The attributes of the clinical trainer as a role model: a systematic review

Towards an empathic hidden curriculum in medical school: A roadmap

The "hidden curriculum" in medical school includes a stressful work environment, un-empathic role models, and prioritisation of biomedical knowledge. It can provoke anxiety and cause medical students to adapt by becoming cynical, distanced and less empathic. Lower empathy, in turn, has been shown to harm patients as well as practitioners. Fortunately, evidence-based interventions can counteract the empathy dampening effects of the hidden curriculum. These include early exposure to real patients, providing students with real-world experiences, training role models, assessing empathy training, increasing the focus on the biopsychosocial model of disease, and enhanced wellbeing education. Here, we provide an overview of these interventions. Taken together, they can bring about an "empathic hidden curriculum" which can reverse the decline in medical student empathy.

[How to Motivate Medical Students to Practice in Rural Areas]

BACKGROUND

The excellent project "LandArztMacher" is an attempt to work against the predicted shortage of rural doctors in Germany with diverse approaches.

METHOD

"LandArztMacher" is a clinical traineeship with four weeks of practical training in general practices and clinics in the Bavarian countryside, accompanied by joint professional teaching. Participants were asked before and after the internship about the topics "importance of an internship in rural areas"; "attractiveness of rural areas" (scale: 0/no agreement to 10/full agreement). Ideas about the tasks of a general practitioner were assessed (scale: 0/no idea at all to 100/exact idea). The present study is a repeated cross-sectional study. The median is reported as the location measure and the interquartile range as the dispersion measure.

RESULTS

Participants (n=363, 74% female, n=267, age: range 19-46 years, mean: 23.2 years, SD: 2.41 years) from the clinical section of the medical studies considered an internship in the rural area before and after the internship very important (median: 8 and 9, respectively) and could well imagine working in the countryside (median: 7 and 8, respectively). Their attitude towards the cultural offerings or the infrastructure did not change (median: 6 in each case). After the internship, the students had a more precise idea of what a general practitioner tasks are (median: 65 and 90, respectively).

SUMMARY

A well-structured four-week rural internship can enhance the appeal of future rural employment through individual supervision and collaborative training.

Nursing students' processes of taking role models and being role models: A descriptive phenomenological study

BACKGROUND

Role models are frequently viewed as a means of motivating people to adopt new behaviors and inspiring them to establish ambitious targets. Role models play a significant role in the characters of individuals and can be effective in shaping their career choices, education, and identities. Within the nursing profession, role models are integral to nursing students' journey towards understanding the nursing role and professional responsibility. For this reason, it is very important for nursing students to identify role models that support the development of students growth and development.

OBJECTIVES

This study aimed to investigate the qualities of nurses who serve as role models for senior undergraduate nursing students in shaping their professional attitudes and behaviors, identify the motivations behind selecting these individuals as role models.

DESIGN

A descriptive phenomenological research method was used.

SETTINGS

The research was conducted at a state university nursing school.

PARTICIPANTS

The study was conducted with the participation of 16 senior nursing students.

METHODS

Data collected from one-on-one interviews. A thematic analysis was used to analyze the data.

RESULTS

Student nurses mostly took clinical nurses and lecturers as professional role models. They were most impressed by their role models' knowledge, strong communication skills, and respect for human beings. To imitate their role models, students were willing to work in the clinic to improve their communication and psychomotor abilities and engaged in research and inquiry in areas where they felt insufficient. However, they also reported that most clinical nurses were not positive role models. They avoided taking nurses as role models because they had low communication skills, did not guide the student, and did not value human beings.

CONCLUSIONS

The study's findings indicated that student nurses were primarily influenced by clinical nurses and viewed them as both positive and negative role models, and they aspired to emulate the qualities of the nurses they considered positive role models while actively avoiding behaviors and traits associated with those seen as negative role models. Clinical nurses, who are in contact with prospective nurses the most, have an important role in guiding them.

Perception of dental students and faculty regarding the practice of professionalism in dentistry using the Professionalism Mini Evaluation Exercise (P-MEX)

BACKGROUND

Professionalism is one of the fundamental traits which includes behaviors, commitments, standards, and goals that helps define a profession.

OBJECTIVE

This study aimed to assess the attitude of dental students and graduates regarding the practice of professionalism in dentistry using the Professionalism Mini Evaluation Exercise (P-MEX) questionnaire.

METHOD

This cross-sectional study was conducted amongst the dental undergraduates, lecturers and postgraduate faculty. Views regarding professionalism were assessed using the P-MEX. The 24-questions based survey form is comprised of questions related to doctor and patient relationship skills, reflective abilities, time management, and lastly, interprofessional relationship expertise. Data was analyzed using SPSS version 23. Descriptive statistics were done using mean and SD, whilst associations between responses were assessed using Mann-Whitney U and Kruskal-Wallis tests. P value less than 0.05 was considered significant.

RESULTS

From a total of 201 participants, 95 (47.3%) were males and 106 (52.7%) were females. Statistically significant association was seen between time management, reflective skills, and interpersonal skills with gender, as well as the domains of P-MEX and years of education.

CONCLUSION

The use of P-MEX provides a valid confirmation for the assessment and awareness of professionalism amongst the dental faculty and students. Females demonstrated higher traits of professionalism as compared to males. The findings from the current study identify that students and faculty members had sufficient awareness regarding professionalism and the practice of professionalism was routinely followed.

Role Modeling in Medical Education: A Twenty-First Century Learner's Perspective

Traditional role modeling is a complex process of observation and emulation delivered by experienced senior physicians with an unknown outcome. Role modeling through organized modalities has been utilized as an educational tool in medical school for years. However, effects of parenting, near peers, gender, race, and social media on role modeling in medical education have not been well characterized yet play a significant role in the development of modern clinicians. The aim of this paper is to encourage students as future medical and clinical educators through an in-depth analysis of role modeling, with the goal of improving their "role modeling consciousness."

