: A survey of breeding and feedlot farms including antibiotic use (from purchase data); a detailed analysis of two feedlot farms' therapeutic antibiotic use records; a survey of vets' views on certain antibiotic practices; and a focus group of farmers and vets focusing on wider influences affecting decision making. Antibiotic use data was calculated using mg/population corrected unit (PCU) (ESVAC) and thematic analysis was used to identify drivers of antibiotic use among participants.

Results

The median use across 17 farms that supplied purchase data was 76.52  mg/kg PCU (ESVAC; IQR  =  36.81  mg/kg PCU [ESVAC]). The detailed farm records showed that the largest reason for treatment was group treatments (72.92% of treatments) followed by treatment for respiratory disease (12.75% of treatments). Macrolides accounted for 76.37% of treatments. Nearly half of farms used routine prophylactic treatment for arriving animals (n  =  7/18). The use of quarantine and 'sick pens' were seen as important by surveyed vets with antibiotic prophylaxis and in-feed antibiotics seen as contributors to antibiotic resistance. The focus group highlighted the influence of the economic and political landscape on husbandry practices and the responsibility the farming sector had towards antibiotic stewardship.

Discussion

Overall, Argentine beef feedlots resemble North American beef feedlots in terms of antibiotic practices but with considerably lower usage, with in-feed monensin representing a large proportion of total ABU. The adaptation period presents a challenge to animal health; antibiotics are administered a prophylaxis, metaphylactic and individual treatments depending on farm management practices. Further research into internationally comparable measures of ABU and detailed cost-benefit analysis of practical, on-farm interventions are needed to aid improved antimicrobial stewardship in livestock systems globally.

"We Need a Seismic Shift": Disabled Student Perspectives on Disability Inclusion in U.S. Medical Education

PURPOSE

Students with disabilities have inequitable access to medical education, despite widespread attention to their inclusion. Although systemic barriers and their adverse effects on medical student performance are well documented, few studies include disabled students' first-person accounts. Existing first-person accounts are limited by their focus predominantly on students who used accommodations. This study bridged these gaps by analyzing a national dataset of medical students with disabilities to understand their perceptions of disability inclusion in U.S. medical education.

METHOD

The authors analyzed 674 open-text responses by students with disabilities from the 2019 and 2020 Association of American Medical Colleges Year Two Questionnaire responding to the prompt, "Use the space below if you would like to share anything about your experiences regarding disability and medical school." Following reflexive thematic analysis principles, the authors coded the data using an inductive semantic approach to develop and refine themes. The authors used the political-relational model of disability to interpret themes.

RESULTS

Student responses were wide-ranging in experience. The authors identified key dimensions of the medical education system that influenced student experiences: program structure, processes, people, and culture. These dimensions informed the changes students perceived as possible to support their access to education and whether pursuing such change would be acceptable. In turn, students took action to navigate the system, using administrative, social, and internal mechanisms to manage disability.

CONCLUSIONS

Key dimensions of medical school affect student experiences of and interactions with disability inclusion, demonstrating the political-relational production of disability. Findings confirm earlier studies on disability inclusion that suggest systemic change is necessary, while adding depth to understand how and why students do not pursue accommodations. On the basis of student accounts, the authors identify existing resources to help medical schools remedy deficits in their systems to improve their disability inclusion practice.

The Conceptual Framework: A Practical Guide

There is no single definition of the conceptual framework (CF) or consensus on how it is best applied in the research process. However, in this piece, the authors argue that the CF is a tool used to link the literature review, research methodology, and study design. The CF grounds the study in the previous literature, theories, and models. It helps the researcher articulate their rationale for why the study should be performed, justify their study design, and describe the lens through which they analyze a phenomenon or research question. Researchers may find the variable use of terms such as theory, theoretical framework, and CF to be confusing. The authors address the distinction between these terms and present strategies to develop and use the CF throughout the research process. The authors provide practical examples and resources for additional learning.

Exploring the "led" in health professional student-led experiences: a scoping review

To support a complex health system, students are expected to be competent leaders as well as competent clinicians. Intentional student leadership development is needed in health professional education programs. Student-led experiences such as student-run clinics and interprofessional training wards, are practice-based learning opportunities where learners provide leadership to clinical services and/or address a gap in the system. Given the absence of leadership definitions and concepts, this scoping review explored how student leadership is conceptualized and developed in student-led experiences. The review was conducted in accordance with best practices in scoping review methodology within the scope of relevant practice-based student-led experiences for health professional students. The research team screened 4659 abstracts, identified 315 articles for full-text review and selected 75 articles for data extraction and analysis. A thematic analysis produced themes related to leadership concepts/theories/models, objectives, facilitation/supervision, assessment and evaluation of curriculum. While responding to system gaps within health professional care, student-led experiences need to align explicit leadership theory/concepts/models with curricular objectives, pedagogy, and assessments to support health professional education. To support future student-led experiences, authors mapped five leadership student role profiles that were associated with student-led models and could be constructively aligned with theory and concepts. In addition to leveraging a student workforce to address system needs, student-led experiences must also be a force for learning through a reciprocal model of leadership and service to develop future health professionals and leaders.

