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Kirtchuk L, Markless S. Communities of practice: A theoretical framework for undergraduate longitudinal placements. CLINICAL TEACHER 2024; 21:e13692. [PMID: 37957816 DOI: 10.1111/tct.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There has been a global shift towards longitudinal placements in undergraduate medicine, which are believed to play an important role in supporting medical student learning and professional identity formation. A better understanding of how learning occurs on such placements is needed, and community of practice (CoP), a social learning theory, has been proposed to form their pedagogical foundations. However, empirical research exploring learning through CoPs on longitudinal placements is limited. METHODS Case study methodology triangulating data from interviews, written reflections and routine evaluations was undertaken to explore how second-year students on an undergraduate longitudinal General Practice placement participated within CoPs and the factors enabling this participation. FINDINGS Routine evaluation data were available for 57% (n239) of students and in-depth interviews were carried out with five students and three tutors across eight placements. Themes identified through inductive thematic analysis were (i) participation within CoPs, (ii) enablers of legitimate peripheral participation and (iii) socialising agents. Student legitimate peripheral participation was greatly facilitated by making contributions to patient care, a welcoming clinical environment, access to the informal spaces and repertoires of the practice and effective brokerage of educational activities by tutors. DISCUSSION CoP is a theory that allows us to make tangible the somewhat abstract when deepening our understanding of how students learn on longitudinal placements. The extent to which students become legitimate peripheral participants varies, and this theoretical framework allows us to consider the factors that can enable such participation, with implications for how educators design curricula and placement infrastructure.
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Affiliation(s)
- Liza Kirtchuk
- King's Undergraduate Medical Education in the Community, Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharon Markless
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Komasawa N, Yokohira M. Comparison of attitudes toward community-based medicine between regional-quota and general-selected medical student in Japan. J Rural Med 2024; 19:10-16. [PMID: 38196803 PMCID: PMC10773998 DOI: 10.2185/jrm.2023-020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: This study compared the regional-quota and general-selected medical students' understanding, interest, and confidence in the community medicine practice and their attitudes toward the concept guidelines. Methods: We conducted a Web-based questionnaire survey regarding the understanding, interest, and confidence in future community medicine practice and attitudes toward concept guidelines among medical students of all grades (regional-quota and general-selected: n=82 and n=617, respectively). Results: The overall response rates were 68.5% (56/82) and 66.0% (409/617) in the regional-quota and general-selected groups, respectively. Although there was no significant difference between the groups in terms of understanding (P=0.998), interest and confidence in future practice were significantly higher in the regional-quota group (both P<0.001). There was no significant difference between the two groups for any of the six questions regarding community medicine guidelines. Conclusion: The understanding of community medicine or its conceptual guidelines did not significantly differ between the two groups; however, interest and confidence in future practice were significantly higher in the regional-quota group. These results suggest that the regional-quota system positively upregulates the interest in community medicine, which could be associated with confidence in future practice. Comprehensive and longitudinal improvements in the regional-quota system may be effective in cultivating community medicine.
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Affiliation(s)
- Nobuyasu Komasawa
- Community Medicine Education Promotion Office, Faculty of Medicine, Kagawa University, Japan
- Department of Medical Education, Faculty of Medicine, Kagawa University, Japan
| | - Masanao Yokohira
- Department of Medical Education, Faculty of Medicine, Kagawa University, Japan
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Latessa RA, Galvin SL, Swendiman RA, Onyango J, Ostrach B, Edmondson AC, Davis SA, Hirsh DA. Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study. BMC MEDICAL EDUCATION 2023; 23:760. [PMID: 37828469 PMCID: PMC10571297 DOI: 10.1186/s12909-023-04622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. METHODS We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. RESULTS Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. CONCLUSIONS This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
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Affiliation(s)
- Robyn A Latessa
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
| | - Shelley L Galvin
- Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, NC, USA
| | - Robert A Swendiman
- Department of Pediatric General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bayla Ostrach
- University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA
- Departments of Family Medicine and Medical Anthropology, Boston University School of Medicine, Boston, MA, USA
| | | | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville, NC, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA.
- Department of Medicine, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, USA.
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Brown MEL, Parekh R, Collin V, Sivam V, Ahuja N, Kumar S. Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care. BMJ Open 2023; 13:e074227. [PMID: 37730387 PMCID: PMC10514660 DOI: 10.1136/bmjopen-2023-074227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school. DESIGN We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis. SETTING One research-intensive medical school based in the UK. Data collection occurred in 2021-2022. PARTICIPANTS 12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year. RESULTS We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning. CONCLUSIONS The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.