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

INTRODUCTION

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

METHODS

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

RESULTS

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

CONCLUSION

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.

RaT race: A standardized open-access education resource provides a structured resident-as-teacher experience

Objectives

There is no unified approach for training residents to be teachers. Foundations of Emergency Medicine (FoEM) is a national program that provides free resident education in emergency medicine (EM) utilizing small-group, case-based instruction delivered by individual program faculty and residents. This study seeks to explore the FoEM resident-as-teacher (RaT) experience.

Methods

We conducted a mixed-methods study of FoEM faculty site leaders and resident teachers in 2022. Site leaders completed an online survey consisting of multiple-choice, completion, and free-response items. We calculated descriptive statistics and applied a thematic qualitative analysis to free-response items. We conducted semistructured interviews with resident teachers. Interview transcripts were analyzed using a thematic approach with a constructivist-interpretivist paradigm.

Results

A total of 133 of 180 (74%) site leaders completed the survey and 11 resident teachers were interviewed. Forty-nine (37%) programs utilize resident instructors. The frequency of residents teaching and degree of faculty supervision varied. Commonly identified advantages include reinforcement of core content for resident teachers (44/49), structured format (35/49), and reduced need for faculty instructors (30/49). The most commonly identified challenges include variable instruction by residents (33/49) and challenge to providing feedback on teaching (20/49). Resident teachers identified benefits including strengthening residency community, improved EM knowledge, and greater teaching skills. For nearly all resident participants, FoEM RaT impacted their career goals by affirming their interest in teaching.

Conclusions

The FoEM curricular model appears to be a valuable and feasible method to incorporate a RaT experience into EM residency training programs.

'A role model is like a mosaic': reimagining URiM students' role models in medical school

BACKGROUND

Role modelling is a widely acknowledged element of medical education and it is associated with a range of beneficial outcomes for medical students, such as contributing to professional identity development and a sense of belonging. However, for students who are racially and ethnically underrepresented in medicine (URiM), identification with clinical role models may not be self-evident, as they have no shared ethnic background as a basis for social comparison. This study aims to learn more about the role models of URiM students during medical school and about the added value of representative role models.

METHODS

In this qualitative study we used a concept-guided approach to explore URiM alumni's experiences with role models during medical school. We conducted semi-structured interviews with ten URiM alumni about their perception of role models, who their own role models were during medical school and why they considered these figures as role models. Sensitizing concepts guided the topic list, interview questions and finally served as deductive codes in the first round of coding.

RESULTS

The participants needed time to think about what a role model is and who their own role models are. Having role models was not self-evident as they had never thought about it before, and participants appeared hesitant and uncomfortable discussing representative role models. Eventually, all participants identified not one, but multiple people as their role model. These role models served different functions: role models from outside medical school, such as parents, motivated them to work hard. Clinical role models were fewer and functioned primarily as examples of professional behaviour. The participants experienced a lack of representation rather than a lack of role models.

CONCLUSIONS

This study presents us with three ways to reimagine role models in medical education. First, as culturally embedded: having a role model is not as self-evident as it appears in existing role model literature, which is largely based on research conducted in the U.S. Second, as cognitive constructs: the participants engaged in selective imitation, where they did not have one archetypical clinical role model, but rather approach role models as a mosaic of elements from different people. Third, role models carry not only a behavioural but also a symbolical value, the latter of which is particularly important for URiM students because it relies heavier on social comparison.

Remodelling family medicine teaching at the University of Lausanne using a modified Delphi method

BACKGROUND

In the context of implementing a new framework for pre-graduate medical education in Switzerland (PROFILES) and the ongoing reform of the medical curriculum at the Faculty of Biology and Medicine of the University of Lausanne, we set out to determine the priority teaching themes of family medicine and to collect expert opinions about the most appropriate teaching methods for family medicine. Such data would contribute to the production of a coherent family medicine teaching programme encompassing its specificities as well as future challenges facing medicine in general.

METHOD

We mapped the current family medicine courses at the Faculty of Biology and Medicine to obtain an overview of current learning objectives and teaching content priorities. We classified and analysed the lessons using the PROFILES grid and the principles of family medicine described by the World Organization of Family Doctors (WONCA). Then we used a modified Delphi method with a selected panel of experts and two consensus rounds to prioritise objectives for family medicine teaching at the University of Lausanne. After choosing the top objectives/activities for family medicine, subgroups of experts then discussed what would be the best teaching methods for family medicine at the University of Lausanne.

RESULTS

The mapping of family medicine teaching at the University of Lausanne showed that current teaching addresses most of the primary topics of family medicine education. The modified Delphi method allowed us to identify priority themes for teaching family medicine at the University of Lausanne: (1) take a medical history and clinical examination; (2) doctor-patient relationship / patient-centred care; (3) clinical reasoning; (4) interprofessional collaboration; (5) care planning/ documentation; (6) shared decision-making; (7) communication; (8) cost-effective care; (9) health promotion; (10) assessment of urgency. The discussion with the experts identified the strengths and weaknesses of the various teaching modalities in family medicine education. Teaching should be structured, coherent and show continuity. Clinical immersion and small group teaching were the preferred teaching modalities.

CONCLUSION

This approach made it possible to create the guidelines for restructuring the family medicine teaching curriculum at the University of Lausanne.

Role modelling in professional identity formation: a systematic scoping review

BACKGROUND

Role modelling's pivotal part in the nurturing of a physician's professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician's thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP).

METHODS

A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices.

RESULTS

12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner's narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences.

CONCLUSION

Role modelling's ability to introduce and integrate beliefs, values and principles into a physician's belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.

