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Alexander M, Behrend R, Franz A, Peters H. Feeling the responsibility: Exploring the emotional experiences of final-year medical students when carrying out clinical tasks. MEDICAL TEACHER 2024:1-8. [PMID: 38771960 DOI: 10.1080/0142159x.2024.2351137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE The concept of Entrustable Professional Activities (EPA) is increasingly used to operationalize learning in the clinical workplace, yet little is known about the emotions of learners feeling the responsibility when carrying out professional tasks. METHODS We explored the emotional experiences of medical students in their final clerkship year when performing clinical tasks. We used an online reflective diary. Text entries were analysed using inductive-deductive content analysis with reference to the EPA framework and the control-value theory of achievement emotions. RESULTS Students described a wide range of emotions related to carrying out various clinical tasks. They reported positive-activating emotions, ranging from enjoyment to relaxation, and negative-deactivating emotions, ranging from anxiety to boredom. Emotions varied across individual students and were related to the characteristics of a task, an increasing level of autonomy, the students' perceived ability to perform a task and the level of supervision provided. DISCUSSION Emotions are widely present and impact on the workplace learning of medical students which is related to key elements of the EPA framework. Supervisors play a key role in eliciting positive-activating emotions and the motivation to learn by providing a level of supervision and guidance appropriate to the students' perceived ability to perform the task.
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Affiliation(s)
- Miriam Alexander
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ronja Behrend
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Franz
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harm Peters
- Dieter Scheffner Center for Medical Education and Educational Research, Dean's Office of Study Affairs, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Elster MJ, Parsons AS, Collins S, Gusic ME, Hauer KE. 'We're like Spider-Man; with great power comes great responsibility': Coaches' experiences supporting struggling medical students. MEDICAL TEACHER 2024:1-9. [PMID: 38588710 DOI: 10.1080/0142159x.2024.2337250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Medical students can experience a range of academic and non-academic struggles. Coaching is a valuable strategy to support learners, but coaches describe working with struggling learners as taxing. Transformative learning theory (TLT) provides insights into how educators grow from challenging experiences to build resilience. This study explores how coaches evolve as educators through supporting struggling students. METHODS This qualitative study grounded in an interpretivist paradigm used interviews of longitudinal medical student coaches at two academic institutions. Interviews, using TLT as a sensitizing concept, explored coaches' experience coaching struggling learners. We performed thematic analysis. RESULTS We interviewed 15 coaches. Coaches described supporting students through multi-faceted struggles which often surprised the coach. Three themes characterized coaches' experiences: personal responsibility, emotional response, and personal learning. Coaches shouldered high personal responsibility for learners' success. For some, this burden felt emotional, raised parental instincts and questions about maintaining boundaries with learners. Coaches evolved their coaching approach, challenged biases, and built skills. Coaches learned to better appreciate the learner point of view and employ resources to support students. DISCUSSION Through navigating learner struggles, educators can gain self-efficacy, learn to understand learners' perspectives, and evolve their coaching approach to lessen their personal emotional burden through time.
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Affiliation(s)
- Martha J Elster
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew S Parsons
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sally Collins
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Karen E Hauer
- University of California San Francisco School of Medicine, San Francisco, California, USA
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Zhu A, Aitken SJ. Failing in the system or systemic failure? The inherent tension within surgical trainee underperformance and remediation. Am J Surg 2024:S0002-9610(24)00177-6. [PMID: 38570218 DOI: 10.1016/j.amjsurg.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Alison Zhu
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney Local Health District, Concord West, NSW, Australia
| | - Sarah Joy Aitken
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney Local Health District, Concord West, NSW, Australia.
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McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D. "I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. Am J Surg 2024:S0002-9610(24)00035-7. [PMID: 38350749 DOI: 10.1016/j.amjsurg.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is a significant gap in the literature regarding trainees' perceptions of remediation. This study aims to explore surgical trainees' experiences and perspectives of remediation. METHODS This qualitative study used semi-structured interviews with 11 doctors who have experienced formal remediation as a surgical trainee. Reflexive thematic analysis was used for data analysis. RESULTS In this study, trainees perceived remediation as a harrowing and isolating experience, with long-lasting emotions. There was a perceived lack of clarity regarding explanations of underperformance and subjective goals. Remediation was viewed as a 'performance' and tick-box exercise with superficial plans, with challenging trainee/supervisor dynamics. CONCLUSIONS These findings about trainees' perspectives on remediation show a need for trainees to be better emotionally supported during remediation and that remediation plans must be improved to address deficits. Integrating the perspectives and experiences of surgical trainees who have undergone remediation should help improve remediation outcomes and patient care.