Occupying liminal spaces: The figured worlds of student affairs senior leaders in the United States

INTRODUCTION

Student Affairs Senior Leaders (SASLs) in the United States lead offices responsible for academic advising, administrative documentation, scheduling, student health, financial aid, and transition to residency, yet they infrequently draw attention in the field's literature. We explore the role of SASLs and how they describe the social space of medical education.

METHODS

Using a constructivist approach informed by Figured Worlds theory, we conducted a sequential narrative and thematic analysis of the stories SASLs tell about their roles and experiences in the world of medical education.

RESULTS

SASLs inhabit complex roles centred on advocating for medical students' academic, personal and social well-being. Their unique position within the medical school allows them to see the harm to vulnerable students made possible by misalignments inherent within medical education. Yet even with the challenges inherent in the environment, SASLs find reasons for hope.

CONCLUSION

SASLs' identities are full of potential contradictions, but they have a unique view into the often-chaotic world of medical education.

Metamotivation in medical education: The 4F conceptual framework

INTRODUCTION

Several models and frameworks have been developed in the past two decades to explain motivation regulation in different fields. However, a comprehensive framework that explains the dimensions of metamotivation in medical education is lacking. This study aims to address this gap by presenting a conceptual framework to understand metamotivation in medical education.

METHOD

This study was conducted at Tehran University of Medical Sciences in 2022-2023. We applied Crawford's guidance on developing a conceptual framework via collecting data from three sources: experience, literature, and theory. We developed the initial draft of the conceptual framework by identifying gaps in existing models. A panel of experts reviewed the draft and provided feedback on the framework's generation, explanation, and argumentation. The final model was designed in the form of a graphical presentation.

FINDINGS

The study's conceptual framework clearly distinguishes between motivational challenges and motivational problems, and outlines four phases that explain each phase's importance, components, and implementation process. The first phase focuses on promoting metamotivational knowledge among learners. In the second phase, learners face motivational challenges and aim to manage them optimally to prevent motivational problems. The third phase occurs when a motivational problem arises, and learners use motivational regulation strategies to resolve it. In the fourth and final phase, learners use psychological skills to stabilize and strengthen the metamotivational process.

CONCLUSION

This study's conceptual framework focuses specifically on the context of medical education to provide guidance for future research and interventions on metamotivation. By presenting this framework, we aim to capture the attention of researchers toward the topic of metamotivation and encourage further exploration of its dimensions.

Qualitative analysis of preparation and planning habits of students with low-performance on high-stakes practice examinations (pre-NAPLEX®)

OBJECTIVE

The purpose of this analysis was to identify, analyze, and report patterns (or themes) of planning and preparation considerations of students that scored less than the historic average score on the Pre-NAPLEX® exam.

METHODS

This qualitative study was a retrospective, inductive thematic analysis of de-identified semi-structured interview field notes collected from student interviews for those students that scored less than the historic average score on the Pre-NAPLEX® exam.

RESULTS

Ninety-one students were initially contacted based on their score on the Pre-NAPLEX® exam to participate in one-on-one virtual discussions (i.e., interviews) with faculty members. Fifty-two responded and participated with their responses analyzed and included in thematic categorization. Four major themes were identified during the analysis. These include 1) Organization and Messaging of NAPLEX® Preparation Efforts, 2) Time Management during Competing Obligations, 3) Test Taking Experience, and 4) Curricular Disconnect.

CONCLUSION

Student performance on the NAPLEX licensing exam is of great concern to many colleges of pharmacy. As a result, many institutions are looking at root-causes for poor performance and working to implement structural changes at their institution to address these concerns. This investigation identified four major themes surrounding the preparation and planning for the Pre-NAPLEX® for students that scored less than the historic average score on the Pre-NAPLEX®. These include 1) Organization and Messaging of NAPLEX® Preparation Efforts, 2) Time Management during Competing Obligations, 3) Test Taking Experience, and 4) Curricular Disconnect. Each of these themes provides potentially actionable items to improve how students prepare and plan for the Pre-NAPLEX®, which may be translatable to informing actions to improve results on the actual NAPLEX exam itself.

