Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow

Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory

Framing the Issue: Medical education programs in the U.S. rely on the aphorism that faculty own the curriculum; that is, the specialized knowledge, skills, and attitudes of a physician are the province of the faculty to be delivered to tuition-paying students. From this view, the learner's role is one of passivity and deference. A contrasting approach, termed curriculum co-creation, frames education as a bi-lateral partnership. Co-creation results from learners, in collaboration with instructors, taking an active role in creating the goals and processes of an educational program. Such a partnership requires substantial revision of the expectations for both learners and instructors. In this Observations article, the idea of co-creation is applied to medical education and an aspirational vision for the role and value of faculty-student co-creation is advocated. Description and Explication: Co-creation partnerships of faculty and students occur in many forms, varying in degree of departure from traditional educational practice. Co-creation principles and partnerships can be deployed for almost all aspects of training including selection and organization of content, effective methods of instruction, and assessment of student learning. The outcomes of co-creation occur at three levels. The most specific outcome of co-creation is characterized by increased student engagement and enhanced learning. Broader outcomes include improved efficacy and value in the educational program and institution while, at the farthest-reaching level, a co-creative process can modify the medical profession itself. Although some specific instructional techniques to promote student involvement and input have historically been deployed in medical education, there is little evidence that students have ever been permitted to share in ownership. Implications for Medical Education: When fully embraced, curricular co-creation will be recognizable through improved student engagement and learning along with a revised understanding of how faculty-student relationships can foment reform in medical education and the culture of the profession. Further scholarship and research will be indispensable to examine how co-creative partnerships can flatten hierarchies within medical education and inspire the medical profession to be more inclusive and effective. Following the model of co-creation is expected to inspire learners by empowering them to participate fully as co-owners of their own education and prepare them to lead medical education in a different direction for the future.

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

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

Implementation of a student-run initiative to facilitate multidisciplinary cancer care in Pakistan: the Tumor Board Establishment Facilitation Forum

BACKGROUND

The lack of a multidisciplinary approach to the management of cancer patients in most parts of Pakistan is a long-standing and major concern. To overcome this disparity, we started a student-run initiative to facilitate the establishment of multidisciplinary tumor boards (MTBs) in oncology, titled "Tumor Board Establishment Facilitation Forum (TEFF)". The objectives of this study were to evaluate the clinical and academic impact of TEFF on cancer care for patients and student education, respectively.

METHODS

The formation of TEFF was based on the Theory of Change model. We conducted a needs assessment based on existing literature, physical evaluation of wards, and consultation with senior academic faculty members. The logic model was refined through multiple meetings between stakeholders. All engagements of TEFF described in this manuscript are limited to the Dow Medical College and its affiliated tertiary care hospital, Dr. Ruth K. M. Pfau Civil Hospital in Karachi, Pakistan. To gauge TEFF's impact, we used administrative data generated between October 2021 to March 2024 to evaluate predefined outcomes (number of MTBs, cases, educational interventions, and research).

RESULTS

The organizational structure comprised of 6 specialized departments: Communications, Operations, Media, Integrated Development, Research and Records, and Finance. We conducted 18 educational sessions for medical students about career guidance, research, cancer awareness; and 4 cancer awareness campaigns. TEFF facilitated the formation of 4 MTBs: breast, head and neck, gynecology, and pediatrics. Across these, 105 cases were discussed in 50 meetings. TEFF provided leadership opportunities, allowed familiarization with oncology, raised awareness of challenges associated with cancer care, allowed networking, and inculcated research-related skills and educational value through its MTBs.

CONCLUSION

Medical students can contribute significantly to clinical care at the undergraduate level. For countries/regions struggling to provide multidisciplinary cancer care, TEFF's model serves as a blueprint for a viable solution.

Incorporating Faculty and Student Co-leadership in Workgroup Structures

In 2020, the Dean of the University of Cincinnati College of Medicine created a college-wide task force to address inequities in the medical school curriculum. The task force consisted of four workgroups, each co-chaired by a faculty member and a student. This co-leadership model was chosen because it provided diverse perspectives and addressed the typical faculty-student power differentials. This co-leadership model balanced knowledge of medical education curriculum with the student experience. It also provided the opportunity for the co-chairs to take on new roles in leadership development: the student assumed a leadership role running the workgroup with guidance from the faculty member, while the faculty member gained insight and perspective on diversity and inclusion from the student. The purpose of this article is to describe our lessons learned during this co-leadership process.

