Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study

Exploring the professional identity process of university social responsibility courses' rural service programs on nursing students: A multi-method research

BACKGROUND

In the 21st century, University Social Responsibility (USR) has become increasingly formalized, highlighting the role of universities in contributing to societal development beyond teaching and research. However, in nursing education, a clear definition of social responsibility for students remains lacking. Previous research has mainly focused on classroom instruction and clinical practice, with limited emphasis on applications in rural areas with insufficient medical services.

OBJECTIVE

This study aims to explore the development of professional identity through rural service courses within the framework of the university's social responsibility program. Specifically, it examines the unique learning experiences offered by the Health Program for Rural Area Children and Adolescents' Health in Taiwan. Unlike traditional clinical settings, this program offers a distinctive and engaging learning opportunity.

DESIGN AND METHODS

The study employs a comprehensive multi-method approach, integrating qualitative methods such as focus group interviews and self-reflection report analysis with a quantitative questionnaire. This combination approach aims to provide an in-depth understanding of nursing students' experiences in delivering healthcare to children and adolescents in rural areas.

RESULTS

The analysis identifies four major themes: Realized Social Responsibility, Development of Empathy, Cultural Competence, and Professional Identity. Participation in rural service courses fosters personal growth and identity development among nursing students while also strengthening their professionalism and sense of social responsibility. The findings highlight the students' emotional and transformative journey.

CONCLUSION

This study underscores the significance of early exposure to diverse healthcare environments in shaping nursing students' professional identities. It strongly advocates for nursing educators, researchers, and policymakers to incorporate such experiences into nursing education programs, not only to enhance health literacy but also to advance health equity.

Instructing to Impact: Exploration of Doctor of Physical Therapy Education Instruction of Social Determinants of Health and Health Equity for People With Disabilities

OBJECTIVE

The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs.

METHODS

A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data.

RESULTS

SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions.

CONCLUSION

Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD.

IMPACT

To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD.

Seeing the invisible: extracurricular learning processes and learning outcome as experienced by student volunteers accompanying persons in a socially vulnerable situation to healthcare appointments-an ethnographic study

Becoming a healthcare professional is a complex process, where learning occurs in various ways. This study explores an extracurricular learning approach, called the Social Health Bridge-Building Programme, designed to address health inequities. Student volunteers accompany persons in a socially vulnerable situation to healthcare appointments. Operating outside the realms of health education, the programme intends to provide an alternative road to training healthcare students to become capable of engaging with diverse populations, and reducing barriers to healthcare access. Based on an ethnographic fieldwork, using interviews and participant observation ("walking along") as methods, the aim of the study was to explore the learning processes and learning outcomes associated with bridge-building, as experienced by students. Our findings show that this extracurricular learning complemented the formal curriculum, and bridged the gap from theoretical knowledge to practice and to real persons, preparing students for their future roles. The particular positioning of walking alongside or sitting beside persons made the invisible visible, enabling student volunteers to see the variety of persons in need of bridge-building, ways of living in a socially vulnerable situation, inequity in health, and see the persons, beyond initial impression, fostering a deeper understanding and empathy among the students. Learning outcomes included communicational, relational, and observations skills, and a more comprehensive grasp of the healthcare system's complexity. We conclude that a non-governmental organization, independent of the healthcare system, may have found a novel way of providing extracurricular learning about health inequity to students. Demonstrating how the Social Health Bridge-Building Programme complements formal curricula, the concept could be applicable in other settings.

The Allied Health Expansion Program: Rethinking how to prepare a workforce to enable improved public health outcomes