Residents' and supervisors' experiences when using a feedback-model in post-graduate medical education

BACKGROUND

Supervisors play a key part as role models and supporting the learning during residents' post-graduate medical education, but sometimes lack sufficient pedagogic training and are challenged by high demands in today's healthcare. The aim of this study was to describe the strengths and areas for improvement identified in the supervision process by residents and supervisors in post-graduate medical education.

METHODS

This study included supervisors and residents working at departments and health centres who have used a web-based questionnaire, as a part of the Evaluation and Feedback For Effective Clinical Teaching (EFFECT) model, during the period 2016-2019. Descriptive statistics and content analysis were used to analyse ratings and comments to describe strengths and areas for improvement in the supervision process.

RESULTS

The study included 287 resident evaluations of supervisors and 78 self-evaluations by supervisors. The supervisor as a role model, being available, and, giving personal support, were the three most important strengths identified by the residents and supervisors. Residents in primary care also identified the role modelling of general practice competence as a strength, whereas residents and supervisors in hospital departments addressed supervisors as energetic and showing work was fun. The area with the need of most improvement was, Giving and receiving feedback.

CONCLUSIONS

To be able to give feedback, residents and supervisors, needed to see each other in work, and the learning environment had to offer time and space to pedagogical processes, like feedback, to improve the learning environment.

A multisite randomized trial of implicit versus explicit modeling in clinical teaching

PURPOSE

Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S. medical students.

METHOD

Fourth-year medical students from six U.S. academic medical centers were randomly assigned one simulated clinical encounter in which faculty provided either implicit or explicit modeling of important communication skills. Outcomes were assessed by electronic surveys immediately before and after the simulations. Students were blinded to the purpose of the study.

RESULTS

Students in the explicit arm were more likely to correctly cite two of the three key specific communication elements modeled by faculty: deliberate body position (53.3% vs. 18.6%, p < 0.001) and summarizing patient understanding (62.2% vs. 11.6%, p < 0.001). More students in the explicit study arm reported faculty 'demonstrated a key behavior that they wanted me to be able to perform in the future' (93.2% versus 62.8%, p = 0.002). Participating faculty stated they would modify their teaching approach in response to their experiences in the study.

CONCLUSIONS

In a multi-center randomized trial, explicit faculty role-modeling led to greater uptake of communication knowledge, greater recognition of skills, and a greater sense that faculty expected these skills to be adopted by students. These results must be considered in the context, however, of a simulated environment and a short timeframe for assessing learning with students who volunteered for a simulated experience.

Awareness, perceptions, and characteristics of internal medicine residents as role models

BACKGROUND

Role modelling is an essential component of medical education in which trainees incorporate observed characteristics into their personal behaviour and practice style. Data on residents as role models is limited. There are no previous quantitative studies addressing residents as role models from the resident's perspective.

OBJECTIVE

This study aimed to dissect the awareness, perception, and positive characteristics of internal medicine (IM) residents as role models.

METHODS

This was a cross sectional study, in which 59 medical students (MS) and 64 IM residents from Medstar Georgetown University Hospital completed a questionnaire on role modelling. Descriptive and comparative analyses between both groups were conducted.

FINDINGS

Most participants perceived IM residents as role models, but MS were more likely to report that IM residents lack awareness of their role model status. While MS perceived spending more hours with residents, the residents perceived dedicating more of the time spent together to teaching. Most participants denied previous training in role modelling but expressed interest in receiving formal role modelling training. Most participants reported MS behaviours were modified based on their observations of IM residents; however, while most of these behaviours were positive, there were also negative behaviours reported.

CONCLUSION

There was a discrepancy between perception and awareness of residents as role models. This characterisation of IM residents as role models sets the ground for the design of interventions to increase awareness and create educational interventions aimed to support residents in their teaching role.

Exploring the experiences and expectations of pharmacist interns in large general hospitals in China: from the perspective of interns

BACKGROUND

Hospital-based pharmacy internship (HBPI) is critical for the transition from "pharmacy students" to "professional pharmacists". This study explores the pharmacist interns' experiences and expectations for HBPI from their personal experiences intending to provide references for future hospital pharmacy education reform and policy development.

METHODS

This is a multicenter qualitative study applying focus group discussions. Pharmacist interns were invited as participants from large teaching hospitals in Henan, China. A thematic analysis was conducted to qualitatively analyze this data. Nvivo 12 was utilized for data management and processing.

RESULTS

Three focus group discussions were conducted, involving 16 interns as participants. Three themes were summarized regarding interns' expectations and experiences: (1) positive experiences of the HBPI; (2) negative experiences of the HBPI; (3) expectations and suggestions for the HBPI.

CONCLUSION

This study finds that the HBPI improves the professional knowledge, professional skills, and core competencies of interns. Therefore, the HBPI is an important preparation and transition stage for pharmacy students. However, the current pharmacy internship in China still has imperfections such as the insufficient ability of clinical teachers, unreasonable internship models, and unscientific internship content.

Clinical Teaching Competencies in Physical Therapist Education: A Modified Delphi Study

OBJECTIVE

Clinical instructors play a key role in physical therapist professional education but may serve with minimal preparation and without clearly defined expectations for their teaching performance. The objective of this study was to utilize a consensus-building process to establish core competencies of clinical teaching within physical therapist education.

METHODS

A modified Delphi approach was used to identify core competencies of clinical teaching. An expert panel consisted of clinical instructors, site coordinators of clinical education, and directors of clinical education, representing multiple geographic regions in the United States. The panel assessed the relevance of 30 original competencies. Criteria for consensus included 75% of participants perceiving the competency as very or extremely relevant and a median score of 2 (very relevant) on a 5-point Likert scale. Consistent with a Modified Delphi approach, quantitative and qualitative data analysis were completed for each of the 3 rounds. Revised surveys were used in Rounds 2 and 3 based on the results from previous data analysis.

RESULTS

Twenty-four competencies achieved final consensus. The competencies were categorized within 3 domains: learner-centered educator (n = 8), assessor/evaluator (n = 7), and professional role model (n = 9).