Neuroleadership: A Concept Analysis and Implications for Nursing

ABSTRACT

BACKGROUND: Neuroleadership in nursing is a specialized leadership approach that integrates insights from social neuroscience with nursing leadership practices, aiming to proficiently lead healthcare teams to enhance patient care, staff productivity, and organizational outcomes. Yet, the exploration of neuroleadership in nursing remains limited. AIM: The aim of this study was to provide an analysis of the concept of neuroleadership and its implications in the nursing context. METHODS: Walker and Avant's 8-step methodology was used for this concept analysis, including identifying the concept, clarifying the purpose of the analysis, exploring the uses of the concept, and defining its attributes, model and contrary cases, antecedents and consequences, and its empirical referents. A comprehensive search included PubMed, CINAHL, and ERIC, between 2000 and 2023. RESULTS: This concept analysis significantly contributes to the literature by providing a comprehensive overview of neuroleadership as a distinct form of nursing leadership. It covers key aspects such as definition, attributes, uses, cases, antecedents, consequences, and empirical evidence, and highlights the importance of specialized education, practical experience, and leadership attributes in this domain. The findings could serve as determinants for establishing a neuroleadership framework and developing a structured questionnaire to measure neuroleadership among nurses and nurse leaders, thereby addressing existing empirical reference gaps. CONCLUSION: Nurse leaders adopting a neuroleadership approach can gain insights into how cognitive processes shape nurses' behaviors and motivation, which directly impact patient outcomes and care quality. Further research is needed to assess the practical impact of neuroleadership and validate its factors and model case in clinical nursing practice.

Precision prevention in occupational health: a conceptual analysis and development of a unified understanding and an integrative framework

Introduction

Precision prevention implements highly precise, tailored health interventions for individuals by directly addressing personal and environmental determinants of health. However, precision prevention does not yet appear to be fully established in occupational health. There are numerous understandings and conceptual approaches, but these have not yet been systematically presented or synthesized. Therefore, this conceptual analysis aims to propose a unified understanding and develop an integrative conceptual framework for precision prevention in occupational health.

Methods

Firstly, to systematically present definitions and frameworks of precision prevention in occupational health, six international databases were searched for studies published between January 2010 and January 2024 that used the term precision prevention or its synonyms in the context of occupational health. Secondly, a qualitative content analysis was conducted to analyze the existing definitions and propose a unified understanding. Thirdly, based on the identified frameworks, a multi-stage exploratory development process was applied to develop and propose an integrative conceptual framework for precision prevention in occupational health.

Results

After screening 3,681 articles, 154 publications were reviewed, wherein 29 definitions of precision prevention and 64 different frameworks were found, which can be summarized in eight higher-order categories. The qualitative content analysis revealed seven themes and illustrated many different wordings. The proposed unified understanding of precision prevention in occupational health takes up the identified themes. It includes, among other things, a contrast to a "one-size-fits-all approach" with a risk- and resource-oriented data collection and innovative data analytics with profiling to provide and improve tailored interventions. The developed and proposed integrative conceptual framework comprises three overarching stages: (1) data generation, (2) data management lifecycle and (3) interventions (development, implementation and adaptation).

Discussion

Although there are already numerous studies on precision prevention in occupational health, this conceptual analysis offers, for the first time, a proposal for a unified understanding and an integrative conceptual framework. However, the proposed unified understanding and the developed integrative conceptual framework should only be seen as an initial proposal that should be critically discussed and further developed to expand and strengthen both research on precision prevention in occupational health and its practical application in the workplace.

Health Disparities Curricula in General Surgery Residency Programs: A Critical Scoping Review

INTRODUCTION

In 2021, the structural determinants of health (SDOH) were added to the Accreditation Council of Graduate Medical Education common program requirements for all accredited residency programs, including general surgery. In this study, we sought to explore the current scope of, and concepts used in, health disparities curricula for general surgery residents, specifically investigating how general surgery residents learn about health disparities and the SDOH.

METHODS

We searched PubMed, EMBASE, Education Research Complete (EBSCOhost), and Web of Science Core Collection using keywords related to health disparities and the SDOH. Inclusion criteria consisted of all studies published after 2005 that discussed health disparities curricula for Accreditation Council of Graduate Medical Education-accredited general surgery residency programs. Five thousand three hundred seventeen articles were screened using a two-phase process. Data extraction and analysis was performed using critical review methods.

