1
|
McOwen KS, Varpio L, Konopasky AW. The figured world of medical education senior leaders: Making meaning and enacting agency. MEDICAL EDUCATION 2024; 58:225-234. [PMID: 37495259 DOI: 10.1111/medu.15164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The field of medical education is relatively new, and its boundaries are not firmly established. If we had a better understanding of the intricacies of the domain, we might be better equipped to navigate the ever-changing demands we must address. To that end, we explore medical education as a world wherein leaders harness agency, improvisation, discourse, positionality and power to act. METHODS Using the constructivist theory of figured worlds (FW), we conducted a narrative analysis of the stories medical education senior leaders tell about their roles and experiences in the world of medical education (n = 9). RESULTS We identified four foundational premises about the world of medical education: (i) medical education stands at the intersection of three interrelated worlds of clinical medicine, hospital administration and university administration; (ii) medical education is shaped by and shapes the clinical learning environment at the local level; (iii) medical education experiences ubiquitous change which is a source of power; and (iv) medical education is energised by relationships between individuals. DISCUSSION Focusing on the FW theory's notions of agency, improvisation, discourse, positionality and power enabled us to describe the world of medical education as a complex domain existing in a space of conflicting power hierarchies, identities and discourses. Using FW allowed us to see the powerful affordances offered to medical education due to its position between worlds amid unceasing change.
Collapse
Affiliation(s)
- Katherine S McOwen
- Academic Affairs, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Lara Varpio
- Emergency Pediatric Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Abigail W Konopasky
- Medical Education, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| |
Collapse
|
2
|
Wood B, Attema G, Ross B, Cameron E. A conceptual framework to describe and evaluate a socially accountable learning health system: Development and application in a northern, rural, and remote setting. Int J Health Plann Manage 2022; 37 Suppl 1:59-78. [PMID: 35986520 PMCID: PMC10087460 DOI: 10.1002/hpm.3555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/10/2022] [Accepted: 07/22/2022] [Indexed: 12/31/2022] Open
Abstract
Health care and academic institutions are increasingly committing to social accountability, a strategic shift that requires priorities, activities, and evaluations to be co-determined with all relevant partners. Consequently, governments, accreditors, funders, and communities are calling for these institutions to communicate their progress towards social accountability. The purpose of this study was to develop a conceptual framework around a socially accountable learning health system. This article presents an integrated analysis of two studies: (i) a narrative review of 11 prominent social accountability and health services conceptual frameworks and (ii) a reflexive thematic analysis of 18 key informant interviews. Using a systematic conceptual framework development and integrated theory of change/realist evaluation methodologies, we describe a synthesis of these findings to develop a conceptual framework for describing and evaluating socially accountable health professional education. The resulting framework describes assessment phases of social accountability, transitions between phases, learning cycles, and the actors and systems that collectively mobilise social accountability at multiple levels in health and education systems. The framework can be used to evaluate interventions or characterise progress towards social accountability in different settings, as illustrated in the example at the end of the paper. The framework emphasises the significance of designing, mobilising, and evaluating social accountability as part of a contextualised learning health system.
Collapse
Affiliation(s)
- Brianne Wood
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| | - Ghislaine Attema
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| | - Brian Ross
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada
| | - Erin Cameron
- Northern Ontario School of Medicine (NOSM) University, Thunder Bay, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| |
Collapse
|
3
|
Wood B, Bohonis H, Ross B, Cameron E. Comparing and using prominent social accountability frameworks in medical education: moving from theory to implementation in Northern Ontario, Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:45-68. [PMID: 36310909 PMCID: PMC9588193 DOI: 10.36834/cmej.73051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Social accountability in medical education is conceptualized as a responsibility to respond to the needs of local populations and demonstrate impact of these activities. The objective of this study was to rigorously examine and compare social accountability theories, models, and frameworks to identify a theory-informed structure to understand and evaluate the impacts of medical education in Northern Ontario. METHODS Using a narrative review methodology, prominent social accountability theories, models, and frameworks were identified. The research team extracted important constructs and relationships from the selected frameworks. The Theory Comparison and Selection Tool was used to compare the frameworks for fit and relevance. RESULTS Eleven theories, models, and frameworks were identified for in-depth analysis and comparison. Two realist frameworks that considered community relationships in medical education and social accountability in health services received the highest scores. Frameworks focused on learning health systems, evaluating institutional social accountability, and implementing evidence-based practices also scored highly. CONCLUSION We used a systematic theory selection process to describe and compare social accountability constructs and frameworks to inform the development of a social accountability impact framework for the Northern Ontario School of Medicine. The research team examined important constructs, relationships, and outcomes, to select a framework that fits the aims of a specific project. Additional engagement will help determine how to combine, adapt, and implement framework components to use in a Northern Ontario framework.