CONCLUSION

The 24 competencies and 3 domains provide the foundation for a competency framework for clinical teaching in physical therapy. This framework provides clarity for the expected knowledge, skills, and attitudes of clinical instructors in physical therapist professional education.

IMPACT

This is the first study, to our knowledge, to utilize a consensus-building strategy to clearly define competencies of clinical teaching in physical therapist professional education. Like efforts in nursing and medical education, adoption of these competencies could promote consistency in clinical instructor teaching behaviors and contribute to the creation of assessment and professional development mechanisms for clinical instructors, positively impacting the preparation of the next generation of excellent physical therapist clinicians.

Evaluating Clinical Educators' Competence in an East Asian Context: Who Values What?

Background

How to evaluate clinical educators is an important question in faculty development. The issue of who are best placed to evaluate their performance is also critical. However, the whos and the hows of clinical educator evaluation may differ culturally. This study aims to understand what comprises suitable evaluation criteria, alongside who is best placed to undertake the evaluation of clinical educators in medicine within an East Asian culture: specifically Taiwan.

Methods

An 84-item web-based questionnaire was created based on a literature review and medical educational experts' opinions focusing on potential raters (i.e., who) and domains (i.e., what) for evaluating clinical educators. Using purposive sampling, we sent 500 questionnaires to clinical educators, residents, Post-Graduate Year Trainees (PGYs), Year-4~6/Year-7 medical students (M4~6/M7) and nurses.

Results

We received 258 respondents with 52% response rate. All groups, except nurses, chose “teaching ability” as the most important domain. This contrasts with research from Western contexts that highlights role modeling, leadership and enthusiasm. The clinical educators and nurses have the same choices of the top five items in the “personal qualities” domain, but different choices in “assessment ability” and “curriculum planning” domains. The best fit rater groups for evaluating clinical educators were educators themselves and PGYs.

Conclusions

There may well be specific suitable domains and populations for evaluating clinical educators' competence in East Asian culture contexts. Further research in these contexts is required to examine the reach of these findings.

Moral Elevation, Physician Role Models, and Selected Markers of Professional Identity Formation and Well-Being: A Secondary Analysis from Two National Surveys

OBJECTIVES

Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation.

METHODS

A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout).

RESULTS

The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey). The national estimates for mean moral elevation in medical students and physicians are 4.34/5.00 and 4.22/5.00, respectively. In medical students and physicians, high moral elevation was associated with higher empathic compassion (student odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02-1.67; physician OR 1.22, 95% CI 1.23-1.65) and, similarly, generosity. In addition, higher moral elevation in the physician cohort was associated with greater life meaning (OR 2.03, 95% CI 1.25-3.32) and similarly spirituality.

CONCLUSIONS

In medical students and practicing physicians, self-reported experiences of high moral elevation with physician role models were associated with higher self-reported measures of patient-centered virtues, spirituality, and life meaning. Our Moral Elevation Scale in Medicine demonstrates preliminary promise as a measure to assess environmental precursors needed for virtue development in professional identity formation, but further reliability and validity testing of this measure is needed.

Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs

Health care providers hold negative explicit and implicit biases against marginalized groups of people such as racial and ethnic minoritized populations. These biases permeate the health care system and affect patients via patient–clinician communication, clinical decision making, and institutionalized practices. Addressing bias remains a fundamental professional responsibility of those accountable for the health and wellness of our populations. Current interventions include instruction on the existence and harmful role of bias in perpetuating health disparities, as well as skills training for the management of bias. These interventions can raise awareness of provider bias and engage health care providers in establishing egalitarian goals for care delivery, but these changes are not sustained, and the interventions have not demonstrated change in behavior in the clinical or learning environment. Unfortunately, the efficacy of these interventions may be hampered by health care providers’ work and learning environments, which are rife with discriminatory practices that sustain the very biases US health care professions are seeking to diminish. We offer a conceptual model demonstrating that provider-level implicit bias interventions should be accompanied by interventions that systemically change structures inside and outside the health care system if the country is to succeed in influencing biases and reducing health inequities.

The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools

INTRODUCTION

Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research.

METHODS

Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows.

RESULTS

We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices).

CONCLUSIONS

Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.

Asian medical students' attitudes towards professionalism

Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between pre-clinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, IrelandMethods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used.Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students.Conclusion: Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.

Professional integrity in maternal - fetal innovation and research: an essential component of perinatal medicine

OBJECTIVES

Clinical innovation and research on maternal-fetal interventions have become an essential for the development of perinatal medicine. In this paper, we present an ethical argument that the professional virtue of integrity should guide perinatal investigators.

METHODS

We present an historical account of the professional virtue of integrity and the key distinction that this account requires between intellectual integrity and moral integrity.

RESULTS

We identify implications of both intellectual and moral integrity for innovation, research, prospective oversight, the role of equipoise in randomized clinical trials, and organizational leadership to ensure that perinatal innovation and research are conducted with professional integrity.

CONCLUSIONS

Perinatal investigators and those charged with prospective oversight should be guided by the professional virtue of integrity. Leaders in perinatal medicine should create and sustain an organizational culture of professional integrity in fetal centers, where perinatal innovation and research should be conducted.

Clinical teachers' perceptions of role modeling: a qualitative study

BACKGROUND

Role modeling has been significantly considered in medical education in recent decades. In the clinical course, students learn necessary skills and accordingly their professional identity is formed by observing and working among clinical educators. Given the importance of the role modeling in medical education, in the present study, it was attempted to explore the clinical teachers' perceptions of being a role model for medical students using a qualitative method.

METHODS

A qualitative design, based on the content analysis approach, was used to analyze the perspectives of 15 clinical teachers. Participants were chosen by purposeful sampling. Data were collected using reflection paper writing.

RESULTS

During the data analysis, five main categories emerged: influencing others, developing different dimensions of student, situational self-awareness, feedback and continuous effort.