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Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Vanessa Sivam
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Neha Ahuja
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
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Brown ME, Collin V, Parekh R, Kumar S. A contextual definition of longitudinal integrated clerkships within the UK and Ireland: A bi-national modified Delphi study. EDUCATION FOR PRIMARY CARE 2023:1-14. [PMID: 37161989 DOI: 10.1080/14739879.2023.2204463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Disagreement exists within the UK and Ireland regarding how Longitudinal Integrated Clerkships should be defined, and the relevance of international definitions. In this modified, online Delphi study, we presented the UK and Ireland experts in Longitudinal Integrated Clerkships with statements drawn from international definitions, published LIC literature, and the research team's experience in this area and asked them to rate their level of agreement with these statements for inclusion in a bi-national consensus definition. We undertook three rounds of the study to try and elicit consensus, making adaptations to statement wording following rounds 1 and 2 to capture participants' qualitative free text-comments, following the third and final round, nine statements were accepted by our panel, and constitute our proposed definition of Longitudinal Integrated Clerkships within the UK and Ireland. This definitional statement corresponds with some international literature but offers important distinctions, which account for the unique context of healthcare (particularly primary care) within the UK and Ireland (for example, the lack of time-based criteria within the definition). This definition should allow UK and Irish researchers to communicate more clearly with one another regarding the benefits of LICs and longitudinal learning and offers cross-national collaborative opportunities in LIC design, delivery and evaluation.
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Affiliation(s)
- Megan El Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Sonia Kumar
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Shagrin BS, Gheihman G, Sullivan AM, Li H, Hirsh DA. Faculty perspectives on facilitating medical students' longitudinal learning: A mixed-methods study. MEDICAL EDUCATION 2022; 56:1002-1016. [PMID: 35599241 DOI: 10.1111/medu.14842] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/01/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Medical students' longitudinal care of patients supports clinical learning and promotes patient-centredness. The literature presents little empirically derived guidance for faculty to facilitate students' longitudinal learning and care. Informed by the conceptual framework of relational learning, this study investigated faculty perspectives about longitudinal teaching, their strategies for facilitating students' longitudinal learning and perceived barriers and enablers. METHODS Using a convergent mixed-methods approach at a single academic medical centre, the authors conducted a survey and two focus groups in 2018-2019 with faculty members teaching in three longitudinal clinical courses. Quantitative analyses included descriptive statistics and chi-square tests. Qualitative content analysis described deductive categories and identified inductive themes. RESULTS Forty-three eligible faculty (69%) completed the survey. Ninety-one percent (n = 39) reported that teaching in a longitudinal model enhanced their experience as preceptors. Faculty described activities students performed to provide longitudinal care: spending time with patients independently (n = 38, 88%), making follow-up phone calls (n = 35; 81%) and participating in home- and community-based visits (n = 20, 47%), among others. Twelve faculty participated in two focus groups. Deductive analysis characterised strategies for facilitating students' longitudinal learning and barriers and enablers. Strategies included "encouraging students to follow patients," "faculty adaptability," "offering guidance and setting expectations," and "careful patient selection." Barriers included scheduling limitations, and enablers included student initiative. Inductive analysis identified two themes: faculty goals for students and faculty benefits from teaching. Goals included meaningful engagement with patients and their illness over time. Benefits from teaching included personal gratification, mentorship, and holistic student assessment. DISCUSSION Our survey and focus group findings demonstrated positive faculty attitudes and experiences, characterised faculty goals and approaches, and identified elements of the educational context that hindered or facilitated longitudinal teaching and learning. This study's faculty perspectives build upon prior investigations of students' and patients' perspectives, offer teaching strategies, and may guide faculty development.
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Affiliation(s)
- Bianca S Shagrin
- Cambridge Integrated Clerkship, Harvard Medical School/Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Galina Gheihman
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy M Sullivan
- Shapiro Institute for Education and Research, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, China
| | - David A Hirsh
- Cambridge Integrated Clerkship, Harvard Medical School/Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Gheihman G, Callahan DG, Onyango J, Gooding HC, Hirsh DA. Coproducing clinical curricula in undergraduate medical education: Student and faculty experiences in longitudinal integrated clerkships. MEDICAL TEACHER 2021; 43:1267-1277. [PMID: 34129424 DOI: 10.1080/0142159x.2021.1935825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Educational coproduction, in which learners partner with educators to create and improve their educational experiences, can facilitate student-centered medical education. Empirical descriptions of best practices for involving students in clinical curricular coproduction are needed. We aimed to understand faculty and student perspectives on methods, perceived benefits, and common barriers and solutions to clinical curricular coproduction. METHODS We conducted an international mixed-methods study of clinical curricular coproduction in undergraduate medical education and longitudinal integrated clerkships specifically. Faculty and students identified through an international listserv received an electronic survey to identify methods, benefits, and challenges of clinical curricular coproduction. We conducted semi-structured interviews with a subset of survey participants. We present descriptive statistics for survey data and themes derived from inductive qualitative analysis. RESULTS Two hundred forty-seven individuals (104 faculty; 143 students) representing 52 medical schools in eight countries completed the survey. Methods for clinical curricular coproduction ranged from informal, low-intensity learner involvement (e.g. verbal feedback) to formal, high-intensity learner involvement (e.g. committee membership). Perceived benefits included improvements in student-faculty relationships, program culture and design, and student development. Structural issues (e.g. scheduling) were the most common perceived barriers. CONCLUSIONS Clinical curricular coproduction among faculty and students is perceived to enhance collaboration, enable curriculum change, and support students' professional development. Our study offers empirical guidance for involving students as partners in clinical curricular coproduction.