Trainees as Agents of Change: A Theory-Informed Model for Trainee-Driven Curricular Advocacy in Medical Education

ABSTRACT

Trainees (medical students, residents, and fellows) are beginning to make strides in pushing for changes to their education. While there are many examples of successful trainee-led curriculum reform efforts, the path to success remains unclear. To better understand the process of trainee-driven curricular advocacy, the author analyzes this process through the lens of ecological systems theory (EST) not only to provide readers with context for the barriers and facilitators to trainee-driven curricular advocacy but also to further medical education's understanding of the sociopolitical forces influencing the process of trainee-driven curricular advocacy and reform through the lens of the trainee. EST explains how individuals are influenced by a complex web of social and environmental forces. The theory outlines 5 ecological systems of influence: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Using EST to explore the process of trainee-driven curricular advocacy therefore clarifies the many layers of influence that trainees must navigate while advocating for curriculum change. The author then draws on this theory and their own experience as a medical student advocating for local and national curriculum reform to develop a model to facilitate trainee-driven curricular advocacy in medical education. The proposed model outlines concrete steps trainees can take while going through the process of curricular advocacy both within their own institutions and on a national level. Through developing this model, the author hopes not only to empower trainees to become agents of change in medical education but also to encourage faculty members and administrators within health professional training programs to support trainees in these efforts.

Medical students' motivations for participating in an elective focused on social inequalities and health disparities

In this study, we examine students' reasons for pursuing elective training focused on medical racism and systemic health inequities at a midwestern medical school. Data collection included semi-structured interviews with students who participated in an optional course focused on these topics. We analyzed their motivations, goals, and interests using reflexive thematic analysis and created three themes based on students' responses. Theme (1) "pre-existing conditions" focuses on students' knowledge, beliefs, worldviews and experience prior to the class. Theme (2) "enacting change" examines their desires to become effective physicians and improve medicine overall. Theme (3) "creating community" considers their preferences for a supportive and connected learning and social environment. We discuss the findings within the context of adult learning theory and Self-Determination Theory. The research provides insight about the overt and underlying factors that drive medical students' participation in training focused on social inequality. We also share recommendations for curriculum development and future research based on the patterns we found in students' discussions of their needs and expectations.

What Works? Fostering Inclusivity in Physician Assistant/Associate Education: The Retention, Outreach, Alignment, and Diversity (ROAD) Framework

INTRODUCTION

There are well-known strategies to increase diversity in health professions education, evidence is sparse on how such strategies are practically implemented and longitudinally sustained. This study investigated the most widely used strategies across physician assistant/associate (PA) educational programs that have consistently demonstrated the ability to graduate racial and ethnic underrepresented students.

METHODS

Following a grounded theory, qualitative interviews were conducted with 41 nationally accredited PA programs identified as top performers in consistently graduating racial and ethnic underrepresented students. Semistructured interviews were conducted with a program representative focused on ascertaining the characteristics and strategies attributable to the successful recruitment and retention of underrepresented PA matriculants. The interviews comprehensively explored program resources, efforts, and practices. Transcripts were coded, and themes were identified.

RESULTS

The study revealed 4 overarching themes: (1) Pathways from the Community to the Program and Into Healthcare; (2) Dedication to Student Retention and Support; (3) Commitment to Diverse and Inclusive Learning Environments; and (4) Alignment of Mission, Inclusive Action, and Improving Diversity Outcomes. Based on these emerging themes, we propose a new diversity framework that hinges on Retention, Outreach, Alignment, and Diversity (ROAD Framework). This framework seeks to explain the overarching goals, high-impact behaviors, and actionable steps that can be effectively implemented across PA education to facilitate further diversification.

DISCUSSION

This study illuminated on What Works to foster diversity in PA programs. By embracing and implementing the ROAD Framework, institutions can effectively address the persistent issue of underrepresentation and contribute to cultivating a more inclusive and representative healthcare workforce.

The enemy within: The new war in medical education

INTRODUCTION

War and military metaphors have long been used in clinical medicine to describe medicine's collective fight against disease. However, recently resistor trainees have used similar language to describe their acts of professional resistance against social harm and injustice. To understand the contours of this war, this study analyzes the metaphoric language these trainees use to describe their acts of resistance.

METHODS

We recruited 18 resisting trainees using our personal and professional networks and snowball sampling. Participants were interviewed from July 2022-February 2023. Using methodological bricolage, we analyzed the data using Wickens' analytical approach, which draws on constant comparative analysis and discursive textual analysis. Data were analyzed in three phases that included a consult with a military historian, isolation of metaphoric language, and a textual analysis using context clues from participants' descriptions of their acts of professional resistance.

RESULTS

Resisting trainees used metaphorical language to signal an insurgency to topple power. These trainees referenced two conflicts: the mistreatment of patients and the mistreatment of trainees. Enemies were conceptualized as anyone who actively protects institutions and the traditions of medicine, such as leaders of medical schools and hospitals, and physicians trained in a more traditional system. Trainees conceptualized the primary battlefield as medicine's process of socialization that integrates trainees into a profession, and accepts mistreatment as the norm. Weapons included LCME site visits and sympathetic faculty members.