CONCLUSIONS

This study will be useful to form role modeling educational programs. Encouraging clinical teachers to make continuous efforts to improve role modeling and educating time management and self-control skills can help reduce the challenges of role modeling for clinical teachers.

Learning shared decision-making in clinical practice

OBJECTIVE

To explore how shared decision-making (SDM) is learned in clinical practice according to professionals and patients.

METHODS

Focus group and individual interviews with interns (n = 9), residents (n = 12), senior physicians (n = 13), and (former) patients and relatives (n = 13) in fertility care and intensive care.

RESULTS

Patients and professionals identified barriers and drivers for SDM related to patient, caregiver, and context. Participants agreed: the nuances of SDM are learned in practice, not during undergraduate medical education. Through observing and copying from other professionals, interns and residents describe building their personal "repertoire" of SDM skills, knowledge, and attitude. Professionals indicated it was helpful to see many different examples - both good and bad - of physicians in action.

CONCLUSION

Learning SDM is a complicated task for both students and professionals in healthcare. Relevant factors are the involvement of patients, the role of informal learning processes and role models, and the importance of reflective practice.

PRACTICE IMPLICATIONS

Learning SDM in practice requires 1) measures to lessen pressures on a meso and macro level that hinder SDM in practice, 2) inventive and precise training and education and paying explicit attention to informal learning processes in clinical practice and learning through role models.

Exploring clinical educators' perceptions of role modeling after participating in a role modeling educational program

INTRODUCTION

Role modeling significantly affects medical students' values, attitudes, and professional behaviors. Role modeling is a complex and multidimensional process that necessitates accurate perception and adequate knowledge and skills. However, most clinical educators do not have adequate awareness and knowledge about the positive and negative effects of role modeling. We aimed to explore clinical educators' perceptions of role modeling after participating in a role modeling educational program.

METHODS

This qualitative study was conducted on eighteen clinical educators who were voluntarily participated in a three-month role modeling educational program. Data were collected using reflection paper writing and were analyzed through conventional content analysis.

RESULTS

Data analysis resulted in the development of three main categories, namely closer attention to role modeling and effort for its promotion, deliberate effort to display role modeling, and creating a positive environment to increase the effectiveness of role modeling.

CONCLUSIONS

Clinical educators have limited role modeling knowledge and skills, and hence, educational programs are required to improve their role modeling knowledge, attitudes, and skills. Role modeling educational programs should aim at developing educators' awareness and knowledge about role modeling, develop their reflection and self-control abilities, and sensitize them to the importance of deliberate use of role modeling.

Revisiting the Concept of the Anti-Role-Model for Social Learning Theory in UK Education

The concept of the anti role model has had much less attention than the role model in modern social learning theory. The anti role model differs in that it describes an individual whose negative behaviours influence another peer or relative to practice the opposite behaviours in order to avoid a negative outcome. It may have become a neglected term because it does not exhibit as significantly in promotion based cultures which appear predominant in western liberal societies. However, in the United Kingdom, poorer socioeconomic subsets of students are now having to complete academic study to a higher standard up to the age of 18 and so these less promotion-based, more collectivist portions of society have become a more important concern for the education system. As such the anti role model concept may be reconsidered with regards to practice and research pertaining to these students and their social backgrounds.

Nursing students' perspectives on observed weight bias in healthcare settings: A qualitative study

BACKGROUND

Weight bias continues to be problematic within the healthcare setting among practicing healthcare providers (HCPs). These HCPs serve as influential role models for nursing students when immersed in the clinical environment. However, if HCPs are demonstrating bias toward patients with obesity, this may influence nursing students' beliefs and practices.

AIMS

This study aimed to explore nursing students' reflections of observed weight bias within the healthcare setting.

MATERIALS & METHODS

A descriptive qualitative study design was used involving reflective journaling and qualitative content analysis. Two cohorts of third-year baccalaureate nursing students (n = 197) participated in weight sensitivity training and submitted reflective journals over one academic semester.

RESULTS

Reports of weight bias were categorized into three themes-(1) Direct Impact: Observed Implicit and Explicit Provider Weight Bias; (2) Indirect Impact: Weight Bias Due to Skills, Equipment, or Staffing/Environmental Deficits; and (3) Reactions toward HCP Weight Bias: Conflict Between Weight Bias Training and Real-World Healthcare Experiences.

DISCUSSION

Weight bias was observed in some HCPs within the healthcare setting. Student reflections explored weight bias and the opposing messages between weight sensitivity training and real-world practices.

CONCLUSION

Preventing bias through continuing education for HCPs is crucial to provide compassionate care and instill ethical values in the next generation nurses.

Providing Effective Feedback in Breast Imaging to Improve Trainee Performance

While feedback is an essential component of medical education, feedback to trainees is frequently nonspecific and not focused on performance improvement. Providing specific feedback to trainees helps them to reflect, develop self-assessment skills, and recalibrate. In light of increasing clinical volumes, stresses related to modern healthcare delivery, and high physician burnout, instructors need efficient methods to provide actionable feedback to trainees. For breast imaging radiologists involved in education, improving feedback skills can help their learners develop expertise in breast imaging while also attracting and inspiring the next generation of radiologists.

Assessing Family Medicine Residents' Preparedness for the Practice of Geriatric Care

Introduction

Family physicians provide care to a growing and often complex group of older adults. Family medicine residencies are expected to prepare trainees to manage the medical and social needs of these seniors, but whether they feel prepared to do so is unknown. This study aimed to assess family medicine residents' sense of preparedness to address geriatric-related issues, and to identify factors that might affect this self-evaluation.

Methods

As an exploratory cross-sectional study, a 28-item questionnaire was circulated among 180 McGill University family medicine residents for voluntary completion. The survey assessed residents' demographics, attitudes toward, and perceptions of their training in geriatrics.