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Affiliation(s)
- Galina Gheihman
- Departments of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, MA, USA
| | - Dana G Callahan
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joshua Onyango
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | | | - David A Hirsh
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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Brown MEL, Whybrow P, Kirwan G, Finn GM. Professional identity formation within longitudinal integrated clerkships: A scoping review. MEDICAL EDUCATION 2021; 55:912-924. [PMID: 33529395 DOI: 10.1111/medu.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Although the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research. METHOD In 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis. RESULTS 849 articles were identified following an extensive search. 131 articles were selected for full-text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity. CONCLUSIONS This scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co-providers of patient care. There are suggestions that LICs encourage the development of an 'ethic of caring'. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Paul Whybrow
- Academy for Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | | | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Atalay AJ, Osman NY, Krupat E, Alexander EK. Building Longitudinal Relationships Into a Traditional Block Clerkship Model: A Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1182-1188. [PMID: 33116060 DOI: 10.1097/acm.0000000000003810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The authors describe the implementation of the novel Longitudinal Clinical Experiences with Patients (LCEP) curriculum, designed to integrate continuity and longitudinal patient relationships into a traditional block clerkship (BC), and present a mixed-methods analysis evaluating program effectiveness to assess its feasibility, value, and impact. METHOD This was a mixed-methods study of 54 Harvard Medical School students who participated in the LCEP during their core clerkship (third) year during the 2013-2014 academic year. Fifty-two students responded to an electronic survey about the patients they followed during the LCEP. Forty-two students completed confidential live interviews. Unique groups of 13-15 students were interviewed at 3 times during the year to assess students' perceptions of the LCEP over time. The data were analyzed using a content analysis framework. RESULTS On average, students followed 3.3 LCEP patients over the clerkship year. Ninety-four percent (n = 49/52) of students were able to follow 2 or more patients longitudinally. Most students met their longitudinal patient in the inpatient setting (71%, n = 37/52). Subsequent encounters were most often in the ambulatory setting. Students described scheduling logistics as key to the success or failure of the program. Many students described the challenges of competing priorities between their BC responsibilities and longitudinal opportunities. Students found the LCEP deepened their understanding of the patient experience, the health care system, and disease progression. Over the course of an academic year, an increased proportion of students (60%) highlighted understanding the patient experience as a core value obtained through the LCEP. CONCLUSIONS The LCEP was feasible and proved successful in promoting longitudinal patient relationships within a traditional BC model. Prioritizing the depth of experience with a smaller number of patients may reduce the barriers described by students. The results suggest that such a hybrid program promotes patient-centeredness.
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Affiliation(s)
- Alev J Atalay
- A.J. Atalay is instructor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora Y Osman
- N.Y. Osman is assistant professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward Krupat
- E. Krupat is associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Erik K Alexander
- E.K. Alexander is professor of medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Hense H, Harst L, Küster D, Walther F, Schmitt J. Implementing longitudinal integrated curricula: Systematic review of barriers and facilitators. MEDICAL EDUCATION 2021; 55:558-573. [PMID: 33099784 DOI: 10.1111/medu.14401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The increase of longitudinal integrated curricula in medical schools worldwide represents the shift towards an outcome-oriented education. This novel model allows comprehensive student-patient interactions over time and integrates the educational content across disciplines. According to quantitative research, students, patients, doctors and communities benefit from this educational model in terms of participant satisfaction, learning outcomes and clinician recruitment. However, quantitative research does not provide detailed information on programme implementation processes. Therefore, this review aims to summarise facilitators and barriers of programme implementation reported in qualitative and mixed methods studies. METHOD The authors reviewed the literature about facilitators and barriers for the implementation of longitudinal integrated curricula in undergraduate medical education programmes. The systematic search was conducted in MEDLINE, Embase and PsycINFO on 2 December 2019. The authors used the CASP checklist for qualitative research for the critical appraisal and summarised the results across studies using thematic content analysis. RESULTS The authors screened 1682 reports. Twenty studies examining 17 different curricula met the inclusion criteria. Most curricula were implemented in the United States (n = 6/17), Australia (n = 5/17) or Canada (n = 4/17). Programme implementation is facilitated and hampered by its educational components (eg continuity of supervision, safe learning environments), organisational structures (eg community involvement) and participating students' and staff' motivation and personality. The critical appraisal revealed that several studies lacked transparent documentation and adequate reflection on the researcher-participant relationship (n = 20/20), data collection instruments (n = 12/20) and recruitment strategy (n = 4/20). CONCLUSIONS The authors derived practical recommendations for the implementation of undergraduate, patient-centred, integrated medical curricula. Programme managers need to define and communicate common objectives with all participants. They should clarify the implementation of the objectives in all processes in a transparent and structured manner. Considering reporting guidelines, future studies in this field should document more transparently the methods used to gain qualitative insights and the researchers' personal involvement.
