International Journal of Medical Education最新文献

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.

Objectives: This study explored the nature of the supervisory relationship between international medical graduates (IMGs) on temporary practice license and their supervisors, including perceptions of the roles and expectations of IMG supervisors in Canada.

Methods: A qualitative phenomenological study comprising six focus group interviews was undertaken. A purposive sample of study participants was recruited via e-mail, and twenty-one supervisors and IMGs on temporary licensure practicing in British Columbia, Canada participated. Focus groups were recorded and transcribed verbatim, and data were analyzed using thematic analysis.

Results: Key themes occurring from the focus groups included the Role of Supervisor, Supervisor Interaction, Supervisor Background, Benefits of Supervision, and Supervisor vs Mentor. The supervisor's role was perceived as necessary in supporting the IMG with adjusting, transitioning, and navigating medical practice in Canada. Access and availability of the supervisor were critical, while supervisors with IMG backgrounds were more empathetic to supervisees' needs. Having mentors, in addition to one's supervisor, was seen as valuable in helping with personal and professional adjustments to life in a new country and a novel medical system.

Conclusions: Supervisors and IMGs felt the supervisory process was beneficial, but could be enhanced to support IMGs' transition better. Supervisor availability and contact were important to foster engagement throughout the supervisory relationship. Supervisor training was essential to prepare for the supervisory role, and combined supervision and mentorship programs were considered helpful for IMGs as they adjusted to their new practices and life in a new country.

Objectives: To develop a Japanese version of the capacity for wonder Scale (J-CfWS) and to examine its psychometric properties.

Methods: An anonymous online self-administered questionnaire was distributed to medical undergraduates in three universities in Japan. We assessed the structural (factor analysis and model fitness test (comparative fit index, root mean square error of approximation, and standardized root mean square residual)) and convergent validity and internal consistency reliability of the scale.

Results: 384 participants were included in the analysis. We employed a split-half validation approach, with exploratory factor analysis (EFA) on one half and confirmatory factor analysis (CFA) on the other. EFA led to a 9-item scale with a three-factor structure. CFA supported this three-factor structure with good model fitness indices (comparative fit index = 0.986, root mean square error of approximation = 0.036, and standardized root mean square residual = 0.036). The Pearson correlation coefficient between J-CfWS total scores and the Epistemic Curiosity Scale total scores was significant, r(382) = .60, p< .001, indicating a positive correlation between the two variables. The internal consistency reliability was good, with an overall Cronbach' alpha of 0.82.

Conclusions: The J-CfWS was developed. We confirmed its psychometric properties. It will be useful in assessing the impact of curricula aimed at cultivating CfW among medical trainees (e.g. arts and humanities courses). It can also be useful to researchers who wish to verify the association between CfW and other concepts.

Objectives: This study aimed to develop and validate entrustable professional activities (EPAs) for the nephrology fellowship program in Saudi Arabia.

Methods: This study utilized a two-round modified Delphi design involving nephrology consultants across Saudi Arabia. The initial list of 39 EPAs was created through a literature review and expert input, followed by a piloting process that refined these activities based on feedback. A target sample of 26 nephrology consultants was invited, achieving an 80% response rate in the first round with 21 participants. Descriptive statistics, including means and percentages, summarized demographic characteristics and group responses. Participants rated the relevance of each EPA using a 5-point Likert scale. Consensus was defined as at least 75% agreement among participants, which guided the refinement of EPAs across the Delphi rounds. The study was approved by the institutional review board at Umm Al-Qura University, Makkah, Saudi Arabia.

Results: In the first round, consensus was achieved for 34 EPAs, while 5 were excluded for lack of relevance and 6 were modified. The second round confirmed full consensus on the revised 34 EPAs, with an 81% response rate among the 21 experts.

Conclusions: This study successfully developed and validated EPAs for the nephrology fellowship program in Saudi Arabia. Implementing these EPAs is expected to enhance training, assessment, and clinical competence for nephrology fellows. Future studies should explore the long-term impact of these EPAs on training outcomes and consider adapting them for other specialties.