CONCLUSION

Whereas metaphorical language around war and the military was previously the purview of physicians, resistor trainees have adopted war metaphors for their own purposes. They do not use these metaphors accidently; they are meant to signal their intentions to restructure medical education. Leaders must begin working with trainees in sincere partnership to create widespread change.

Student, Staff and Faculty Experience with a Medical School Racial and Sociopolitical Trauma Protocol: A Mixed Methods Study

Problem: Medical students experience racial and sociopolitical trauma that disrupts their learning and wellbeing. Intervention: University of California, San Francisco (UCSF) School of Medicine students advocated for a systems approach to responding to traumatic events. Students partnered with educators to introduce an innovative protocol that affords short-term flexibility in curricular expectations (e.g., defer attendance, assignments, assessments) to empower students to rest, gather, or pursue community advocacy work. This study explored students' protocol utilization and student, staff, and faculty experience with its implementation. Context: UCSF is a public medical school with a diverse student body. Students raised the need to acknowledge the effects of trauma on their learning and wellbeing. Consequently, students and educators created the UCSF Racial and Sociopolitical Trauma protocol ('protocol') to allow students time-limited flexibility around academic obligations following events anticipated to inflict trauma on a school community level. The protocol affords students space to process events and engage with affected communities while ensuring all students achieve school competencies and graduation requirements. Impact: We conducted a two-phase mixed methods study: (1) retrospective analysis of quantitative data on students' protocol use and (2) focus groups with students, staff, and faculty. We used descriptive statistics to summarize students' protocol use to adjust attendance, assignment submission, and assessments and thematic analysis of focus group data. Across eight protocol activations June 2020 - November 2021, 357 of 664 (54%) students used it for 501 curricular activities: 56% (n = 198) for attendance, 71% (n = 252) for assignments, and 14% (n = 51) for assessments. When deciding to utilize the protocol, student focus group participants considered sources of restoration; impact on their curricular/patient responsibilities; and their identities. The protocol symbolized an institutional value system that made students feel affirmed and staff and faculty proud. Staff and faculty initially faced implementation challenges with questions around how to apply the protocol to curricular components and how it would affect their roles; however, these questions became clearer with each protocol activation. Questions remain regarding how the protocol can be best adapted for the clerkship setting. Lessons Learned: High protocol usage and focus group data confirmed that students found value in the protocol, and staff and faculty felt invested in the protocol mission. This student-initiated intervention supports a cultural shift beyond diversity toward trauma-informed medical education. Partnership among learners and educators can contribute to transforming learning and healthcare environments by enacting systems and structures that enable all learners to thrive.

Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis

BACKGROUND

Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities.

METHODS

In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results.

RESULTS

A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5).

CONCLUSIONS

Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.

Educational Policy Development as a Leadership Experience: Inclusive Institutional Change

Medical students have a unique opportunity to advocate for educational policies that promote best practices in undergraduate medical education. At the Geisel School of Medicine at Dartmouth, students play a crucial role in the development of medical education policies. This article describes two innovative, inclusive, and effective approaches to increase student engagement: (1) restructuring Medical Education Subcommittees to diversify student perspectives and (2) including students in a values-based design thinking approach to the development of new academic advancement and promotion and conduct policies. Through deliberate participation, medical students gain valuable skills that can be applied as future educators and academic leaders.

Communication skills in practice vs. communication in the real world: Insights from an international medical student symposium

OBJECTIVE

To explore and compare medical students' experiences with communication skills training (CST) in medical education.

METHOD

Five medical students from the U.S., U.K., and Ireland shared their experiences with CST at a 90-minute symposium held at the 2022 International Conference on Communication in Healthcare (ICCH).

RESULTS

Students identified two areas of CST that may affect their preparedness for real-world clinical practice: 1) the impact of the COVID-19 pandemic on communication teaching and learning, and 2) the need to effectively communicate with diverse patient populations.

CONCLUSION

The COVID-19 pandemic brought major changes to CST, and though training programs varied in their approach, students found that they were able to successfully adapt while gaining valuable skills needed to navigate communicating with patients on virtual platforms. When learning to communicate with patients from diverse backgrounds, students perceived generalized strategies that equipped them with the skills needed to adapt to uncertainty to be the most valuable.

PRACTICE IMPLICATIONS

Collaboration between medical schools, both nationally and internationally, provides opportunity to share areas of strength and avenues for improvement in CST. Representation of learner perspectives is essential in order to better understand how well current educational methodologies prepare learners to enter real world clinical practice.