RESULTS

Seventeen articles were identified. Within these articles, seven unique health disparities curricula were found. All seven of the identified curricula employed cultural frameworks as methods to mitigate health disparities. Three curricula, all published after 2011, included education on the SDOH. A wide variety of educational methods were utilized; in-person didactics was the most common.

CONCLUSIONS

In the current literature, culture continues to play a large role in health disparities training for general surgery residents. Though further efforts are needed to understand the methods used in programs that have not published scholarly work, it is imperative to ensure that residents are provided with the sociopolitical perspective needed to understand the SDOH and serve all patients, including those affected by health disparities.

The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery

BACKGROUND

The aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery.

METHODS

This study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention.

RESULTS

The results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001).

CONCLUSION

The H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery.

IMPLICATIONS TO PRACTICE

The results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.

It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations

Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.

Physicians' lifelong learning journeys: A narrative analysis of continuing professional development struggles

INTRODUCTION

Despite tenacious efforts of continuing professional development (CPD) developers and educators, physician engagement in CPD is fraught with challenges. Research suggests that these educational interventions and the maintenance of professional competence systems that mandate them are often seen as impractical, decontextualized and check-box activities by participants. This study explores physicians' learning post graduate medical education (GME) training across their CPD journey to understand how they (a) conceive of themselves as learners and (b) engage in lifelong learning across the course of their professional careers.

METHODS

Using narrative inquiry and holistic narrative analysis situated within a social constructivist orientation, we carried out individual interviews with physicians from across a large children's hospital network including academic hospitals, community hospitals and primary care practices. Timelines and story arcs were used to support the narrative analysis's re-storying.

RESULTS

Twelve physicians from six different sub-specialties were interviewed. We identified three noteworthy challenges as particularly salient across participants' re-storied narratives: (i) train-on-a-track to treading water, (ii) learning takes a backseat, and (iii) learning through foraging or hunting and gathering. Participants described significant change when transitioning from GME to CPD learning. While participants identified as learners, they described the disorienting impact of losing GME's formal supports and structures. They articulated that patient care trumped learning as their top priority. They lamented having limited insight into their learning needs (e.g. little feedback data) and so resorted to engaging in CPD activities that were readily at hand-but not necessarily relevant-and to finding learning resources that might not be formally recognised for CPD credit.

CONCLUSIONS

Physicians' learning journeys post-GME are challenging, and the systems created to support that learning are ill equipped to meet the needs of physicians transitioning from GME to CPD. To encourage meaningful learning, the complex interplay of factors impeding CPD engagement should inform future innovations.

A Goffmanian analysis of impact of unclear professional identity and role negotiation of pharmacists in primary care: A multiple case study

BACKGROUND

Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams.

OBJECTIVES

This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams.

METHODS

This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case.

RESULTS

Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist.

CONCLUSION

Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings.

Incorporating Anti-racist Principles Throughout the Research Lifecycle: A Position Statement from the Society of General Internal Medicine (SGIM)

Biomedical research has advanced medicine but also contributed to widening racial and ethnic health inequities. Despite a growing acknowledgment of the need to incorporate anti-racist objectives into research, there remains a need for practical guidance for recognizing and addressing the influence of ingrained practices perpetuating racial harms, particularly for general internists. Through a review of the literature, and informed by the Research Lifecycle Framework, this position statement from the Society of General Internal Medicine presents a conceptual framework suggesting multi-level systemic changes and strategies for researchers to incorporate an anti-racist perspective throughout the research lifecycle. It begins with a clear assertion that race and ethnicity are socio-political constructs that have important consequences on health and health disparities through various forms of racism. Recommendations include leveraging a comprehensive approach to integrate anti-racist principles and acknowledging that racism, not race, drives health inequities. Individual researchers must acknowledge systemic racism's impact on health, engage in self-education to mitigate biases, hire diverse teams, and include historically excluded communities in research. Institutions must provide clear guidelines on the use of race and ethnicity in research, reject stigmatizing language, and invest in systemic commitments to diversity, equity, and anti-racism. National organizations must call for race-conscious research standards and training, and create measures to ensure accountability, establishing standards for race-conscious research for research funding. This position statement emphasizes our collective responsibility to combat systemic racism in research, and urges a transformative shift toward anti-racist practices throughout the research cycle.

Unravelling underlying processes in intraprofessional workplace learning in residency

BACKGROUND

To deliver high-quality collaborative care, residents need to be trained across the boundaries of their medical specialty (intraprofessional learning). The current literature does not provide insights into the underlying processes that influence intraprofessional learning. The aim of this study was to gain insight into the processes that occur during intraprofessional workplace learning in residency training, by exploring everyday intraprofessional interactions experienced by residents, with the ultimate objective of improving collaborative practice.

