The influence of role-modeling on clinical empathy of medical interns: A qualitative study

The impact of emotionally challenging situations on medical students' professional identity formation

In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students' experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students' professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students' reflective essays at the end of their education (tenth term). The analysis showed that students' main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students' development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.

Role modelling in professional identity formation: a systematic scoping review

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Effective and innovative teaching methods in psychiatry for the medical undergraduates in South India: An exploratory study of teachers' and students' perspectives

Background

Effective teaching methods are important in psychiatry. Previous studies have focused on the assessment of students about the effective teaching methods but not on a self-assessment by teachers.

Aims

Primary objective is to evaluate the teachers' and students' perspectives of effective teaching methods in psychiatry for medical undergraduates. Secondary objectives include assessment of the concordance of each item and exploring innovative teaching methods.

Settings and Design

A cross-sectional study design used in teachers and medical students from St. John's Medical College, Bangalore (India).

Methods and Material

A modified teachers and medical students perspectives of effective psychiatry teaching methods were used.

Statistical Analysis

Differences in continuous variable assessed with independent sample-test and categorical variables with Chi-square test. The Domain scores were divided into tertiles and the highest and lowest tertiles were analyzed.

Results

Both students and teachers had high perspectives on most of the teaching methods. Differences were found in items such as "using multimedia slide effectively," "good sense of humor while teaching," "presentation summarizes the key points," and "presentation links ideas effectively." Role play-based and live/simulated patient-based teachings were reported most frequently by both. Significantly, a higher proportion of the 6th term students and a lesser proportion of teachers were associated with the lowest tertiles for Domain 1, 2, and 3. Significantly, increased number of 8th term students were found in the higher tertiles in Domain 3.

Conclusions

These findings have practical implications in identifying the gaps in effective teaching methods by the teachers. Teachers can improve their teaching methods by upgrading their presentation skills, employing new and innovative teaching skills.

Predicting medical graduates' clinical performance using national competency examination results in Indonesia

BACKGROUND

Indonesia has applied a national competency exit-examination for medical graduates since 2014, called The Indonesia Medical Doctor National Competency Examination (IMDNCE). This examination is administered to ensure the competence of medical graduates from at present 83 medical schools in Indonesia. Although many studies reported their evaluation on medical licensing examinations, there are not many studies performed to evaluate the correlation of a national licensing examination to the graduates' clinical practice.

AIMS

This research aimed to evaluate the performance of new medical doctors in Indonesia in their internship period after the IMDNCE completion, and whether it might become a predictive indicator for the new medical doctors' clinical performance.

METHODS

An observational cross-sectional study was performed in November-December 2017 on 209 doctors who were new medical graduates. Thirty-one senior doctors from a range of regions in Indonesia who were recruited and trained previously participated in the observation. The Clinical Performance Instrument (CPI) tool was developed as an evaluation tool of the new doctors' clinical competence to be observed for three weeks. The obtained data were analysed using descriptive statistics and correlated to the IMDNCE scores.

RESULTS

The mean (95% CI) of the CPI for all participants was 83.0 (80.8-85.2), with no correlation of CPI score with IMDNCE results in domains of communication, professionalism and patient safety (p > 0.05). However, the mean total of the CPI observation scores from doctors who graduated from public medical schools was higher than those graduating from private medical schools. Also, there were differences in scores related to the institution's accreditation grade (p < 0.05).

CONCLUSION

There is no difference between CPI and national competency examination results. There was no statistical correlation between the clinical performance of new medical doctors during their internship to CBT and OSCE scores in the national competency examination. New doctors' performance during internship is affected by more complex factors, not only their level of competencies.

Humanism in clinical education: a mixed methods study on the experiences of clinical instructors in Iran

BACKGROUND

Medical education is currently more considerate about the human dimension. The present qualitative study aimed to explain the experiences of clinical professors with regard to humanism in clinical education in Iran.

METHODS

This mixed methods study had two phases, a quanitative phase of scientometrics and a qualitative phase of a content analysis. In the scientometrics phase, Ravar PreMap and VOSviewer software programs were utilized for plotting the conceptual networks. The networks were analyzed at the micro-level based on centrality indices (closeness, degree, and betweenness). The conceptual network was plotted and the prominent topics in clinical education were identified using co-word analysis. In the second qualitative phase on the topic, based on the scientometrics phase, semi-structured interviews were conducted with clinical professors. The interviews were transcribed verbatim and analyzed.

RESULTS

On the basis of the analysis of titles, abstracts, and keywords of the retrieved articles on clinical education from ISI Web of Science, Scopus, and PubMed, 1412 keywords were extracted. After the refining process, 356 keywords with 6741 relations remained. Upon plotting the conceptual network, 19 conceptual clusters related to clinical education were obtained. Then, micro-level network analysis (centrality criteria) indicated that the keyword humanism with the frequency of 137 had the highest rate (97.753), closeness (97.802), and betweenness (13.407). Moreover, from the interview data analysis, two themes of "intertwined nature of the human spirit in clinical education" and "humanistic behavior of professors in clinical education" were extracted.

CONCLUSION

As a part of the educational culture, humanistic values must be intertwined with the medical education curriculum. In this regard, humanism and clinical reasoning are the two major clusters of clinical teaching; moreover, altruism and adherence to humanistic values, and scientific qualification are other main pillars that should be considered as the criteria for the selection of clinical professors and medical students.

The need for empathetic healthcare systems

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

Can empathy be preserved in medical education?

OBJECTIVES

The aim of this study was to investigate changes in empathy during medical education, as well as to identify promoters and inhibitors of empathy and analyse their roles.

METHODS

We used qualitative content analysis to examine 69 critically reflective essays written by medical students as a part of their final examination at the end of the medical program. The essays were based on previous self-evaluations performed each term and represented retrospective reflections on their professional development.

RESULTS

A majority of the students felt that their empathy did not decrease during medical education. On the contrary, many felt that their empathy had increased, especially the cognitive part of empathy, without loss of affective empathy. Many of them described a professionalisation process resulting in an ability to meet patients with preserved empathy but without being overwhelmed by emotions. They identified several factors that promoted the development of empathy: a multiplicity of patients, positive role models, and educational activities focusing on reflection and self-awareness. They also identified inhibitors of empathy: lack of professional competence and a stressful and empathy-hostile medical culture.

CONCLUSIONS

Our analysis of these retrospective reflections by students suggests that empathy can be preserved during medical education, despite the presence of important inhibitors of empathy. This finding might be due to the presence of more potent promoters and/or to the fact that educational activities might result in a decreased susceptibility to empathy-decreasing circumstances.