Results

One hundred residents (55.5% response rate) completed the questionnaire. Residents perceived their level of preparedness increasing as they progressed in their training; however, they felt least comfortable managing behavioral problems and engaging community resources. Positive perceptions about their training for geriatric care was proportionate to the number of positive role models they had during training. Sense of preparedness was most strongly and significantly associated with the duration of exposure residents had to long-term care.

Conclusion

The aging population requires physicians who are interested in care of the elderly and who are adequately prepared through comprehensive training to care for the complex medical and social issues that affect this large segment of society. This study, through its survey of family medicine residents, provides insights about potential curriculum changes and recommendations for updating the approach to care of the elderly.

Enhancement of role modelling in clinical educators: A randomized controlled trial

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling.Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the 'Positive Doctor Role Modelling' framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior.Results: In the intervention group (N = 18), the mean score of satisfaction was 4.7 (SD = 0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33-4.34), comparing to the control group (3.53-3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program.Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling.

A new instrument to measure high value, cost-conscious care attitudes among healthcare stakeholders: development of the MHAQ

BACKGROUND

Residents have to learn to provide high value, cost-conscious care (HVCCC) to counter the trend of excessive healthcare costs. Their learning is impacted by individuals from different stakeholder groups within the workplace environment. These individuals' attitudes toward HVCCC may influence how and what residents learn. This study was carried out to develop an instrument to reliably measure HVCCC attitudes among residents, staff physicians, administrators, and patients. The instrument can be used to assess the residency-training environment.

METHOD

The Maastricht HVCCC Attitude Questionnaire (MHAQ) was developed in four phases. First, we conducted exploratory factor analyses using original data from a previously published survey. Next, we added nine items to strengthen subscales and tested the new questionnaire among the four stakeholder groups. We used exploratory factor analysis and Cronbach's alphas to define subscales, after which the final version of the MHAQ was constructed. Finally, we used generalizability theory to determine the number of respondents (residents or staff physicians) needed to reliably measure a specialty attitude score.

RESULTS

Initial factor analysis identified three subscales. Thereafter, 301 residents, 297 staff physicians, 53 administrators and 792 patients completed the new questionnaire between June 2017 and July 2018. The best fitting subscale composition was a three-factor model. Subscales were defined as high-value care, cost incorporation, and perceived drawbacks. Cronbach's alphas were between 0.61 and 0.82 for all stakeholders on all subscales. Sufficient reliability for assessing national specialty attitude (G-coefficient > 0.6) could be achieved from 14 respondents.

CONCLUSIONS

The MHAQ reliably measures individual attitudes toward HVCCC in different stakeholders in health care contexts. It addresses key dimensions of HVCCC, providing content validity evidence. The MHAQ can be used to identify frontrunners of HVCCC, pinpoint aspects of residency training that need improvement, and benchmark and compare across specialties, hospitals and regions.

Attributes of Effective Clinical Teachers in Dental Hygiene Education

Many health professions have identified characteristics of an effective clinical instructor and used this information to create tools to measure clinical teaching effectiveness (CTE) in their disciplines. However, minimal research has been conducted to explore the attributes of an effective clinical instructor in dental hygiene education. The aim of this study was to identify the attributes of dental hygiene clinical instructors associated with effective teaching. This study used a Delphi research design to iteratively survey an expert panel of 14 dental hygiene instructors in dental hygiene programs from 13 U.S. states in 2019. A cumulative overall response rate of 89.3% was achieved after conducting three survey rounds. The results showed statistically significant consensus on 91 CTE characteristics. Participants agreed that effective clinical instructors should possess the ability to clearly communicate, foster interpersonal relationships, encourage a climate of mutual respect, and act as good role models who are emotionally intelligent, caring, trustworthy, fair, honest, and supportive. There was also agreement that effective clinical instructors were those who created a safe learning environment centered on collaboration, motivation, guidance, and positive corrective feedback. These results were similar to those identified in other health professions. However, there is a need for dental hygiene education to develop its own CTE assessment tool for use in professional development.

Gender and role models in the education of medical doctors: a qualitative exploration of gendered ways of thinking

OBJECTIVES

To examine how 'gendered ways of thinking' relate to role models in medical education.

METHODS

This study employed an explorative, qualitative, and cross-sectional design. A total of 57 interviews were held with medical students (28 interviews) and with faculty members (29 interviews) at a Swedish medical school. Participants were asked to describe their role models and the attributes that made certain individuals role models. Data were analysed using an inductive approach in three separate steps that explored the relationship between role models and gender.

RESULTS

Males do not generally consider female doctors as role models, and male role models are generally viewed as more admirable than female role models. This was shown in all steps of the analysis and most prominently in how male role models were described as qualitatively more admirable than female role models. Male role models are thus more common (for male and female students) and described as more admirable. The results point to the persistence of 'gendered ways of thinking' that subtly shape medical students.

CONCLUSIONS

Gendering role models is disadvantageous to female doctors in several ways, so the results have implications for women's career paths and opportunities. The results can thus form a basis for discussing and teaching the importance of gender in role modelling and in medical education in general.

Educational roles as a continuum of mentoring's role in medicine - a systematic review and thematic analysis of educational studies from 2000 to 2018

BACKGROUND

Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

METHODS

A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke's (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them. Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion. Stage three infuses mentoring into the findings delineated in stage one.

RESULTS

Seventeen thousand four hundred ninety-nine citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified - characteristics, processes, nature of relationship, and problems faced in each of the four educational roles.

CONCLUSIONS

Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.

Role modelling in the training of hospital-based medical specialists: a validation study of the Role Model Apperception Tool (RoMAT)

INTRODUCTION

Role modelling is a key component in the training of doctors that influences professional behaviour, identity and career choices. Clinical teachers and residents are often unaware of this, thereby risking transmission of negative behaviour. On the other hand, awareness positively affects role model behaviour. To assess role model behaviour, the Role Model Apperception Tool (RoMAT) was developed and validated in general practice training. The aim of the current study was to validate the RoMAT in the hospital-based training setting.