METHOD

We conducted a focused ethnography using field observations and in-depth interviews with residents at an academic children's hospital in the Netherlands. In 2022, nine residents from four different medical specialties were shadowed and/or interviewed. In total, >120 hours of observation and 10 interviews were conducted. Data collection and analysis were conducted iteratively and discussed in a research team with diverse perspectives, as well as with a sounding board group of stakeholders.

RESULTS

Residents were involved in numerous intraprofessional interactions as part of their daily work. We identified three themes that shed light on the underlying processes that occur during intraprofessional workplace learning: (1) residents' agency, (2) ingroups and outgroups and (3) communication about intraprofessional collaboration.

CONCLUSIONS

Collaborative practice offers many intraprofessional learning opportunities but does not automatically result in learning from, with and about other specialties to improve intraprofessional collaborative care. Overarching the identified themes, we emphasise the pivotal role of the resident-supervisor dyad in facilitating residents' engagement in the learning opportunities of complex intraprofessional care. Furthermore, we propose that promoting deliberate practice and shared responsibility in collaborative care are crucial to better prepare residents for their roles and responsibilities in delivering high-quality collaborative patient care.

Reflections on theoretical framework use in nursing research

OBJECTIVES

to reflect on theoretical framework use in nursing research.

METHODS

a theoretical-reflexive study, based on concepts and constructs pertinent to using nursing theories and other sciences, considering issues of epistemology or philosophy of science.

RESULTS

we presented what it is and why to do nursing research and what a theoretical framework is and why to use it, in addition to some considerations regarding theoretical framework use in nursing research, essential for constructing disciplinary knowledge, which enables the materialization of researchers' work and the presentation of propositions resulting from investigations in and for nursing as a discipline and science.

FINAL CONSIDERATIONS

based on a reflection based on epistemological conceptions, it is possible to affirm that a theoretical framework is the core of researchers' thinking, delimiting a problem to be investigated and, based on it, outlining methodological strategies to be followed, supporting nursing action and thinking as discipline and science.

Battle of the sections: Student outcomes and course feedback support combined prosection and dissection laboratory formats to maximize student success

Gross anatomy laboratories frequently utilize dissection or prosection formats within medical curricula. Practical examination scores are consistent across the formats, yet these examinations assessed larger anatomical structures. In contrast, a single report noted improved scores when prosection was used in the hand and foot regions, areas that are more difficult to dissect. The incorporation of prosected donors within "Head and Neck" laboratories provided an opportunity to further characterize the impact of prosection in a structurally complex area. Retrospective analysis of 21 Head and Neck practical examination questions was completed to compare scores among cohorts that utilized dissection exclusively or incorporated prosection. Mean scores of practical examination questions were significantly higher in the prosection cohort (84.27% ± 12.69) as compared with the dissection cohort (75.59% ± 12.27) (p < 0.001). Of the 12 questions that performed better in the prosection cohort (88.42% ± 8.21), 10 items mapped to deeper anatomical regions. By comparison, eight of nine questions in the dissection cohort outperformed (88.44% ± 3.34) the prosection cohort (71.74% ± 18.11), and mapped to anatomically superficial regions. Despite the mean score increase with positional location of the questions, this effect was not statically significant across cohorts (p = 1.000), suggesting that structure accessibility in anatomically complex regions impacts performance. Student feedback cited structure preservation (71.5%) and time savings (55.8%) as advantages to prosection; however, dissection was the perceived superior and preferred laboratory format (88.6%). These data support combined prosection and dissection formats for improving student recognition of deeply positioned structures and maximizing student success.

Seven Practical Recommendations for Designing and Conducting Qualitative Research in Medical Education

Qualitative research seeks to provide context, nuance, and depth of understanding in regard to systems, behaviors, and/or lived experiences. As such, it plays a key role in many areas of medical education. Composed of myriad methods and methodologies, each of which may be valuable for some areas of inquiry but less so for others, qualitative research can be challenging to design, conduct, and report. This challenge can be conceptualized as ensuring that the study design, conduct, and reporting are "fit for purpose," following directly from a well-formulated research question. In this Perspective, we share seven important and practical recommendations to enhance the design and conduct of high-quality qualitative research in medical education: 1) craft a strong research question, 2) link the study design to this question, 3) assemble a team with diverse expertise, 4) prioritize information power when selecting recruitment and sampling strategies, 5) collect data carefully, 6) rigorously analyze data, and 7) disseminate results that tell a complete story.