Collapse
Affiliation(s)
- Brianne Wood
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Hafsa Bohonis
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| | - Brian Ross
- Northern Ontario School of Medicine, Ontario, Canada
| | - Erin Cameron
- Medical Education Research Lab in the North (MERLIN), Northern Ontario School of Medicine, Ontario, Canada
| |
Collapse
|
4
|
Shah D, Blythe J. Using community diagnosis on primary care placements for medical students. EDUCATION FOR PRIMARY CARE 2021; 33:109-112. [PMID: 34486941 DOI: 10.1080/14739879.2021.1955624] [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: 10/20/2022]
Abstract
BACKGROUND Over 35 years ago Julian Tudor Hart highlighted how medical undergraduate education needed to adapt to produce clinicians who were better situated in communities. However, we still struggle to engage medical students in understanding the social and environmental determinants of health, the value population level data and public health interventions. Our approach: Third year medical students carried out a community diagnosis project where they evaluated quantitative, qualitative and observational data for the community in which they were living. They examined Public Health England fingertips data to choose a topic, gathered and evaluated further information, considered potential solutions, and created a 5-min presentation for their small group tutorial. The students were supported by GP tutors from East London, allowing a novel role for GP tutors to teach on this topic. EVALUATION GP tutors and students gave positive feedback on both the design and delivery of the module. Students frequently made the link between their previous theoretical teaching in public health and the application of it in the GPCD module, appreciated the value of investigating their local area and commented upon the opportunity to consider the wider determinants of health. The GP tutors felt the project gave the students an insight into the lived realities of others. CONCLUSIONS This module was an effective cross-collaborative approach between primary care and public health. It gave a practical application to build on previous theoretical public health learning, and evidence of transformational learning for the students, helping them to understand the impact of health inequalities.
Collapse
Affiliation(s)
- Deepa Shah
- Barts and the London Medical School, Queen Mary University of London, London, UK
| | - Jenny Blythe
- Barts and the London Medical School, Queen Mary University of London, London, UK
| |
Collapse
|
5
|
Burrows AM, Laupland KB. Comprehensiveness of distributed medical education systems: a regional population-based perspective. BMC MEDICAL EDUCATION 2021; 21:42. [PMID: 33422086 PMCID: PMC7796546 DOI: 10.1186/s12909-020-02466-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND The core business of medical schools includes clinical (education and service) and academic (research) activities. Our objective was to assess the degree to which these activities exist in a distributed medical education system in Canada. METHODS A population-based design was utilized. Programs were contacted and public records were searched for medical trainees and faculty positions within a province in Canada during the 2017/2018 academic year. Data were expressed as positions per 100,000 residents within the Lower Mainland, Island, and Northern and Southern interior geographical regions. RESULTS Substantial differences in the distribution of medical students by region was observed with the highest observed in the Northern region at 45.5 per 100,000 as compared to Lower Mainland, Island, and Southern regions of 25.4, 16.8, 16.0 per 100,000, respectively. The distribution of family medicine residents was less variable with 14.9, 10.7, 8.9, and 5.8 per 100,000 in the Northern, Island, Southern, and Lower Mainland regions, respectively. In contrast, there was a marked disparity in distribution of specialty residents with 40.8 per 100,000 in the Lower Mainland as compared to 7.5, 3.2, and 1.3 per 100,000 in the Island, Northern, and Southern regions, respectively. Clinical faculty were distributed with the highest observed in the Northern region at 180.4 per 100,000 as compared to Southern, Island, and Lower Mainland regions of 166.9, 138.5, and 128.4, respectively. In contrast, academic faculty were disproportionately represented in the Lower Mainland and Island regions (92.8 and 50.7 per 100,000) as compared to the Northern and Southern (1.4 and 1.2 per 100,000) regions, respectively. CONCLUSIONS While there has been successful redistribution of medical students, family medicine residents, and clinical faculty, this has not been the case for specialty residents and academic faculty.
Collapse
Affiliation(s)
- Andrea M Burrows
- Research and Knowledge Translation, Royal Inland Hospital and Interior Health Authority, 311 Columbia Street, British Columbia, V2C 2T1, Kamloops, Canada.
