International Journal of Medical Education最新文献

Objectives: This study aimed to elucidate, through qualitative analysis, the cognitive processes by which experienced oncology nurses regulate their emotions when facing anxiety and emotional conflict in communication with patients.

Methods: We employed a qualitative exploratory design using semi-structured individual interviews with six certified oncology nurses in Japan. Participants were recruited via snowball sampling and provided written informed consent. Interviews were conducted in Japanese using a pre-tested interview guide; audio data were transcribed verbatim. Data were analyzed with the Steps for Coding and Theorization (SCAT) method. Metacognitive theory-distinguishing metacognitive knowledge and metacognitive regulation-guided interpretation of the findings.

Results: Analysis of 38 theoretical descriptions yielded two overarching themes: (1) anxiety and conflict in communication with cancer patients, and (2) metacognitive emotion-regulation strategies. The latter comprised two subthemes: (a) patient-oriented cognitive strategies (e.g., linguistic adjustments, trust-building, facilitating patients' self-regulation), and (b) self-oriented cognitive restructuring (e.g., reframing dilemmas, monitoring and modulating one's own emotional responses). These processes reflected deliberate monitoring and regulation of thinking and feelings to sustain constructive engagement with patients.

Conclusions: Experienced oncology nurses use metacognition to recognize, interpret, and flexibly regulate emotions in challenging interpersonal situations. Educational implications include integrating structured metacognitive reflection alongside empathy and mindfulness training to cultivate durable, transferable coping skills. Future studies should examine this approach in diverse clinical contexts, include larger and cross-cultural samples, and evaluate longer-term outcomes in nurses' emotional resilience and clinical practice.

Objectives: This study aims to explore the preparedness of faculty in health professions education at three Malaysian universities by assessing their perceptions of basic concepts in microlearning as well as factors affecting effective content construction and digital format preferences.

Methods: An explanatory sequential mixed-method approach was used to systematically analyse faculty perceptions by integrating quantitative and qualitative findings. A total of 121 faculty members voluntarily completed the online survey. A qualitative exploratory study was conducted with 20 selected staff members, followed by a thematic analysis. Descriptive and analytical statistics, including Pearson's chi-square test, were used to analyse the data.

Results: The survey revealed that 95.9% (n=116) of faculty members agreed that microlearning is ideal for the acquisition of microcontent with single learning outcomes. The optimal duration should be between 3 and 5 minutes. Strong associations [χ²(16, N=121) =33.17, p=0.007] between time duration and content size and content size and form of knowledge [χ²(16, N=121) =28.79, p=0.025] were observed in chi-square goodness-of-fit test. Microcontent of a single learning outcome, chunking of content, cognitive load, and degree to which topic connects with the media used emerged as primary sub-themes. Challenges in adapting skills to construct engaging microlearning content were highlighted.

Conclusions: The study provides a microlearning framework for health professional educators to consider the complexity of content, its format, and integration with suitable digital tools. Future research should explore how combinations of microlearning and other instructional formats optimise learning outcomes.

Objectives: To address the problem of medical school applicants' lying about their reasons for becoming physicians in the admissions process, this study aims to explore the grounds for their reasons by distinguishing between their beliefs and statements.

Methods: The participants, recruited by convenience sampling, were 15 medical students and physicians who had entered graduate-entry programs of medical schools in Japan. We conducted individual semi-structured online interviews in 2020 and performed a reflexive thematic analysis.

Results: We generated five themes regarding the grounds for applicants' reasons in their beliefs: consistency with past interests, experience of being underprivileged, experience of family disease, parental influence, and no grounds; four themes regarding the grounds for applicants' true reasons in their statements: consistency with actual past interests, actual experience of being underprivileged, actual experience of family disease, and actual experience of being powerless for patients; and four themes regarding the grounds for applicants' untrue reasons in their statements: consistency with actual or fictional past interests, actual experience of family disease, fictional parental influence, and convenient origin.

Conclusions: This study is the first to distinguish between applicants' beliefs and statements and analyze the grounds for their reasons for becoming physicians. The findings propose a reconstruction of the concept of reasons for becoming physicians and suggest that admissions committees may be able to verify applicants' reasons in their statements by asking them to present the grounds for them.

Objectives: This study aimed to develop a reliable and valid scale to assess nurses' information ethics behavior, facilitating self-reflection and supporting the application of ethical principles in clinical settings involving digital information management.

Methods: A scale development study with exploratory factor analysis was conducted in 2023, targeting 1,464 hospital-based and home-visit nurses across Japan. Participants completed a preliminary version of the Information Ethics Behavior Evaluation Scale for Nurses along with demographic questions. Item analysis and exploratory factor analysis (EFA) using the alpha factor extraction method and promax rotation were performed. Criterion-related validity was assessed via Spearman's rank-order correlation with the Self-Evaluation Scale for Ethical Behavior as a Nurse.

Results: Valid responses were obtained from 427 participants. Item analysis led to the exclusion of 14 items due to low factor loadings or double loading. EFA identified a three-factor structure comprising 21 items: (1) conscious behavior in handling information, (2) appropriate information management, and (3) response to information leakage risk. The scale demonstrated strong internal consistency (Cronbach's α = .86). Criterion-related validity was supported by a significant correlation with the external measure (r_s = .74, p < .001).

Conclusions: The Information Ethics Behavior Evaluation Scale for Nurses is a brief, reliable, and valid tool for assessing ethical conduct related to information handling in nursing practice. It provides a framework for ethical self-assessment and may contribute to the prevention of information breaches and the promotion of ethical decision-making. Further research should investigate the integration of digital literacy and internet-specific ethical competencies.

