International Journal of Medical Education最新文献

Objectives: This study aims at evaluating the role of Monash Online Simulated Clinical Examination (MONSCE, where students demonstrate their clinical consultation, problem solving and counselling skills in a virtual encounter) in relation to the Observed Structured Clinical Examination (OSCE).  The study addresses feasibility and application, student, tutor and Simulated Patient (SP) acceptance and also assessing future role in student assessment.

Methods: Drawing on social constructivism, the study employed a qualitative methodology to explore perspectives of medical students, examiners and SPs across metropolitan Melbourne, rural Victoria and Malaysia. Data included individual interviews with nine examiners, eleven SPs, and three focus groups with students. Data were transcribed and thematically analysed using framework analysis.

Results: Analysis demonstrated overlapping perspectives with five themes - fit for purpose assessment, focus on dynamics of online discourse, perceiving realism, readiness for practice and implications for future, with ongoing role in Telehealth. Readiness or preparation for practice was acknowledged through impact on student performance for progression, examiners' focus on assessment rigour replicating chaos and complexity of real life and SPs drew analogy with real-life clinical consultations.

Conclusions: MONSCE assessments appear to be useful for student assessment of skills like history taking and clinical counselling. Their role was considered complementary to in-person clinical skills assessment but not replace the complexity of real life or replicate skills assessment of empathy, physical examination, and difficult communication, where in-person assessment may be preferred.

Objectives: To cross-culturally validate the Feedback Orientation Scale in the clinical workplace, focusing on the Spanish adaptation of the instrument in the Chilean context.

Methods: A cross-cultural validation of the Feedback Orientation Scale was conducted across six Chilean universities and nine health professions education programs. The target population were students in their clinical clerkship. The scale was translated through a rigorous process and was applied online. Validity and reliability of the constructs were evaluated through confirmatory factor analysis. A descriptive statistical analysis was conducted.

Results: A total of 510 students participated (70% female, average age 24.1 years, 30% response rate). Students' responses were from Medicine (n=128), Physiotherapy (n=128), Nursing (n=63), Dentistry (n=49), and five other disciplines. Confirmatory factor analysis showed a sufficient fit of the original factor structure CFI = 0.96, SRMR = 0.045, RMSEA = 0.051, 90% CI [0.044, 0.057]. Item loadings were above 0.50. Factor reliability ranged from 0.77 to 0.91. Overall, students' perception of receptivity to feedback was positive, and the Feedback Self-efficacy subscale had the most "disagree" and "strongly disagree" responses.

Conclusions: Our findings provide evidence regarding the validity and reliability of the Feedback Orientation Scale for assessing the feedback orientation of health profession education students in the clinical workplace. Students scored lowest on two items related to feedback self-efficacy, indicating low confidence in handling feedback. This Feedback Orientation Scale can reveal valuable insights into how students may differ in their receptivity and use of feedback in the clinical workplace, informing teaching practices and interventions, and redesigning existing feedback practices.

Objectives: The aim of this study was to create a new integrated competency framework for the postgraduate training in obstetrics and gynaecology and to reach consensus through a Delphi study.

Methods: Using the Canadian Medical Education Directives for Specialists (CanMEDS) framework as a basis, three existing frameworks were merged by screening for keywords. Subsequently, consensus on the unified framework was reached through a Delphi study: a group of 18 Belgian experts was asked for their opinions on the competencies through three successive questionnaires.

Results: In the first round, one of the in total 91 competencies was deemed irrelevant. In the second round, the competencies were reviewed for content and formulation, after which consensus was not reached on 15 competencies. These 15 competencies were adjusted as needed based on comments collected during the first two rounds. The adjusted competencies were then sent back to the experts in the third round, resulting in a final consensus on all 91 competencies. However, the comments indicated that several competencies were considered broad or vague, casting doubt on their practical applicability.

Conclusions: Through a Delphi study, consensus was reached on a newly composed competency framework. Such a holistic competency framework can form the basis of a curriculum reform in the postgraduate training in obstetrics and gynaecology within Belgium, but also in a more international context. Further research is needed to develop an assessment tool to implement these competencies in practice.

Objectives: This study was aimed at improving clarity regarding the goals underlying motivation for attendance at international meetings to accommodate evolving needs.

Methods: We performed a case study of a large international medical conference by undertaking (a) semi-structured interviews with 13 multi-disciplinary stakeholders, which underwent thematic analysis, and (b) surveys of 1229 conference attendees, which underwent descriptive statistical analysis and directed content analysis.