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Affiliation(s)
- Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia; Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, Australia
| | - Julian Archer
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia
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Patel D, Alismail A. Relationship Between Cognitive Load Theory, Intrinsic Motivation and Emotions in Healthcare Professions Education: A Perspective on the Missing Link. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:57-62. [PMID: 38264765 PMCID: PMC10804965 DOI: 10.2147/amep.s441405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
Cognitive Load Theory (CLT) is one of the key cognitive theories that have been used to assess learners' information and working memory load. CLT has been applied to Simulation Based Education (SBE) and optimizing instructional design. However, a challenge that occurs is that these high-fidelity simulations and mannequins of critically ill patients can elicit negative emotions in learners which can unfavorably impact the learning process. There is also a potential for cognitive overload if the simulation is more authentic and requires more dynamic interactions and lead to high levels of anxiety due to a novel learning environment, which can also have detrimental effects on learning process. Hence, it is critical for health professional educators (HPE) to know how to minimize cognitive load to improve learning as a professional in a workplace setting. The literature on the role of emotions, intrinsic motivation, cognitive load is scarce in HPE literature. Specifically when not being studied together at once since they move dynamically together and affect the learning for the learner. Therefore, the purpose of this perspective paper is to cover the gap in the literature and propose a framework and recommendation for future HPE research.
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Affiliation(s)
- Dhruvita Patel
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, USA
| | - Abdullah Alismail
- Department of Cardiopulmonary Sciences, School of Allied Health Professions, Loma Linda University Health, Loma Linda, CA, USA
- Department of Medicine, School of Medicine, Loma Linda University Health, Loma Linda, CA, USA
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Cale AS, Hoffman LA, McNulty MA. Pre- and post-examination reflections of first-year medical students in an integrated medical anatomy course. ANATOMICAL SCIENCES EDUCATION 2024; 17:186-198. [PMID: 37772662 DOI: 10.1002/ase.2340] [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: 12/14/2022] [Revised: 07/13/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
Due to the rigor and pace of undergraduate medical anatomy courses, it is not uncommon for students to struggle and fail initially. However, repetition of coursework places an additional burden on the student, instructor, and institution. The purpose of this study was to compare the exam preparation strategies of repeating and non-repeating students to identify areas where struggling students can be supported prior to course failure. As part of their integrated anatomy course, first-year medical students at Indiana University completed a metacognitive Practice-Based Learning and Improvement (PBLI) assignment prior to and after their first exam. In the PBLIs, students were asked to reflect on their exam preparation strategies, confidence, and satisfaction, as well as their predicted and actual exam performance. PBLI responses from non-repeating and repeating students were then analyzed quantitatively and qualitatively. A total of 1802 medical students were included in this study, including 1751 non-repeating and 51 repeating students. Based on their PBLI responses, non-repeating students were appropriately confident, somewhat satisfied, and more accurate when predicting their exam performance. Repeating students were overconfident, dissatisfied, and inaccurate when predicting their first exam performance on their initial, unsuccessful attempt but were more successful on their second, repeat attempt. Qualitative analysis revealed that repeating students aimed to improve their studying by modifying their existing study strategies and managing their time more effectively. In conjunction with other known risk factors, these insights into repeater and non-repeater exam preparation practices can help anatomy educators better identify and support potential struggling students.
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Affiliation(s)
- Andrew S Cale
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leslie A Hoffman
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - Margaret A McNulty
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Percival CS, Maggio LA, Wyatt TR, Martin PC. 'The program director's word … it's stronger than the word of God': Epistemic injustice revealed through narratives of remediated graduate medical education residents. MEDICAL EDUCATION 2023. [PMID: 38131235 DOI: 10.1111/medu.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Though graduate medical education (GME) residency training provides positive experiences for many trainees, it may also result in major stressors and negative experiences, particularly for those requiring remediation. Residents requiring remediation may experience feelings of dismay, shame and guilt that can negatively affect their training, self-efficacy and their medical careers. Power differentials between educators and residents may set the stage for epistemic injustice, which is injustice resulting from the silencing or dismissing a speaker based on identity prejudice. This can lead to decreased willingness of trainees to engage with learning. There is a paucity of literature that explores GME experiences of remediation from the resident perspective. OBJECTIVE To synthesise the narratives of physician experiences of remediation during residency through the lens of epistemic injustice. METHODS Between January and July 2022, we interviewed US physicians who self-identified as having experienced remediation during residency. They shared events that led to remediation, personal perspectives and emotions about the process and resulting outcomes. Interviews were analysed using narrative analysis with attention to instances of epistemic injustice. RESULTS We interviewed 10 participants from diverse backgrounds, specialties and institutions. All participants described contextual factors that likely contributed to their remediation: (1) previous academic difficulty/nontraditional path into medicine, (2) medical disability or (3) minoritised race, gender or sexual identity. Participants felt that these backgrounds made them more vulnerable in their programmes despite attempts to express their needs. Participants reported instances of deflated credibility and epistemic injustices with important effects. CONCLUSIONS Participant narratives highlighted that deep power and epistemic imbalances between learners and educators can imperil GME trainees' psychological safety, resulting in instances of professional and personal harm. Our study suggests applying an existing framework to help programme directors (PDs) approach remediation with epistemic humility.