METHODS

The authors asked first to last year residents, regardless of their specialty, to participate after written approval from their clinical teachers. The tool was completed online in 2017. The authors performed a principal component analysis and investigated internal consistency, construct validity, inter-rater reliability, known-groups comparisons and floor and ceiling effects.

RESULTS

Of the 473 residents contacted, 187 (40%) completed the questionnaire. As in the primary validation study, the authors extracted two components: 'Caring Attitude' and 'Effectiveness', explaining 67% of the variation with a Cronbach's alpha of 0.94 and 0.93 respectively. Evidence for construct validity was found and there were no floor or ceiling effects, but inter-rater reliability was low.

DISCUSSION

The RoMAT was internally consistent and valid to assess role model behaviour of the clinical teacher towards the resident in the hospital-based training of medical specialists. The poor inter-rater reliability, most likely due to homogeneous RoMAT responses, should be borne in mind when evaluating RoMAT scores on individual clinical teachers.

From critic to inspirer: four profiles reveal the belief system and commitment to educational mission of medical academics

BACKGROUND

The educational beliefs of medical academics influence how they act in class and thus influence student learning. One component of these are beliefs academics hold about the qualities of teachers themselves. These teacher qualities range from behaviours and competencies to more personal attributes such as the teacher's identity and mission. However, it is unclear what medical academics believe to be key teacher qualities. Therefore, this study explored the variety of medical academics' beliefs about 'teacher qualities', aiming to identify and characterise profiles of academics with similar beliefs.

METHODS

We interviewed 26 expert academics from two medical schools to explore their beliefs about teacher qualities. A concentric onion-model focusing on teacher qualities was used to analyse and categorise the data deductively. Within each theme we developed subthemes inductively. To gain insight into the variety of beliefs we then clustered the participants into teacher profiles according to the themes. To better understand each of the profiles we carried out a quantitative study of the differences between profiles regarding subthemes, contextual and personal factors, and analysed statistical significance using Fisher's exact- and Student's t-tests for categorical and continuous data, respectively.

RESULTS

Four profiles of medical academics were identified, corresponding to the most central theme that each participant had reflected on: the 'Inspirer', 'Role-model', 'Practitioner', and 'Critic'. The focus of the profiles varied from external constraining factors within the 'Critic' profile to affective personal qualities within the 'Role-model' and 'Inspirer' profiles. The profiles could be regarded as hierarchically ordered by inclusiveness. Educational institute was the only significant factor related to the profiles.

CONCLUSIONS

Besides the relevance of affective teacher qualities, the 'Inspirer' profile demonstrates the importance of developing a clear mission as a teaching academic, centred around student learning and professional development. In our view, academics who inspire their students continue to be inspired themselves. The practical implications are described for faculty development programmes, and for the potential value of using these profiles within medical schools. In the discourse on educational beliefs, the authors argue that more attention should be paid to affective qualities, in particular to explicating the educational mission of academics.

How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study

BACKGROUND

Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant.

METHODS

We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains.

RESULTS

Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills.

CONCLUSIONS

Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.

Cross-cultural Comparison of Pharmacy Students' Attitudes, Knowledge, Practice, and Barriers Regarding Evidence-based Medicine

Objective. To explore cultural influences on US and Japanese pharmacy students' evidence-based medicine (EBM) attitudes, knowledge, and behavior. Methods. A cross-sectional study was conducted using a self-administered survey. Senior students in one pharmacy school in the United States and two pharmacy schools in Japan were invited to complete a 33-item survey instrument. Results. Students in both countries reported having positive attitudes and understanding of EBM concepts. In their self-evaluation, American students rated their current EBM practice, EBM skills, and access to EBM resources higher than Japanese students rated themselves in these areas. The most common barriers to EBM for American students were lack of time (84.5%), lack of statistical knowledge (63.9%), and lack of critical appraisal skills (53.1%). The most common barriers to EBM for Japanese students were lack of training (92.6%), lack of clinical knowledge (90.4%), and lack of opportunity (88.8%). Conclusion. Although barriers to implementing EBM and confidence levels in using EBM differed between US and Japanese pharmacy students, both cohorts recognized EBM as an important skillset for the pharmacy profession. Culturally specific approaches to teaching EBM to pharmacy students are needed to improve EBM use in practice.

Supervision training interventions in the health and human services: realist synthesis protocol

INTRODUCTION

Supervision training aims to develop workplace supervisory competencies. Despite extensive supervision literature, including literature reviews, the processes through which supervision training interventions produce their effects, for whom and under what circumstances is not clearly delineated. The purpose of this study is to explain the effect of contextual factors on the underpinning mechanisms of supervision training outcomes.

METHODS AND ANALYSIS

We propose to examine supervision training interventions across the health and human services workforce using realist methods. Pawson's five stages for undertaking a realist synthesis will be followed: (1) clarifying the scope of the review; (2) determining the search strategy; (3) study selection; (4) extracting data and (5) synthesising the evidence and drawing conclusions. Extracted data will include study characteristics, characteristics of participant cohort, intervention type, contextual factors, underlying mechanisms and supervision training outcomes. Patterns in context-mechanism-outcome configurations will be identified. Initial programme theories will be developed based on a comprehensive search of the literature, which will include key terms relating to supervision and training. The search strategy will involve: (1) electronic database searching using Medline, Cumulative Index to Nursing and Allied Health Literature, Social Services Abstracts, Educational Resources Information Center, PsycINFO and Australian Public Affairs Information Service and (2) hand and citation searching. We will also contact authors where necessary and discuss identified literature among the project team with extensive expertise in supervision training.