Results: Interviews suggested scientific updates and networking are priorities for in-person formats whereas flexibility and reduced travel are priorities for virtual formats. Surveys suggested motivations for attending both in-person and virtual conferences included: scientific updates (81.3% and 85.4%, respectively) and advancements in patient care (76.6%, 78.2%). Social interaction (e.g., to meet experts 80.6% and make/deepen professional connections 69.3%) was highly rated for in-person meetings, but not virtual meetings (51.0% and 30.8%, respectively). 58.9% of attendees prefer future meetings to be hybrid, including both in-person and virtual formats.

Conclusions: We found a disconnect between attendees' preferences and recommendations currently put forward as socially responsible in terms of climate, equity and diversity. Meeting organisers may need to educate others about the value and costs involved in hybrid formats. When hybrid formats are possible, our data provide guidance on what to prioritize during in-person components and how to combine those with the benefits of global accessibility and flexibility enabled by virtual technology.

Objectives: We aimed to determine if shared decision-making (SDM) self-assessment of a standardized patient (SP) scenario was reliable, specifically whether students' communication resulted in each SP-student pair reporting internally consistent final treatment choices. We hypothesized student self-assessment would differ from SP and faculty assessment indicating a need for multisource feedback.

Methods: In this observational case study from 2016-2017, all third-year post-clerkship medical students received evidence-based treatment options for sinusitis and SDM lectures followed by a SP encounter on sinusitis. Students, faculty, and SPs then completed a 9-question assessment covering SDM skills, perceived empathy, and final treatment choice. Mean self-assessment was compared to faculty and SP scores using paired t-test. Effectiveness of SDM communication was assessed as rate of treatment agreement, defined as percent of student-SP pairs reporting consistent final treatment choices.

Results: Compared to SPs (M = 23.4, SD = 3.6), 120 students (M = 22.6, SD = 3.1) reported lower mean SDM skills, t₍₁₁₉₎ = 2.25, p = .027. Conversely, SPs (M = 8.0, SD = 1.5) compared to students (M = 8.5, SD = 1.1) reported lower mean empathy, t₍₁₁₉₎ = 3.43, p < .001.  Faculty ratings of students' SDM (M = 22.7, SD = 3.5) and empathy (M = 8.3, SD = 1.7) was not statistically different than students' ratings, t₍₁₁₉₎ = 0.46, p = .645 and t₍₁₁₉₎ = 1.40, p = .164 respectively. Seventeen (14%) student-SP pairs reported different final treatment choices.

Conclusions: We demonstrated the limitations of self-perception of SDM and empathy skills, highlighting the importance of multisource feedback for assessing trainee communication skills. Disagreement between student-SP pairs on perceived final treatment choice underscores the need for ongoing SDM practice.

Objectives: To explore association between perceived stress and psychological distress (depressive symptoms and anxiety), and the stress-buffering effects of social support (parents, partners, friends, peers, teachers, social media), sense of community belonging and meaningfulness of studying.

Methods: A cross-sectional study was conducted in 2018 using a convenience sample of 800 healthcare students from the University of Helsinki, Finland. Participants completed an online survey. Logistic regression analyses were performed using the PROCESS Macro to explore the relationship between perceived stress and psychological distress, and the moderator effects.

Results: Perceived stress was associated with depressive symptoms and anxiety. Perceived stress had significant interactions with parent (B =-.03, t₍₇₈₃₎ = -2.4, p < .001), partner (B = -.05, t₍₇₈₃₎ = -4.3, p < .001) and peer support (B=-.04, t₍₇₈₃₎ = -3.0, p < .001), sense of community belonging (B=-.06, t₍₇₈₃₎ = -2.7, p < .01) and meaningfulness of studying (B=-.12, t₍₇₈₃₎ = -4.5, p < .001) in predicting depressive symptoms, and with parent (B = -.05, t₍₇₈₃₎= -3.8, p < .001), partner (B = -.03, t₍₇₈₃₎ = -2.2, p < .05) and peer support (B=-.05, t₍₇₈₃₎ =-3.5, p < .001), sense of community belonging (B=-.05, t₍₇₈₃₎=-2.5, p < .01) and meaningfulness of studying (B = -.08, t₍₇₈₃₎ = -3.0, p < .01) in predicting anxiety. Perceived stress had weaker effects on depressive symptoms and anxiety at higher levels of support, sense of community belonging and meaningfulness of studying.