An Overview of This Year's Trainee-Authored Letters to the Editor

Academic Medicine 's call for trainee-authored letters to the editor, which has occurred annually since 2016, has successfully provided a forum for collecting and amplifying trainee perspectives. In the latest call in 2022, trainees shared a transformative moment that occurred during their educational journey and how it shaped their identity as a health professional. In this Commentary, 2 members of the journal's staff provide a brief retrospective of the annual call using key demographics of published letters and letter writers. The authors then delve into the published letters from the 2022 call. To showcase the myriad of transformations described, they conceptualize 3 themes that best characterize these special moments: (1) reshaping the trainee experience through advocacy; (2) exploring humanism, morals, and relationality; and (3) finding one's mark within medicine. In addition, to display the depth and richness of transformative moments, the authors include an in-depth analysis of the letters by sampling those that were identified to each theme. In this overview, they hope to present readers with inspiration from trainees around the globe and invite them to reflect on and identify the significant experiences encountered in their own educational journey that altered their professional identity.

Subgroups of self-directed learning ability and their differences in professional identity among nursing undergraduates during the COVID-19 pandemic: a latent profile analysis

BACKGROUND

Promoting self-directed learning (SDL) among nursing undergraduates is crucial to meet the new requirements of the healthcare system and to adapt to online learning contexts during the COVID-19 pandemic. Therefore, identifying the classification features of SDL ability and developing targeted interventions are both critical. Professional identity (PI) may contribute to the cultivation of SDL ability, but their relationship remains relatively unknown. This study aimed to explore the subgroups of SDL ability and their differences in PI among nursing undergraduates during the COVID-19 pandemic.

METHODS

A total of 2438 nursing undergraduates at four universities in China were enrolled in this cross-sectional study from November 2021 to February 2022. The Self-Directed Learning Scale of Nursing Undergraduates (SLSNU) and the Professional Identity Scale for Nursing Students (PISNS) were administered. A latent profile analysis was performed to explore SDL ability latent profiles. Multinomial logistic regression analysis was conducted to examine the predictors of profile membership, and a one-way analysis of variance was applied to compare the PI scores in each latent profile.

RESULTS

Three latent profiles were identified and labeled 'low SDL ability' (n = 749, 30.7%), 'low initiative of help-seeking' (n = 1325, 54.4%) and 'high SDL ability' (n = 364, 14.9%). Multinomial logistic regression analysis suggested that nursing undergraduates who voluntarily chose a nursing major, had served as a student cadre, and had participated in clinical practicum were less likely to be included in the "low SDL ability" group. The average PI score was statistically different across the three profiles (F = 884.40, p < 0.001).

CONCLUSION

The SDL ability among nursing undergraduates was divided into three profiles, and results show that promoting PI may effectively foster SDL ability. This study highlights the importance of targeted interventions by considering their distinct SDL ability patterns, especially during the COVID-19 pandemic.

Commentary on Barradell and Bell (2021)-applying a critical lens to the role of students as partners in health professions education: challenges, risks, and potential

This commentary is a response to Barradell and Bell's (2021) qualitative research synthesis on the role of students as partners (SaP) in health professions education (HPE), which was recently published in Advances in Health Sciences Education. Through an exploration of some of the challenges and risks of SaP in HPE, the author argues that the uncritical application of SaP carries with it a risk of harm to students and faculty. The commentary ends with suggestions on how the potential of SaP in HPE might be better realized.

The mediating effect of self-directed learning in the relationship between caring and resilience among Chinese nursing students: A multi-center cross-sectional study

BACKGROUND

Despite the proliferation of literature focusing on resilience, a paucity of research has attempted a thorough and accurate examination of factors that contribute to resilience among nursing students.

OBJECTIVES

To examine the mediating effect of self-directed learning in the relationship between caring and resilience in Chinese nursing students.

DESIGN

A cross-sectional design.

SETTINGS

Five universities in China.

PARTICIPANTS

Undergraduate nursing students (N = 511).

METHODS

The Caring Ability Inventory, Self-Rating Scale of Self-Directed Learning, and Connor-Davidson Resilience Scale (CD-RISC) were administered. Socio-demographic and academic data were collected from nursing students after obtaining their informed consent. A multiple linear regression analysis was performed to assess factors associated with resilience. A structural equation model with bootstrapping estimation was conducted to further explore the potential mediating role of self-directed learning in the relationship between caring and resilience.

RESULTS

The average score of CD-RISC for nursing students was 92.96 ± 14.85. Multiple linear regression analyses indicated that caring and self-directed learning were significantly positively associated with resilience. Self-directed learning (β = 0.327, 95% Confidence Interval [CI]: 0.049-6.667, p < 0.001) had a significant mediating effect on the relationship between caring and resilience in nursing students, explaining 67.1% of the total effect of caring on resilience.

CONCLUSIONS

Interventions that enhance students' self-directed learning have the potential to enhance resilience level. Innovative pedagogical approaches, strategic reinforcement, and nursing curriculum transformation are recommended to promote self-directed learning awareness and internalize self-directed learning skills.