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Affiliation(s)
- Helene Hense
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lorenz Harst
- Research Association Public Health, Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Denise Küster
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Felix Walther
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Komasawa N, Terasaki F, Nakano T, Kawata R. Correlation of student performance on clerkship with quality of medical chart documentation in a simulation setting. PLoS One 2021; 16:e0248569. [PMID: 33720982 PMCID: PMC7959337 DOI: 10.1371/journal.pone.0248569] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical chart documentation is an essential skill acquired in a clinical clerkship (CC). However, the utility of medical chart writing simulations as a component of the objective structured clinical examination (OSCE) has not been sufficiently evaluated. In this study, medical chart documentation in several clinical simulation settings was performed as part of the OSCE, and its correlation with CC performance was evaluated. METHODS We created a clinical situation video and images involving the acquisition of informed consent, cardiopulmonary resuscitation, and diagnostic imaging in the emergency department, and assessed medical chart documentation performance by medical students as part of the OSCE. Evaluations were conducted utilizing original checklist (0-10 point). We also analyzed the correlation between medical chart documentation OSCE scores and CC performance of 120 medical students who performed their CC in 2019 as 5th year students and took the Post-CC OSCE in 2020 as 6th year students. RESULTS Of the OSCE components, scores for the acquisition of informed consent and resuscitation showed significant correlations with CC performance (P<0.001 for each). In contrast, scores for diagnostic imaging showed a slightly positive, but non-significant, correlation with CC performance (P = 0.107). Overall scores for OSCE showed a significant correlation with CC performance (P<0.001). CONCLUSION We conducted a correlation analysis of CC performance and the quality of medical chart documentation in a simulation setting. Our results suggest that medical chart documentation can be one possible alternative component in the OSCE.
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Affiliation(s)
- Nobuyasu Komasawa
- Medical Education Center, Osaka Medical College, Osaka, Japan
- * E-mail:
| | - Fumio Terasaki
- Medical Education Center, Osaka Medical College, Osaka, Japan
| | - Takashi Nakano
- Medical Education Center, Osaka Medical College, Osaka, Japan
| | - Ryo Kawata
- Medical Education Center, Osaka Medical College, Osaka, Japan
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Gupta S, Howden S. Medical students' perceptions of 'community' in a longitudinal integrated clerkship. EDUCATION FOR PRIMARY CARE 2020; 32:157-165. [PMID: 33342354 DOI: 10.1080/14739879.2020.1850211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, UK
| | - Stella Howden
- School of Medicine, University of Dundee, Dundee, UK
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13
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Early longitudinal community pharmacy placements: Connection, integration and engagement. Res Social Adm Pharm 2020; 17:1313-1320. [PMID: 33060020 DOI: 10.1016/j.sapharm.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Longitudinal placements are defined as involving "a regular, recurrent placement in the same setting with the same supervisor over a period of time". "Continuity" is the organising principle for promoting learning through continuity of care, curriculum and supervision. Longitudinal placements are widely used in medicine, but less is known about their use in pharmacy and whether the educational principles translate to community pharmacy practice. OBJECTIVE This study sought to explore if a longitudinal community pharmacy placement (LCPP) for Year 2 pharmacy students promoted learning through student patient-centeredness, curricular integration, and growing professional engagement. METHODS An explanatory mixed methods study design was used. Quantitative data for the study was collected prior to and after the LCPP using a questionnaire incorporating a validated measure of professional engagement and items relating to patient-centeredness and curriculum integration. Pre and post-responses were compared using the Wilcoxon-signed rank test. To further understand the quantitative findings, semi-structured interviews were conducted with students, supervisors and practice-educators and thematically analysed through a constructivist lens. RESULTS There was a 78% response rate (47/60 paired responses) to the questionnaire and 25 interviews were conducted. There was quantitative and qualitative evidence of patient connection during LCPPs, yet some students had limited opportunities to connect with people. Curriculum integration was enhanced by the longitudinal nature of the placement. There was a significant increase in the sum scores of the S-PIPE instrument indicating enhanced professional engagement. Qualitatively there was evidence that engagement was promoted through role modelling and supervision, but continuity was compromised with changing supervisors. CONCLUSIONS An early LCPP promotes learning by providing opportunities for curriculum integration and professional engagement. It may be worth considering as a way to enhance integration through experiential learning in curriculum design. The placement needs to be of a sufficient length to enable repeated patient interaction and ideally provide continuity of supervision for maximum benefit.