ETHICS AND DISSEMINATION

The realist synthesis will propose an evidence-informed theory of supervision training interventions (ie, what interventions work for whom and why). The findings will be disseminated in peer-reviewed journals and presentations and through discussions with relevant organisations and stakeholders. The research will be used by educators to develop evidenced-based supervision training interventions. It will also help workplace supervisors to better understand what types of supervision training might work most optimally for them and their colleagues. Other researchers could use the synthesis findings to guide future supervision research.

PROSPERO REGISTRATION NUMBER

CRD42018094186.

Clinical educators' skills and qualities in allied health: a systematic review

BACKGROUND

The skills and qualities of effective clinical educators are linked to improved student learning and ultimately patient care; however, within allied health these have not yet been systematically summarised in the literature.

AIMS

To identify and synthesise the skills and qualities of clinical educators in allied health and their effect on student learning and patient care.

METHOD

A systematic search of the literature was conducted across five electronic databases in November 2017. Study identification, data extraction and quality appraisal were performed in duplicate. Qualitative and quantitative data were extracted separately but analysed together using a thematic analysis approach whereby items used in quantitative surveys and themes from qualitative approaches were interpreted together.

RESULTS

Data revealed seven educator skills and qualities: (i) intrinsic and personal attributes of clinical educators; (ii) provision of skillful feedback; (iii) teaching skills; (iv) fostering collaborative learning; (v) understanding expectations; (vi) organisation and planning; and (vii) clinical educators in their professional role. Across all themes was the concept of taking time to perform the clinical educator role. No studies used objective measurements as to how these skills and qualities affect learning or patient care.

DISCUSSION AND CONCLUSION

Despite much primary evidence of clinical educator skills and qualities, this review presents the first synthesis of this evidence in allied health. There is a need to examine clinical education from new perspectives to develop deeper understanding of how clinical educator qualities and skills influence student learning and patient care.

Good educators and orphans: the case of direct observation and feedback

The authors propose the concept of orphaned competencies, those that are good for clinical education, but often are not taken up by good clinical educators. Prolonged direct observation is promoted as a way forward.

The attitudes of nursing students and clinical instructors towards reporting irregular incidents in the medical clinic

Despite efforts to increase patient safety, medical incidents and near misses occur daily. Much is still unknown about this phenomenon, especially due to underreporting. This study examined why nursing students and clinical instructors underreport medical events, and whether they believe that changes within their institutions could increase reporting. 103 third- and fourth-year nursing students and 55 clinical instructors completed a validated questionnaire. The results showed that about one-third of the instructors and one-half of the nursing students believed that circumstances and lack of awareness, and fear of consequences, lead to underreporting. Both nursing students and clinical instructors ranked "fear of consequences" as the main reason for not reporting, yet students ranked this higher than their instructors. Moreover, both groups believed that incident reporting could be increased following changes in the clinical field, mainly by increasing awareness and knowledge. A large percentage of participants also wrote that they do not report errors that are the result of circumstances and lack of awareness, mainly fear of consequences. Therefore, hospitals and academic institutions may need to create a more accepting organizational climate. Moreover, institutions that allow incident reports to be submitted anonymously and that take educational (not disciplinary) action, may increase incident reporting.

Medical students' professional identity development from being actors in an objective structured teaching exercise

INTRODUCTION

Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students' professional identity development.

METHODS

University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie's personality and social structure perspective model.

RESULTS

Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback.

CONCLUSION

Taking part in OSTEs as a simulated resident has a positive impact on students' vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.

Perceptions of occupational therapy students and clinical tutors on the attributes of a good role model

BACKGROUND

Occupational therapy students learn in different environments, where role modelling takes place. Nevertheless, little is known about student and tutors perceptions on model´s characteristics.

OBJECTIVES

The aims of this study were to investigate the perceptions of occupational therapy students on the most important attributes of role models and to confront their views with those of clinical tutors.

METHODS

A sample of 61 students completed a structured, standardized online questionnaire. Ten clinical tutors regarded by students as good models underwent a semi-structured individual interview. Data were analyzed quantitatively and qualitatively (thematic content analysis).

RESULTS

The most important attributes of a good role model according to student perception were: good relationship with patients, integrity and ethical behaviour, respectful relationships with colleagues, patient management skills, commitment to personal and professional growth and enthusiasm for the profession. Clinical tutors believed that they were nominated as good role models because they demonstrated empathy towards patients, good relationships with students and enthusiasm for their profession.

CONCLUSIONS AND SIGNIFICANCE

Perceptions of occupational therapy students and clinical tutors about role models characteristics were similar. Identification of attributes of good role models may inform teacher training and faculty development in occupational therapy.

Those Who Teach, Can Do: Characterizing the Relationship Between Teaching and Clinical Skills in a Residency Program

BACKGROUND

Teaching practice is presumed to have significant overlap with clinical skills, yet few studies to date have assessed how residents' teaching skills influence their clinical performance.

OBJECTIVE

We examined the relationship between the professional roles of residents as teachers and as practicing clinicians as well as how learning about teaching contributes to enhanced skills in the clinical realm.

METHODS

Using the framework method, the authors performed a 2-phased (exploratory and confirmatory) qualitative analysis on the data sets to characterize the relationship between resident teaching and clinical skills. To investigate the relationship between teaching and clinical work, we extracted qualitative data from 300 evaluations of clinical performance for residents in a large, urban, academic internal medicine residency program submitted over a 3-year period. Informed by the preliminary framework that evolved from this analysis, we conducted a focus group of 6 residents in a dedicated clinician-educator track to examine how teaching was related to clinical work.

RESULTS

We identified attributes and skills of good resident teachers that enhance clinical skills, categorized as 18 subdomains within 4 domains: relationships, communication, relation to self, and relationship with knowledge.

CONCLUSIONS

Themes that link clinical and teaching skills are similar for both patient-physician and learner-teacher relationships. Improving residents' teaching skills may not only benefit the education of learners but also improve the care of patients.