International Journal of Medical Education最新文献

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.

Objectives: This study aimed to enhance the learning experience among medical students by empowering them to co-create learning tools and classroom activities.

Methods: A cross-sectional study was conducted with 10 participants from Year 2 of the new curriculum volunteering to participate in this study. Five were selected based on their diversities and empowered to design learning tools and class activities. Student satisfaction was presented as mean scores. A comparison of self-confidence scores in subjects learned before and after the class was analyzed using the paired t-test. Comparisons of multiple-choice question (MCQ) scores before and after the class between Years 2 (n = 96) and Year 3 of the previous curriculum attending inclass teaching (n = 98) were analyzed using the independent sample t-test.

Results: A high level of satisfaction (M=87.5, SD=15.7%) and significant improvements in student self-confidence in subjects learned between before (M=46.4, SD=20.8%) and after (M=82.7, SD=16.9%) the class were noted (t ₍₂₂₃₎ = -23.73, p<.001). Additionally, Year 2 students achieved significantly higher MCQ scores after the class (M=85.6, SD=19.0%) compared with the scores from Year 3 (M=77.3, SD=23.6%) (t ₍₁₉₀₎ = 3.32, p<.001).

Conclusions: Empowering medical students to co-create learning tools and class activities could positively enhance their learning experience. The result of this study addressed the importance of student empowerment with well-designed student-centered learning strategies based on their learning environment. Additional qualitative research is required to better understanding the "why" and "how" behind the findings of this study.

Objectives: We aimed to explore healthcare students' intercultural sensitivity profiles and their relationship with empathy to develop effective education methods that promote non-discriminatory patient care.

Methods: We conducted a cross-sectional questionnaire study, involving a total of 508 international (n= 100) and local (n= 408) healthcare students in Hungary by convenience sampling. The survey included demographics, the Intercultural Sensitivity Scale, and the Interpersonal Reactivity Index. We applied latent profile analysis to identify distinct sensitivity profiles and used multinomial logistic regression to estimate the predictive power of several background variables on profile group membership.

Results: A four-profile solution emerged: "Interculturally average" (n= 241), "Interculturally uncertain" (n= 76), "Interculturally sensitive" (n= 132), and "Interculturally refusing" (n= 54). The model (R²= 0.123; p= 0.001) revealed that psychology major tended to predict "uncertain" group membership (OR= 0.56, p= 0.08) and higher personal distress was a significant predictor of this group (OR=1.11, p= 0.002). Male gender (OR= 3.03, p= 0.001), medicine major (OR= 5.49, p= 0.01), lower perspective-taking (OR= 0.91, p= 0.007) and higher personal distress (OR= 1.09, p= 0.028) were identified as predictors of "refusing" group membership, compared to the "average" group.

Conclusions: By exploring the ways students experience intercultural situations, a more personalized medical education can be developed with a special focus on vulnerable subgroups. For the "uncertain" group, the focus should be more on developing confidence, and intercultural experiences, whereas in the "refusing" group on strengthening empathy. In general, it can be useful to create mixed-gender, multidisciplinary, and intercultural learning environments.