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Reflections of an Integrated Maternal-Child Health Medical Student Assignment. Matern Child Health J 2020; 24:679-686. [PMID: 32277385 DOI: 10.1007/s10995-020-02907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Clinical experiences expose learners to the patient perspective, which can have a lasting impact on students' professional identity. However, in busy clinical settings where opportunities for reflection may be limited, listening to patients' stories is often neglected. We used a reflection assignment to augment a new maternal-child health integrated curriculum. METHODS Medical students completed a brief assignment from their session in the neonatal intensive care unit (NICU), which included reflective writing, between fall 2016 and summer 2017. The Depth of Reflection rubric was used to score reflections on a scale: "Knowledge and Comprehension" (Level I), "Analysis" (Level II), and "Synthesis and Evaluation" (Level III). A constant comparison method based on grounded theory elicited prenatal and postnatal themes from medical students' reflective writing. RESULTS All students completed narratives (n = 166); 70% (n = 116) achieved a Depth of Reflection of Level II or III. Six overarching themes emerged: (1) Conception, Pregnancy, and Delivery Experiences; (2) Positive Support Structures; (3) Barriers and Stressors to Care; (4) Future Plans; (5) Unexpected Complications; and (6) Student Career and Professional Considerations. DISCUSSION Reflections from a novel and brief integrated maternal-child health experience demonstrated high levels on the Depth of Reflection scale. This experience exposed students to core themes central to a family's pregnancy and perinatal experience. Professional identity formation also emerged as a theme. Reflective writing assignments in a busy NICU can facilitate exploration of medical students' knowledge of maternal-child health patient experiences.
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Komasawa N, Terasaki F, Nakano T, Kawata R. Relationships between objective structured clinical examination, computer-based testing, and clinical clerkship performance in Japanese medical students. PLoS One 2020; 15:e0230792. [PMID: 32214357 PMCID: PMC7098585 DOI: 10.1371/journal.pone.0230792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/08/2020] [Indexed: 11/18/2022] Open
Abstract
Background It is unclear how comprehensive evaluations conducted prior to clinical clerkships (CC), such as the objective structured clinical examination (OSCE) and computer-based testing (CBT), reflect the performance of medical students in CC. Here we retrospectively analyzed correlations between OSCE and CBT scores and CC performance. Methods Ethical approval was obtained from our institutional review board. We analyzed correlations between OSCE and CBT scores and CC performance in 94 medical students who took the OSCE and CBT in 2017 when they were 4th year students, and who participated in the basic CC in 2018 when they were 5th year students. Results Total scores for OSCE and CBT were significantly correlated with CC performance (P<0.001, each). More specifically, medical interview and chest examination components of the OSCE were significantly correlated with CC performance (P = 0.001, each), while the remaining five components of the OSCE were not. Conclusion Our findings suggest that the OSCE and CBT play important roles in predicting CC performance in Japanese medical education context. Among OSCE components, medical interview and chest examination were suggested to be important for predicting CC performance.
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Affiliation(s)
- Nobuyasu Komasawa
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
- * E-mail:
| | - Fumio Terasaki
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
| | - Takashi Nakano
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
| | - Ryo Kawata
- Medical Education Center, Osaka Medical College, Takatsuki, Japan
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Mylopoulos M, Kulasegaram KM, Weyman K, Bernstein S, Martimianakis MAT. Same but Different: Exploring Mechanisms of Learning in a Longitudinal Integrated Clerkship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:411-416. [PMID: 31436627 DOI: 10.1097/acm.0000000000002960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Longitudinal integrated clerkships (LICs) are a widely used method of delivering clerkship curricula. Although there is evidence that LICs work and core components of LIC training have been identified, there is insufficient understanding of which components are integral to why they work. To address this question, this research explored how students experienced the first year of an LIC program. The aim was to use participants' understanding of their learning experiences to identify potential mechanisms of the LIC curriculum model. METHOD Thirty-two interviews were conducted with 13 University of Toronto students, 7 LIC and 6 block rotation students from the same site, from October 2014 to September 2015. A thematic analysis was performed iteratively to explore participants' understanding of their key learning experiences and outcomes. RESULTS Participants in both cohorts described their key learning outcome as integration and application of knowledge during patient care. Experiences supporting this outcome were articulated as longitudinal variable practice and continuity of relationships with preceptors and patients. Critically, these experiences manifested differently for the 2 cohorts. For block students, these learning experiences appeared to reflect the informal curriculum, whereas for LIC students, learning experiences were better supported by the LIC formal curriculum. CONCLUSIONS The results illustrate the importance of learning experiences that support longitudinality and continuity. By also emphasizing variability and knowledge integration, they align with literature on expert development. Notably, many of the learning experiences identified resulted from informal learning and thus support going beyond the formal curriculum when evaluating the effectiveness of curricula.
