"Finding My Piece in That Puzzle": A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems

Assessment of students' ability to represent determinants of health and health systems science content on concept maps in a pre-clerkship curriculum

BACKGROUND

Hackensack Meridian School of Medicine (HMSOM) was founded on a vision of addressing the determinants of health (DoH) in the daily practice of medicine. The school has an active learning curriculum partially conducted through a small group modified problem-based-learning entitled Patient Presentation Problem-based-learning Curriculum (PPPC). This course includes a Monday discussion of a patient case and a Friday small group session includes concept mapping of the week's basic, clinical, and health systems science (HSS) content. To help students contextualize and bring HSS principles into practice, PPPC at HMSOM requires that concept maps include not just basic science content from the week but also explicitly HSS topics and the DoH.

METHODS

We reviewed group concept maps from 7 pre-clerkship courses. There were an average of 18.9 group concept maps per course available to review, with roughly 8 students per group. We reviewed concept maps for inclusion of DoH icons and HSS content and followed the trend throughout each course of the pre-clerkship curriculum.

RESULTS

HSS content appeared in 45% of group concept maps in the first pre-clerkship course, but did not appear in any concept maps in subsequent courses. DoH content was inconsistently present in group concept maps throughout the first three courses, increased towards the end of the first academic year, and then showed a steady decline towards the end of the pre-clerkship curriculum.

CONCLUSIONS

Students sometimes include DoH on their concept maps and this improves from the first three courses towards the end of the first academic year. However, students do not prioritize inclusion of DoH in their concept maps at the end of the pre-clerkship curriculum. HSS content is included in less than half of the concept maps in the first course, and then is not included in any group concept maps for the remainder of the curriculum. This may be due to a decreased focus on DoH and HSS, or related to students' tiring of pre-clerkship curricular activities including concept mapping. Providing feedback to students on inclusion of DoH and HSS in concept mapping may help improve this skill prior to the start of clerkships.

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

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

Twelve tips for creating a longitudinal quality improvement and safety education for early health professions students

Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.

A Pilot Study Assessment of Medical Student Knowledge and System Citizenship Attitudes Pertaining to Health Systems Science

Background and Purpose

Health system science (HSS) has been described as the third pillar of medical education. We introduced a new health system science and interprofessional practice (HSSIP) curriculum, and measured students' HSS knowledge and attitudes concerning health system citizenship.

Methods

This pilot study involved first-year (M1) and fourth-year (M4) medical students in two cohorts across 2 years. Only M1 students in the second cohort participated in the new HSSIP curriculum. We compared student performance on a new National Board of Medical Examiners (NBME) HSS subject exam, and student attitudes toward system citizenship via a new attitudinal survey.

Results

Fifty-six eligible fourth-year students (68%) and 70 (76%) study eligible first-year students participated in the study. NBME HSS exam performance by M4 students was statistically significantly higher than M1 students for both cohorts, with moderate to large effect sizes. Exam performance for M1 students not experiencing the HSS curriculum was higher than for M1 students who received HSS curricular content. Attitudes toward HSS by M4 versus M1 students were statistically significantly different on several survey items with moderate effect sizes. Scale internal consistency for the HSS attitude survey was strong (0.83 or higher).

Discussion

There were differences among M4 and M1 medical students concerning knowledge of and attitudes toward HSS, with performance on the NBME subject exam similar to a national sample. Exam performance by M1 students was likely impacted by class size and other factors. Our results support the need for increased attention to HSS during medical education. Our health system citizenship survey has potential for further development and cross-institutional collaboration.