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Queensland, Brisbane, Australia
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| |
Collapse
|
6
|
Ellaway RH, Kehoe A, Illing J. Critical Realism and Realist Inquiry in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:984-988. [PMID: 32101916 DOI: 10.1097/acm.0000000000003232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Understanding complex interventions, such as in medical education, requires a philosophy of science that can explain how and why things work, or fail to work, in different contexts. Critical realism and its operationalization in the form of realist inquiry provides this explanatory power. Ontologically, critical realism posits that the social world is real, that it exists independent of our knowledge of it, and that it is driven by causal mechanisms. However, unlike postpositivism, a realist epistemological position is that our understanding of the mechanisms that underlay social reality is limited and subjective. Critical realism is focused on understanding the mechanisms that drive social reality even when they are not directly observable. One of the most commonly used methodologies in the critical realist paradigm is realist inquiry, which focuses on the relationships between context, mechanisms, and outcomes. At its core, realist inquiry is concerned with "What works for whom, under what circumstances, how, and why?" To that end, realist inquiry explores the mechanisms that drive social systems and the ways in which these mechanisms work to develop explanatory theories of the phenomena under consideration. Although, compared with other approaches, realist inquiry is relatively new in medical education, the value of realist inquiry is in its ability to model how complex interventions function differently across multiple contexts, explaining what works, how it works, for whom, and in what contexts.
Collapse
Affiliation(s)
- Rachel H Ellaway
- R.H. Ellaway is professor, Department of Community Health Sciences, and director, Office of Health and Medical Education Scholarship, University of Calgary, Calgary, Alberta, Canada. A. Kehoe is a research associate, School of Medical Education, Newcastle University, Newcastle-upon-Tyne, United Kingdom. J. Illing is professor of medical education research, School of Medical Education, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | | |
Collapse
|
7
|
Pierce C, Corral J, Aagaard E, Harnke B, Irby DM, Stickrath C. A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61. MEDICAL TEACHER 2020; 42:604-615. [PMID: 31961206 DOI: 10.1080/0142159x.2019.1708294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.
Collapse
Affiliation(s)
- Cason Pierce
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Janet Corral
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Eva Aagaard
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz, Aurora, CO, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chad Stickrath
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| |
Collapse
|
8
|
Kato D, Wakabayashi H, Takamura A, Takemura YC. Identifying the learning objectives of clinical clerkship in community health in Japan: Focus group. J Gen Fam Med 2019; 21:3-8. [PMID: 32161694 PMCID: PMC7060287 DOI: 10.1002/jgf2.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
Background The value of medical education in the community has been increasingly and globally recognized. In 2015, the World Federation for Medical Education emphasized the importance of medical education in various settings in their standard. Similarly, in Japan, the Model Core Curriculum for Medical Education in Japan (MCCMEJ) is revised in 2016. However, both the learning objectives of such clerkships and their concrete strategies in Japan are not clearly established. In this study, the authors identified the learning objectives of clinical clerkship in community health reflecting the perspectives of medical professionals and community inhabitants. Methods They held six focus groups that included physicians, other medical professionals, and inhabitants (n = 35) who were involved in a clinical clerkship in community health at three prefectures in Japan from 2017 to 2018. Further, they recorded, transcribed, and thematically analyzed the discussion using MCCMEJ as conceptual frameworks. Results The learning objectives comprised of 13 domains. The following four domains were not found in "Basic Qualities and Capacities for Physicians" in MCCMEJ: "future-oriented systematic view," "organic integration of knowledge/skill," "understanding of the community," and "awareness as an individual physician." Conclusion With the community inhabitants' participation, the study results reflect the community needs in Japan. The authors hope that the outcome of this study will be useful to further improve clinical clerkship in community health.