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Affiliation(s)
- Maria Mylopoulos
- M. Mylopoulos is associate professor, Department of Paediatrics, curriculum scientist, MD Program, and scientist and associate director, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. K. Kulasegaram is assistant professor, Department of Family and Community Medicine, and scientist, MD Program and The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. K. Weyman is associate professor, St. Michael's Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. S. Bernstein is associate professor, Department of Paediatrics, and clerkship director, MD Program, University of Toronto, Toronto, Ontario, Canada. M.A. Martimianakis is associate professor and director, Medical Education Scholarship, Department of Paediatrics, and scientist and associate director, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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Wilbur K, BenSmail N, Ahkter S. Student feedback experiences in a cross-border medical education curriculum. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2019; 10:98-105. [PMID: 31129658 PMCID: PMC6766385 DOI: 10.5116/ijme.5ce1.149f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine non-Western situated health professional student experiences and preferences for feedback in workplace-based settings. METHODS We conducted five focus groups with 27 students of Arab-origin enrolled in a Canadian-accredited cross-border pharmacy program in Qatar. Transcripts of recorded discussions were analyzed using the framework method. Hofstede's and Hall's cultural dimension models were employed to understand described feedback encounters and behaviours. RESULTS We identified three themes associated with cultural influences on student feedback experiences, namely: 1) collectivism; 2) power distance; and 3) context. Trainees described clinical supervisors who inadequately recognized individual performance, rejected critique, and insufficiently documented feedback onto the written in-training evaluation report. Conversely, students expected specific and timely feedback, invited criticism for learning, and desired clear written commentary. CONCLUSIONS Feedback behaviours of clinical supervisors, but not those of trainees, were consistent with local cultural norms as described by Hofstede and Hall. Instead, feedback expectations of pharmacy students in Qatar largely echo those of other trainees enrolled in professional curricula situated outside the Middle East. Principles for optimal feedback in clinical training largely arise from Western perspectives but are not necessarily universal. Our work demonstrates that practices, in part, may be subject to local socio-cultural influences. This is of particular importance in the experiential training component of cross-border medical education programs adopted by overseas institutions. Our findings also further add to the growing body of literature reporting suboptimal feedback in workplace-based learning, reinforcing the need to cultivate more student-centered practices in health professional training globally.
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Affiliation(s)
- Kerry Wilbur
- Faculty of Pharmaceutical Sciences, the University of British Columbia, Vancouver, Canada
| | - Nawal BenSmail
- Clinical Pharmacist, Hamad Medical Corporation, Doha, Qatar
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Brown MEL, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519849409. [PMID: 31206031 PMCID: PMC6537286 DOI: 10.1177/2382120519849409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.
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Affiliation(s)
- Megan EL Brown
- Megan EL Brown, Health Professions Education
Unit, Hull York Medical School, University of York, York YO10 5DD, UK.
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Gheihman G, Jun T, Young GJ, Liebman D, Sharma K, Brandes E, Ogur B, Hirsh DA. A review of longitudinal clinical programs in US medical schools. MEDICAL EDUCATION ONLINE 2018; 23:1444900. [PMID: 29542394 PMCID: PMC5907349 DOI: 10.1080/10872981.2018.1444900] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools. OBJECTIVE Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs' structures and goals. DESIGN Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student-patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals. RESULTS We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included 'clinic attachments' (50.0%), 'longitudinal integrated clerkships' (26.5%), and 'patient attachments' (20.4%). We identified goals in 89 programs, including 'exposing students to specific topics, patient demographics, or practice settings' (78.7%); 'clinical or professional skill development' (65.2%); and 'understanding the patient experience' (19.1%). Patient attachments were associated with 'exposure to specific patient demographics' (P = .04) and 'understanding the patient experience' (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01). CONCLUSIONS Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.
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Affiliation(s)
| | - Tomi Jun
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Barbara Ogur
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - David A. Hirsh
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- CONTACT David A. Hirsh Department of Medicine, Cambridge Health Alliance (CHA), Macht Building 4th floor, 1493 Cambridge St, Cambridge, MA02139, United States
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Ali K, Cockerill J, Zahra D, Qazi HS, Raja U, Ataullah K. Self-perceived preparedness of final year dental students in a developing country-A multi-institution study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e745-e750. [PMID: 30098082 DOI: 10.1111/eje.12389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 05/05/2023]
Abstract
AIMS To evaluate the self-perceived preparedness to practice of final year dental undergraduate students in three dental institutions. METHODS Dental undergraduate students in their final year from three dental institutions in Pakistan were invited to participate in an online study to assess self-perceived preparedness using a validated preparedness assessment scale. RESULTS In total, 134 students responded to the questionnaire yielding a response rate of 72%. Students felt adequately prepared to carry out several clinical procedures including clinical assessment, fillings, tooth extractions and communication skills. However, perceived preparedness was low in the students' ability to undertake intraoral radiographs, treatment planning, crowns, multirooted endodontics, research skills, referral for suspected oral cancer and raising concerns regarding inappropriate behaviour of colleagues. CONCLUSIONS This is the first study which investigates the self-perceived preparedness of final year undergraduate dental students in Pakistan. The results show that the self-perceived preparedness of final year students was satisfactory for a range of clinical and affective skills. However, several areas of weaknesses were identified which underscore the need for additional training and consolidation.