Improvements in global public health require universal health care supported by a health workforce with competencies appropriate for local population needs-the right capabilities, in the right place, and at the right time. Health inequities persist in Tasmania, and Australia more broadly, most notably for those people living in rural and remote areas. The article describes the curriculum design thinking approach being used to codesign and develop a connected system of education and training to target intergenerational change in the allied health (AH) workforce capacity in Tasmania, and beyond. A curriculum design thinking process is engaging AH participant groups (faculty, AH professionals, and leaders across health, education, aged and disability sectors) in a series of focus groups and workshops. The design process deals with four questions: What is? What if? What wows? and What works? It also involves Discover, Define, Develop and Deliver phases that continue to inform the development of the new suite of AH education programs. The British Design Council's Double Diamond model is used to organize and interpret stakeholder input. During the initial design thinking discover phase, stakeholders identified four overarching problems: rurality, workforce challenges, graduate skill set shortfalls, and clinical placements and supervision. These problems are described in terms of relevance to the contextual learning environment in which AH education innovation is occurring. The develop phase of design thinking continues to involve working collaboratively with stakeholders to codesign potential solutions. Solutions to date include AH advocacy, a transformative visionary curriculum, and an interprofessional community-based education model. In Tasmania, innovative educational innovations are catalyzing attention and investment in the effective preparation of AH professionals for practice to deliver improved public health outcomes. A suite of AH education that is deeply networked and engaged with Tasmanian communities is being developed to drive transformational public health outcomes. These programs are playing an important role in strengthening the supply of allied health professionals with the right capabilities for metropolitan, regional, rural, and remote Tasmania. They are situated in a broader AH education and training strategy that supports the ongoing development of the AH workforce to better meet the therapy needs of people in Tasmanian communities.

Residents' Reflections on Cost-Conscious Care after International Health Electives: A Single-Center Qualitative Study

BACKGROUND

Estimates suggest 30% of health care expenditures are wasteful. This has led to increased educational interventions in graduate medical education (GME) training aimed to prepare residents for high value, cost-conscious practice. International health electives (IHE) are widely available in GME training and may be provide trainees a unique perspective on principles related to high value, cost-conscious care (HVCCC).

OBJECTIVE

The purpose of this study was to explore how trainee reflections on IHE experiences offer insight into HVCCC.

DESIGN

The authors conducted an applied thematic analysis of narrative reflective reports of GME trainees' IHE experiences to characterize their perceptions of HVCCC.

PARTICIPANTS

The Mayo International Health Program (MIHP) supports residents and fellows from all specialties across all Mayo Clinic sites. We included 546 MIHP participants from 2001 to 2020.

APPROACH

The authors collected post-elective narrative reports from all MIHP participants. Reflections were coded and themes were organized into model for transformative learning during IHEs, focusing on HVCCC.

KEY RESULTS

GME trainees across 24 different medical specialties participated in IHEs in 73 different countries. Three components of transformative learning were identified: disorienting dilemma, critical reflection, and commitment to behavior change. Within the component of critical reflection, three topics related to HVCCC were identified: cost transparency, resource stewardship, and reduced fear of litigation. Transformation was demonstrated through reflection on future behavioral change, including cost-aware practice, stepwise approach to health care, and greater reliance on clinical skills.

CONCLUSIONS

IHEs provide rich experiences for transformative learning and reflection on HVCCC. These experiences may help shape trainees' ideology of and commitment to HVCCC practices.

How do dentists perceive portable dentistry? A qualitative study conducted in Quebec

INTRODUCTION

People with impaired mobility face difficulty accessing dental care. One solution is portable dentistry, which includes delivering dental care in homes or residential institutions. Dentists, however, appear reluctant to offer such services. Our objective was to understand how dentists perceived portable dentistry and potential challenges to its implementation.

METHODS

We conducted a qualitative descriptive study based on semi-structured interviews with a sample of dentists in Quebec, Canada. We employed a combination of maximum variation and snowball sampling strategies to recruit 14 participants. The interviews were conducted and audio-recorded through Zoom and lasted approximately 40 minutes. After transcribing them, we performed a thematic analysis with a combination of inductive and deductive coding.

RESULTS

Despite perceiving portable dentistry as a valuable practice model, participants showed little interest in adopting this approach, arguing it was not every dentist's "job" to provide portable services. They believed portable dentistry must be financially burdensome and difficult to integrate into their daily work due to lack of time and portable equipment. Accordingly, participants considered it was the duty of governments, professional organisations overseeing dentistry education and practice, and dental schools to develop portable dentistry programs and hire dentists to deliver such services.

CONCLUSIONS

To promote portable dentistry, it may be necessary to improve the knowledge and competencies of dentists, but also to challenge their professional identity as well as the current model of dental clinics as the standard of care delivery. To achieve this, we need strong leadership from dental schools, professional organisations and government.