Collapse
Affiliation(s)
- Daisuke Kato
- Department of Family Medicine Mie University Graduate School of Medicine Mie Japan
| | - Hideki Wakabayashi
- Department of Community Medicine Kameyama, Mie University School of Medicine Mie Japan
| | - Akiteru Takamura
- Department of Medical Education Kanazawa Medical University Ishikawa Japan
| | - Yousuke C Takemura
- Department of Family Medicine Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| |
Collapse
|
9
|
Pitama S, Beckert L, Huria T, Palmer S, Melbourne-Wilcox M, Patu M, Lacey C, Wilkinson TJ. The role of social accountable medical education in addressing health inequity in Aotearoa New Zealand. J R Soc N Z 2019. [DOI: 10.1080/03036758.2019.1659379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Suzanne Pitama
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tania Huria
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Maira Patu
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Tim J. Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
10
|
Maggio LA, Thomas A, Chen HC, Ioannidis JPA, Kanter SL, Norton C, Tannery NH, Artino AR. Examining the readiness of best evidence in medical education guides for integration into educational practice: A meta-synthesis. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:292-301. [PMID: 30229529 PMCID: PMC6191397 DOI: 10.1007/s40037-018-0450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND To support evidence-informed education, health professions education (HPE) stakeholders encourage the creation and use of knowledge syntheses or reviews. However, it is unclear if these knowledge syntheses are ready for translation into educational practice. Without understanding the readiness, defined by three criteria-quality, accessibility and relevance-we risk translating weak evidence into practice and/or providing information that is not useful to educators. METHODS A librarian searched Web of Science for knowledge syntheses, specifically Best Evidence in Medical Education (BEME) Guides. This meta-synthesis focuses on BEME Guides because of their explicit goal to inform educational practice and policy. Two authors extracted data from all Guides, guided by the 25-item STructured apprOach to the Reporting In healthcare education of Evidence Synthesis (STORIES). RESULTS Forty-two Guides published in Medical Teacher between 1999 and 2017 were analyzed. No Guide met all STORIES criteria, but all included structured summaries and most described their literature search (n = 39) and study inclusion/exclusion (n = 40) procedures. Eleven Guides reported the presence of theory and/or educational principles, and eight consulted with external subject matter experts. Accessibility to each Guide's full-text and supplemental materials was variable. DISCUSSION For a subset of HPE knowledge syntheses, BEME Guides, this meta-synthesis identifies factors that support readiness and indicates potential areas of improvement, such as consistent access to Guides and inclusion of external subject matter experts on the review team. This analysis is useful for understanding the current readiness of HPE knowledge syntheses and informing future reviews to evolve so they can catalyze translation of evidence into educational practice.
Collapse
Affiliation(s)
- Lauren A Maggio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - H Carrie Chen
- Georgetown University School of Medicine, Washington, DC, USA
| | - John P A Ioannidis
- School of Medicine and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Steven L Kanter
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | | | - Anthony R Artino
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
11
|
Kelly M, Ellaway RH, Reid H, Ganshorn H, Yardley S, Bennett D, Dornan T. Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:833-851. [PMID: 29761255 DOI: 10.1007/s10459-018-9829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/07/2018] [Indexed: 06/08/2023]
Abstract
Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity.
Collapse
Affiliation(s)
- Martina Kelly
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
| | - Rachel H Ellaway
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
| | - Helen Reid
- Queen's University, Belfast, Northern Ireland, UK
| | - Heather Ganshorn
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
- Engineering and Science, University of Calgary, Calgary, Canada
| | - Sarah Yardley
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Tim Dornan
- Queen's University, Belfast, Northern Ireland, UK
| |
Collapse
|
12
|
Somporn P, Ash J, Walters L. Stakeholder views of rural community-based medical education: a narrative review of the international literature. MEDICAL EDUCATION 2018; 52:791-802. [PMID: 29603320 DOI: 10.1111/medu.13580] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/02/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. OBJECTIVES The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. METHODS This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. RESULTS Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. CONCLUSIONS Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.
Collapse
Affiliation(s)
- Praphun Somporn
- Hatyai Medical Education Centre, Hatyai Hospital, Hat Yai, Songkhla, Thailand
| | - Julie Ash
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
| |
Collapse
|
13
|
Phillips JP, Wendling AL, Fahey CA, Mavis BE. The Effect of a Community-Based Medical School on the State and Local Physician Workforce. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:306-313. [PMID: 28678097 DOI: 10.1097/acm.0000000000001823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess the effect of community-based medical education as implemented by Michigan State University College of Human Medicine (MSU-CHM), which has immersed students in diverse communities across Michigan since its founding, on the physician workforce in the six communities in which clinical campuses were initially established. METHOD The authors used American Medical Association Masterfile data from 2011 to obtain practice locations and specialty data for all MSU-CHM graduates from 1972 through 2006. They classified physicians as either practicing primary care or practicing in a high-need specialty. Using Geographic Information Systems software, the authors geocoded practice locations to the ZIP Code level, evaluated whether the practice was within a Health Professional Shortage Area, and determined rurality, using 2006 Rural-Urban Commuting Area Code data. They visually compared maps of the footprints of each campus to glean insights. RESULTS The authors analyzed 3,107 of 3,309 graduates (94%). Of these, 635 (20%) practiced within 50 miles of their medical school campus. Saginaw and Flint graduates were more likely to practice in Detroit and its surrounding suburbs, reflecting these communities' urban character. Grand Rapids, the community with the strongest tertiary medical care focus, had the lowest proportions of rural and high-need specialty graduates. CONCLUSIONS This case study suggests that distributed medical education campuses can have a significant effect on the long-term regional physician workforce. Students' long-term practice choices may also reflect the patient populations and specialty patterns of the communities where they learn.