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Affiliation(s)
- Kamran Ali
- Peninsula Dental School, University of Plymouth, Plymouth, UK
| | | | - Daniel Zahra
- Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Haroon S Qazi
- Islamabad Medical and Dental College, Islamabad, Pakistan
| | - Ulfat Raja
- International Islamic Dental College, Riphah International University, Islamabad, Pakistan
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Abdel-Misih S, Verbeck N, Walker C, Musindi W, Strafford K, Meyers L, Tartaglia K, Harzman A. Early experience with a combined surgical and obstetrics/gynecology clerkship: We do get along. Am J Surg 2018; 216:1016-1021. [PMID: 29471965 DOI: 10.1016/j.amjsurg.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2012, the Ohio State University College of Medicine (OSUCOM) implemented a new undergraduate medical curriculum. We compare outcomes of a third year traditional clerkship format to a combined Surgery and Obstetrics/Gynecology 'ring'. METHODS Performance outcomes of 4 consecutive classes were compared between pre- (2014, 2015) and post-curricular revision (2016, 2017). RESULTS Three hundred ninety-one students consented use of their educational data for research. We examined medical knowledge (NBME scores, USMLE Step 1 and Step 2 CK scores) and student satisfaction between pre- and post-curricular revision. Results demonstrated no statistically significant difference in the Obstetrics/Gynecology NBME shelf examination. Surgery NBME and USMLE Step 2 scores were increased and statistically significant but satisfaction of both disciplines was higher pre-curricular revision. CONCLUSION Medical knowledge outcomes in this combined 'ring' were similar to or higher than performance in previous years'. Future analyses are needed to assess the impact of OSUCOM curricular revision.
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Affiliation(s)
- Sherif Abdel-Misih
- The Ohio State University Wexner Medical Center, Department of Surgery, 320 W. 10th Ave., M256 Starling Loving Hall, Columbus OH 43210, USA.
| | - Nicole Verbeck
- The Ohio State University College of Medicine, 370 W. 9th Ave., 209, Columbus OH 43210, USA.
| | - Curtis Walker
- OhioHealth Care, Special Projects and Healthcare Policy Consultant, 370 W. 9th Ave., 203, Columbus OH 43210, USA.
| | - Wanjiku Musindi
- Mt. Carmel Health, Department of Obstetrics/Gynecology, Mount Carmel St. Ann's OB/Gyn Clinic, 500 S. Cleveland Ave, 1st Floor Women's Pavilion OB/Gyn Clinic, Westerville, OH 43081, USA.
| | - Katherine Strafford
- The Ohio State University Wexner Medical Center, Department of Obstetrics & Gynecology, 395 W. 12th Ave., Room 520, Columbus OH 43210-1267, USA.
| | - Lori Meyers
- The Ohio State University Wexner Medical Center, Department of Anesthesia, 410 W. 10th Ave., N411 Doan Hall, Columbus OH 43210-1267, USA.
| | - Kimberly Tartaglia
- The Ohio State University Wexner Medical Center, Department of Internal Medicine, 320 W. 10th Ave., M112 Starling Loving Hall, Columbus OH 43210, USA.
| | - Alan Harzman
- The Ohio State University Wexner Medical Center, Department of Surgery, 410 W. 10th Ave., N749 Doan Hall, Columbus OH 43210, USA.
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Ellaway RH, Bates J, Teunissen PW. Ecological theories of systems and contextual change in medical education. MEDICAL EDUCATION 2017; 51:1250-1259. [PMID: 28857233 DOI: 10.1111/medu.13406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/18/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Contemporary medical practice is subject to many kinds of change, to which both individuals and systems have to respond and adapt. Many medical education programmes have their learners rotating through different training contexts, which means that they too must learn to adapt to contextual change. Contextual change presents many challenges to medical education scholars and practitioners, not least because of a somewhat fractured and contested theoretical basis for responding to these challenges. There is a need for robust concepts to articulate and connect the various debates on contextual change in medical education. Ecological theories of systems encompass a range of concepts of how and why systems change and how and why they respond to change. The use of these concepts has the potential to help medical education scholars explore the nature of change and understand the role it plays in affording as well as limiting teaching and learning. METHODS This paper, aimed at health professional education scholars and policy makers, explores a number of key concepts from ecological theories of systems to present a comprehensive model of contextual change in medical education to inform theory and practice in all areas of medical education. RESULTS The paper considers a range of concepts drawn from ecological theories of systems, including biotic and abiotic factors, panarchy, attractors and repellers, basins of attraction, homeostasis, resilience, adaptability, transformability and hysteresis. Each concept is grounded in practical examples from medical education. CONCLUSION Ecological theories of systems consider change and response in terms of adaptive cycles functioning at different scales and speeds. This can afford opportunities for systematic consideration of responses to contextual change in medical education, which in turn can inform the design of education programmes, activities, evaluations, assessments and research that accommodates the dynamics and consequences of contextual change.
