Medical Education最新文献

Background: Rural areas house nearly half the global population yet face a significant shortage of skilled health professionals, exacerbating health inequities. Short-term rural immersion programs offer a cost-effective approach to exposing health professional students to the unique challenges of rural healthcare. Transformative learning theory is well suited to examining how these programs foster critical reflection and perspective shifts in students.

Objectives: To explore the potentially transformative impact of short-term (<6 weeks) rural immersion programs on health professional students through the lens of transformative learning theory.

Methods: This review synthesised findings from various studies on the impact of rural immersion programs. Comprehensive searches were conducted across multiple databases, identifying 17 studies published between 2001 and 2024. Data extraction and thematic synthesis were guided by Mezirow's transformative learning framework, identifying key patterns and insights through an iterative process.

Results: Rural immersion programs deepen students' understanding of the unique health needs of rural and remote communities. These experiences promote personal and professional growth, enhance critical thinking, problem-solving abilities, cultural competence and social accountability and foster a commitment to serving underserved populations. The collaborative role of the community, student cohort and academic staff in facilitating transformative learning is emphasised.

Conclusion: Short-term rural immersion programs offer invaluable and transformative educational opportunities that extend beyond traditional learning environments.

Background: In 1962, the idea emerged that medical students' tolerance of uncertainty could determine their specialty choice. While some studies supported this claim, others refuted it, often using independently developed instruments. We explored whether the reported link between specialty choice and uncertainty tolerance is more myth than evidence by employing established instruments to investigate whether specialty choice could be explained by variance in uncertainty tolerance.

Method: We conducted a cross-sectional online survey at two periods of time. From February to June 2023, we queried 563 final-year medical students from 34 German medical universities (1) on their uncertainty tolerance using three validated tools (the modified tolerance for ambiguity scale, the physicians' reaction to uncertainty scale and the uncertainty intolerance scenario method) and (2) on their intended specialty choice. In a follow-up 1 year later (May to June 2024), 263 of those medical students responded to our query on their final specialty choice and again on their uncertainty tolerance.

Results: Participants' (N = 563) median age was 26.0 years (mean: 27.2; SD = 3.8), and 70% (n = 396) were female. Originally reported differences and rank orders in uncertainty tolerance among medical students with different intended specialty choices could not be replicated for any of the three scales. Instead, our results suggest different rank orders of uncertainty tolerance by different tools, as well as nonsignificant differences between intended medical specialties. Intercorrelation coefficient analyses demonstrated that, depending on the scale, only 0.3% to 1.5% of the variance in uncertainty tolerance could be attributed to specialty choice. Follow-up data using actual instead of intended medical choices left findings unchanged.

Discussion: Our findings suggest that the presumed link between uncertainty tolerance and specialty choice is more myth than evidence. Instead of teaching this link or using it as an admissions criterion, medical schools should equip students with the skills needed to navigate uncertainty across their careers.

Introduction: Intraprofessional collaboration between family physicians (FPs) and specialist physicians (SPs) is posited to improve patient outcomes but is hindered by power dynamics. Research informing intraprofessional training on hospital wards often conceptualizes power at an interactional level. However, less is known about how social structures make these power dynamics possible. This study explores how structural forms of power shape how FP and SP supervisors engage with and teach intraprofessional collaboration in outpatient settings and to what effect.

Methods: Using diabetes as a case study of intraprofessional collaboration, we conducted a discourse analysis of formal documents (written to guide how collaboration should be practiced) and interview transcripts with 15 FP and SP supervisors. Informed by governmentality and the sociology of professions, we analysed how discourses governing diabetes care shape FPs' and SPs' clinical and teaching behaviours, implications for jurisdictional boundaries and the nature of their collaborative relationships.

Results: Discourses of evidence-based medicine construct a hierarchical social structure in medicine that permeates how physicians engage with and teach intraprofessional collaboration. FPs and SPs enact and teach these hierarchical roles when collaborating in the referral-consultation process in ways that establish and reinforce jurisdictional boundaries. The interactions at the intersection of these boundaries foster a form of collaboration characterized by SPs surveilling and regulating FPs' practices.

Discussion: As currently constructed, intraprofessional collaboration in outpatient settings may be practiced and taught in ways that reinforce asymmetric power dynamics between FPs and SPs. Without awareness of this unintentional effect, educational attempts to advance this constructed notion of collaboration may ironically impede the achievement of collaborative ideals. Outlining the processes by which structural power permeates FPs' and SPs' collaborative behaviours opens space for educators to acknowledge and mitigate the effects of social structures on intraprofessional training in other clinical and educational contexts.