Collapse
Affiliation(s)
- Julie P Phillips
- J.P. Phillips is associate professor of family medicine and assistant dean, Student Career and Professional Development, Michigan State University College of Human Medicine, East Lansing, Michigan; ORCID: http://orcid.org/0000-0001-5566-2384. A.L. Wendling is associate professor of family medicine and director, Rural Health Curriculum, Michigan State University College of Human Medicine, East Lansing, Michigan; ORCID: http://orcid.org/0000-0001-5136-6465. C.A. Fahey was, at the time of this study, geographic information science support and research analyst, Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, and is now graduate student, Division of Epidemiology, University of California Berkeley, Berkeley, California; ORCID: http://orcid.org/0000-0001-9865-2397. B.E. Mavis is professor and director, Learning Societies and Faculty Academy, Office of Medical Education Research and Development, Michigan State University College of Human Medicine, East Lansing, Michigan; ORCID: http://orcid.org/0000-0003-2145-3634
| | | | | | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Sholl S, Ajjawi R, Allbutt H, Butler J, Jindal-Snape D, Morrison J, Rees C. Balancing health care education and patient care in the UK workplace: a realist synthesis. MEDICAL EDUCATION 2017; 51:787-801. [PMID: 28429527 DOI: 10.1111/medu.13290] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/11/2016] [Accepted: 01/19/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODS We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTS The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. CONCLUSION Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
Collapse
Affiliation(s)
- Sarah Sholl
- Business School, Edinburgh Napier University, Edinburgh, UK
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Burwood, Vic., Australia
| | - Helen Allbutt
- Planning and Corporate Governance, NHS Education for Scotland, Edinburgh, UK
| | - Jane Butler
- Health Education England - Kent, Surrey and Sussex, Crawley, UK
| | | | - Jill Morrison
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, HealthPEER (Health Professions Education and Education Research), Monash University, Clayton, Vic., Australia
| |
Collapse
|
16
|
Vyas A, Rodrigues VC, Ayres R, Myles PR, Hothersall EJ, Thomas H. Public health matters: Innovative approaches for engaging medical students. MEDICAL TEACHER 2017; 39:402-408. [PMID: 28379091 DOI: 10.1080/0142159x.2017.1294753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern. METHODS We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline. RESULTS Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level. CONCLUSIONS The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student-teacher interface.
Collapse
Affiliation(s)
- A Vyas
- a Public Health , Norwich Medical School, University of East Anglia , Norwich , UK
| | - V C Rodrigues
- b Public Health and Medical Education , Norwich Medical School, University of East Anglia , Norwich , UK
| | - R Ayres
- c Population Health , Plymouth Peninsula Schools of Medicine and Dentistry , Plymouth , UK
| | - P R Myles
- d Health Protection and Epidemiology, Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - E J Hothersall
- e Public Health Medicine, Systems in Practice Convenor , Dundee Medical School and NHS Tayside , Dundee , UK
| | - H Thomas
- f Public Health and Primary Care , St George's, University of London , London , UK
| |
Collapse
|
17
|
Boelen C, Pearson D, Kaufman A, Rourke J, Woollard R, Marsh DC, Gibbs T. Producing a socially accountable medical school: AMEE Guide No. 109. MEDICAL TEACHER 2016; 38:1078-1091. [PMID: 27608933 DOI: 10.1080/0142159x.2016.1219029] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the "Social Accountability of Medical Schools" - a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve. Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.
Collapse
Affiliation(s)
| | | | | | - James Rourke
- d Memorial University of Newfoundland , St. John's , NL , Canada
| | | | - David C Marsh
- f Northern Ontario School of Medicine , Sudbury , ON , Canada
| | | |
Collapse
|