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Affiliation(s)
- Candace S Percival
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lauren A Maggio
- Department of Medicine, Center for Health Professions Education at Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Tasha R Wyatt
- Department of Medicine, Center for Health Professions Education at Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paolo C Martin
- Department of Medicine, Center for Health Professions Education at Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Dart J, Rees C, Ash S, McCall L, Palermo C. Shifting the narrative and practice of assessing professionalism in dietetics education: An Australasian qualitative study. Nutr Diet 2023. [PMID: 36916155 DOI: 10.1111/1747-0080.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Abstract
AIM We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? METHOD We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace-based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team-based, framework analysis. RESULTS Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. CONCLUSIONS These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student-centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation.
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Affiliation(s)
- Janeane Dart
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Charlotte Rees
- Head of School, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Susan Ash
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Louise McCall
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Office of the Deputy Dean Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Colonnello V, Fino E, Russo PM. Attachment anxiety and depressive symptoms in undergraduate medical students : The mediating role of emotion regulation strategies. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:207-212. [PMID: 35587333 PMCID: PMC9391533 DOI: 10.1007/s40037-022-00713-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Several studies report that medical students are at high risk of depression. Despite the variability in students' vulnerability to depression, the role of individual differences in depression risk among medical students has hardly been investigated. Studies outside of medical student populations have shown that individual differences in attachment style and emotion regulation participate in vulnerability to depression. OBJECTIVES This study investigates to what extent medical students' depressive symptoms are related to differences in students' insecure attachment styles and their perception of reduced access to emotion regulation strategies. METHODS In a cross-sectional quantitative study, undergraduate medical students at the beginning of their second academic year completed online questionnaires measuring their attachment style, difficulties in emotion regulation, and depressive symptoms. RESULTS Out of the 390 medical students invited, 267 participated in the survey. Higher secure attachment was associated with fewer depressive symptoms. Medical students' insecure attachment style and emotion dysregulation were significantly related to depressive symptoms. Difficulties in employing strategies to disengage from one's own negative affect partly mediated the effects of two dimensions of insecure anxious attachment-need for approval and preoccupation with relationships-on depressive symptoms. DISCUSSION Anxious attachment style and limited access to emotion regulation strategies participate in medical students' depressive symptoms. These findings highlight the need for acknowledging medical students' attachment style and students' perceived access to emotion regulation strategies for the early identification of and intervention programs for the risk of depression.
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Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Edita Fino
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paolo Maria Russo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Bourgeois-Law G, Regehr G, Teunissen PW, Varpio L. Strangers in a strange land: The experience of physicians undergoing remediation. MEDICAL EDUCATION 2022; 56:670-679. [PMID: 35080035 DOI: 10.1111/medu.14736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The experience of remediation in practising physicians has not been widely studied. Remediatees frequently present negative emotions, but observers can only infer the underlying reasons behind these. Understanding remediatees' perspectives may help those mandating and organising remediation to structure the process in ways that improve the experience for all concerned parties and maximise chances of a successful outcome for remediatees. METHODS Seventeen physicians who had undergone remediation for clinical competence concerns were interviewed via telephone. Participant data were first iteratively analysed thematically and then reanalysed using a narrative mode of analysis for each participant in order to understand the stories as wholes. Figured worlds (FW) theory was used as a lens for analysing the data for this constructivist research study. RESULTS Participants entering the FW of remediation perceived that their position as a 'good doctor' was threatened. Lacking experience with this world and with little available support to help them navigate it, participants used their agency to draw on various discursive threads within the FW to construct a narrative account of their remediation. In their narratives, participants tended to position themselves either as victims of regulatory bodies or as resilient individuals who could make the best of a difficult situation. In both cases, the chosen discursive threads enabled them to maintain their self-identity as 'good doctor'. CONCLUSION Remediation poses a threat to a physician's professional and personal identity. Focusing mainly on the educational aspect of remediation-that is, the improvement in knowledge and skills-risks missing its impact on physician identity. We need to ensure not only that we support physicians in dealing with this identity threat but that our assessment and remediation processes do not inadvertently encourage remediatees to draw on discursive threads that lead them to see themselves as victims.
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Affiliation(s)
- Gisèle Bourgeois-Law
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Glenn Regehr
- Department of Surgery, University of British Columbia, Vancouver, Canada
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lara Varpio
- Graduate Programs in Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Monrad SU. Perceptions and emotions about learning and assessment: Why should we care? MEDICAL EDUCATION 2022; 56:354-356. [PMID: 35106802 DOI: 10.1111/medu.14739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Seetha U Monrad
- Departments of Internal Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Brennan N. Emotions, psychological safety and recommendations for designing remediation programmes. MEDICAL EDUCATION 2022; 56:141-143. [PMID: 34761423 DOI: 10.1111/medu.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
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Colonnello V. Enhancing remediation by focusing on affective experience. MEDICAL EDUCATION 2021; 55:1338-1340. [PMID: 34558109 PMCID: PMC9293010 DOI: 10.1111/medu.14670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 05/02/2023]
Abstract
Colonnello offers the affective neuroscience view as a means for better understanding the role of emotions in remediation and nurturing synergistic interactions between research and education.
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Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic and Specialty MedicineUniversity of BolognaBolognaItaly
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