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Affiliation(s)
- Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Bates
- Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pim W Teunissen
- Faculty of Health, School of Health Professions Education (SHE), Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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Asgarova S, MacKenzie M, Bates J. Learning From Patients: Why Continuity Matters. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:S55-S60. [PMID: 29065024 DOI: 10.1097/acm.0000000000001911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Patient continuity, described as the student participating in the provision of comprehensive care of patients over time, may offer particular opportunities for student learning. The aim of this study was to describe how students experience patient continuity and what they learn from it. METHOD An interpretive phenomenological study was conducted between 2015 and 2016. Seventeen fourth-year medical students were interviewed following a longitudinal clinical placement and asked to describe their experiences of patient continuity and what they learned from each experience. Transcripts were analyzed by iteratively refining and testing codes, using health system definitions of patient continuity as sensitizing concepts to develop descriptive themes. RESULTS Students described three different forms of patient continuity. Continuity of care, or relational continuity, enabled students to build trusting and professional relationships with their patients. Geographical continuity allowed students to access information about patients from electronic records and their preceptors which allowed students to achieve diagnostic closure and learn to reevaluate their decisions. Students valued the learning that accrued from following challenging patients and addressing challenging decisions over time. Although difficult, these patient continuity experiences led students to critical reflection that was both iterative and deep, leading to intentions for future behavior. CONCLUSIONS Patient continuity in medical education does not depend solely on face-to-face continuity. Within various patient continuity experiences, following challenging patients and experiencing unanticipated diagnostic and management outcomes trigger critical reflection in students, leading to deep learning.
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Affiliation(s)
- Sevinj Asgarova
- S. Asgarova is a doctoral candidate, School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada. M. MacKenzie is clinical associate professor, Department of Family Practice, Faculty of Medicine, British Columbia, Vancouver, British Columbia, Canada. J. Bates is professor, Department of Family Practice, and scientist, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1313-1319. [PMID: 28248695 DOI: 10.1097/acm.0000000000001621] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The authors explored affordances that contribute to participants' successful learning in longitudinal integrated clerkships (LICs). METHOD This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine-Asheville campus from 2009 to 2013. The survey questions asked LIC graduates to rate components of LICs that they perceived as contributing to successful learning. A research assistant interviewed a subset of study participants about their learning experiences. The authors analyzed aggregate data quantitatively and performed a qualitative content analysis on interview data. RESULTS The graduates reported multiple affordances that they perceive contributed to successful learning in their LIC. The most reported components included continuity and relationships with preceptors, patients, place, and peers, along with integration of and flexibility within the curriculum. CONCLUSIONS As LIC models grow in size and number, and their structures and processes evolve, learners' perceptions of affordances may guide curriculum planning. Further research is needed to investigate to what degree and by what means these affordances support learning in LICs and other models of clinical education.
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Affiliation(s)
- Robyn A Latessa
- R.A. Latessa is director and assistant dean, University of North Carolina (UNC) School of Medicine-Asheville Longitudinal Integrated Clerkships Program, Asheville, North Carolina, and professor of family medicine, UNC School of Medicine, Chapel Hill, North Carolina. R.A. Swendiman is a general surgery resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. A.B. Parlier is a research project coordinator, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina. S.L. Galvin is director of research, Center for Research at Mountain Area Health Education Center, Asheville, North Carolina, and adjunct assistant professor, Department of Obstetrics/Gynecology, UNC School of Medicine, Chapel Hill, North Carolina. D.A. Hirsh is director, Harvard Medical School Cambridge Integrated Clerkship, Cambridge Health Alliance, Cambridge, Massachusetts, director, Harvard Medical School Academy Medical Education Fellowship, and associate professor of medicine, Harvard Medical School, Boston, Massachusetts
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Being centred in education and health care. CLINICAL TEACHER 2017; 14:5-7. [DOI: 10.1111/tct.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Walters L, Brooks K. Integration, continuity and longitudinality: the 'what' that makes patient-centred learning in clinical clerkships. MEDICAL EDUCATION 2016; 50:889-91. [PMID: 27562886 DOI: 10.1111/medu.13118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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