Conclusions: Support from parents, romantic partners and peers, sense of community belonging and meaningfulness of studying may buffer the negative psychological outcomes of perceived stress. Promoting social support, sense of community and the meaningfulness of studying can help prevent psychological distress in healthcare students. Longitudinal research and further investigation on factors related to sense of community belonging and meaningfulness of studying are warranted.

Objectives:  The purposes of this study were to identify reflective processes from patients' points of view for difficult patient-doctor interactions and learn how the processes made medical students and residents aware of their own medical practice.  These processes were compared in two countries (US and Japan).

Methods:  The study was a descriptive qualitative study utilizing semi-structured interviews.  Participants were from US and Japan.  We analyzed the data using reflective thematic analysis of the implementation of reflections (from a patient's point of view) into medical clinical education and training from a constructivism paradigm.

Results:  We included twenty participants each from US and Japan by convenience sampling.  The participants were medical students during clinical clerkship and post graduate year-1, 2, and 3 medical residents.  Medical students and residents realized four cognitions (different expectations of patients and doctors, language communication barrier, time restriction and healthcare system challenges) from reflections from patients' perspectives.  Subsequently, medical students and residents identified three types of awareness (appropriate communication, empathy, and patient-doctor relationship of trust).  During these reflections from patients' perspectives, the medical students and residents had a willingness to change future behavior.

Conclusions:  This study revealed one aspect of medical students' and residents' cognitions and awareness of clinical experiences through reflection from patients' perspectives.  This cognitive process aligns the ideas of medical students and residents more closely with the patients' perceptions and influences their willingness to change their behavior. This process enables comprehensive realization in person-centered care.

Objectives: The aim of this study was to confirm and evaluate the learning effect of a physician-facing e-learning course on genetic medicine for improving genomic literacy.

Methods: We employed qualitative and quantitative methodology to survey 103 physicians who took the course at a national university in Japan. Evaluations were conducted at the levels of participant feedback, learning, and behaviour. Participants completed a questionnaire and test (full score = 100) before and after the course. Pre- and post-test scores were compared using paired-samples t-tests and Mann-Whitney U test was used to compare the difference their clinical experience. The effect size was estimated using Cohen's d.

Results: Responses were obtained from 96 physicians. Approximately 80% (n = 75-93) of participants responded positively to the course, a result supported by the qualitative data. The mean scores for the pre- and post-test showed an increase from 71.25 to 74.58 (p=0.008). In particular, mean test scores increased significantly from 68.94 to 75.53 (p<0.001) in physicians with no clinical experience in genetic medicine, while no significance was observed scores for physicians with clinical experience in genetics from 73.47 to 73.67 (p=0.903). Behavioural assessment was carried out for 28 participants; however, no statistically significant differences were identified.

Conclusions: Our findings indicate that our e-learning course was useful for physicians with no experience of genetic medicine. For those with experience, it may be necessary to provide more practice-based education and educational methodologies. Behavioural assessment needs to be examined further.

Objectives: To explore how mentors perceive and perform their role in a longitudinal mentorship programme with the objective of guiding medical students in becoming reflective learners.

Methods: A qualitative exploratory study was conducted using semi-structured interviews with 16 mentors from the Ghent University medical education mentoring programme. Participants were selected by purposeful sampling on gender, years of experience and area of specialisation. Interview transcripts were analysed using inductive thematic analysis. Afterwards, all transcripts were re-analysed combining the resulting themes to identify different mentoring profiles.

Results: Our analysis yielded three themes. First, the basic conditions for mentorship showed wide differences in competencies that mentors considered necessary. Second, goals and purposes of mentoring identified roles ranging from ombudsperson, confidential advisor, role model to guide towards professional and personal growth. Third, attitudes to the mentoring programme revealed a wide variation from fully embracing to rejecting the reflective method. Further analysis led to three mentor profiles: reflective, sharing and advising. Even reflective mentors struggled in varying degrees with applying the guidelines, mostly depending on prior experience with reflection. Advising mentors found the intervision techniques too constrictive and expressed doubts about the usefulness of the programme.

Conclusions: In this reflection-based mentoring programme, different mentor perceptions strongly determined how reflection is being taught to medical students. This may affect the students' professional identity formation. Training should enable mentors to reflect on their beliefs and mentoring style. Further research is needed on the effects of reflection in mentoring and on mentor selection.