Objectives: This study investigated the perspectives of residents on training in error managing. The research question was: how do residents perceive and experience their training in handling errors in clinical practice?

Methods: The study used a qualitative exploratory design to gain insight into the residents' experiences. The data consisted in seven virtual focus groups with 22 Danish residents from 11 specialties at various educational levels, i.e. from first to fourth year of their training. The data were transcribed and analyzed using reflexive thematic analysis.

Results: The analysis showed three themes: 1) formal education, 2) culture and clinical context, and 3) the need for more training. The residents reported learning primarily about the legal aspects of errors, complaints, and the adverse events reporting system. They emphasized the need for practical training in error disclosure and managing emotional reactions to errors. Training in error managing was described as sporadic in specialist training, often contingent on departmental culture and individual supervisors.

Conclusion: The study revealed that residents perceive their training in error handling as inadequate, particularly in terms of disclosure, emotional reactions, and victim support, and identified the need for greater emphasis on these aspects in both undergraduate education and postgraduate training. The Danish framework for physician roles and specialist training curricula should be revised and a more open culture regarding medical errors fostered. Furthermore, supervisor training is crucial as training in error management should be integrated into the clinical setting where errors occur.

Objectives: This quasi-experimental study evaluated the impact of simulation-based emergency training on novice critical care nurses' knowledge, skills, and confidence compared to traditional clinical teaching, aiming to enhance their preparedness for high-pressure emergency scenarios.

Methods: A pretest-posttest non-equivalent control group design was conducted in a Taiwan medical center's critical care unit from October 2023 to January 2024. Sixty-seven nurses with less than two years of experience were recruited via convenience sampling and assigned to an experimental group (n=32, simulation-based training) or a control group (n=35, traditional teaching). The experimental group underwent an OSCE-based intervention with three stations. Data were collected using the Nursing Competency Questionnaire, OSCE scoring rubric, and Learning Satisfaction Scale. Paired and independent t-tests with effect sizes (Cohen's d) were used for analysis.

Results: The simulation group showed significant improvements in skills (t₍₃₁₎ = 1.92, p = .016, d = .34) and confidence (t₍₃₁₎ = 2.92, p = .004, d = .40); the traditional group improved in confidence only (t₍₃₄₎ = 2.24, p = .027, d = .33). No significant between-group differences were found (e.g., skills: t₍₆₅₎ = 1.29, p = .201, d = .33).

Conclusions: Simulation-based training effectively enhances skills and confidence in novice critical care nurses, complementing traditional methods. Integrating both approaches can optimize training outcomes, improving patient safety and nurse retention in medical education. These findings advocate for incorporating simulation into nursing curricula to better prepare novice nurses for emergency care. Future research should explore multi-center studies with objective measures.

Objectives: This study aims to enhance our understanding of how educational supervision operates from the perspective of medical residents, and how they engage with it within the context of implementing competency-based medical education.

Methods: We conducted a qualitative research study following the principles of grounded theory methodology. Participants were recruited from national residency training courses. Data was collected using an electronically distributed questionnaire with open-ended questions, which invited respondents to share their experiences with educational supervision. 96 written narrative responses were applicable for analysis.

Results: We identified three categories indicative of residents' experiences with educational supervision: I) Access to educational supervision, II) Links between quality of educational supervision and organisational facilitation, and III) Pushbacks to educational supervision and how residents cope with pushbacks. Residents' experiences varied significantly. When educational supervision was well-organised and available, residents managed to express how educational supervision enhanced their education. However, many residents struggled to access educational supervision (ES). Conclusion: When educational supervision is integrated into clinical practice, residents perceive its benefit to their education. Conversely, inadequate organisation of educational supervision forces residents to expend significant effort to ensure meetings occur. Amidst the implementation of competency-based medical education, residents risk being left with the individual responsibility to initiate and sustain educational supervision, which in turn places an undue burden on trainees to navigate repeated pushbacks, and workplace cultures that devalues educational support. Further research is needed to explore the affordances relevant for different medical specialties, and observational studies are much needed as a complement to self-reported data.

Objectives: To explore how clinical instructors in emergency medicine perceive and integrate Entrustable Professional Activities (EPAs) into their teaching practices, identify challenges they face, and explore the support required for effective implementation.

Methods: This study utilized grounded theory methodology to explore the pedagogical experiences of clinical instructors within emergency medicine. A qualitative approach was adopted, involving semi-structured interviews with participants recruited through purposive and snowball sampling techniques. A total of 18 emergency physicians, each with over five years of clinical teaching experience in a teaching hospital, were included in the study.

Results: The study revealed several critical insights: (a) Emergency medicine clinical instructors are integral in supervising, training, and providing feedback to residents, facilitating their development. (b) The implementation of EPAs is hindered by limited resources, time constraints, and the challenges of delivering real-time feedback. Instructors often experience a lack of confidence in their teaching efficacy, observe diminished motivation among residents, and encounter difficulties in assessing residents' soft skills. (c) The effective implementation of EPAs necessitates a supportive educational environment, a robust reward system, and objective feedback mechanisms. (d) Instructors derive a significant sense of fulfillment from witnessing the progression of residents into competent and autonomous practitioners, underscoring the importance of empowering educators through enhanced training and institutional support.

Conclusions: The findings offer valuable insights for developing of emergency medical education programs and underscore the need for targeted strategies to enhance the quality of clinical instruction in emergency settings.