Gabrielle M. Finn, Joanna Tai, Vishna Devi Nadarajah
<div> <section> <h3> Context</h3> <p>In this article, we draw upon diverse and contextually different experiences of working on inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for health professions education (HPE) within universities. Instead of juxtaposing our views from three countries, we combine our perspectives to advocate for inclusive assessment.</p> </section> <section> <h3> Discussion</h3> <p>Creating an inclusive assessment culture is important for equitable education, even if priorities for inclusion might differ between contexts. We recognise challenges in the enactment of inclusive assessment, namely, the notion of lowering standards, harming reliability and robustness of assessment design and inclusion as a poorly defined and catchall term. Importantly, the lack of awareness that inclusion means recognising intersectionality is a barrier for well-designed inclusive assessments. This is why we offer considerations for HPE practitioners that can guide towards a unified direction of travel for inclusive assessments. This article highlights the importance of contextual prioritisation and initiatives to be considered at the global level to national, institutional, programme and the individual level. Utilising experience and literature from undergraduate, higher education contexts, we offer considerations with applicability across the assessment continuum.</p> </section> <section> <h3> Context</h3> <p>In this state of science paper, we were set the challenge of providing cross-cultural viewpoints on inclusive assessment. In this discursive article, we focus on inclusive assessment within undergraduate health professions education whilst looking to the wider higher education literature, since institutional policies and procedures frequently drive assessment decisions and influence the environment in which they occur. We explore our experiences of working in inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for HPE. Unlike other articles that juxtapose views, we all come from the perspective of supporting inclusive assessment.</p> <p>We begin with a discussion on what inclusive assessment is and then describe our contexts as a basis for understanding differences and broadening conversations. We work in the United Kingdom, Australia and Malaysia, having undertaken research, facilitated workshops and seminars on inclusive assessment nationally and internationally. We recognise our perspectives will differ as a consequence of our global context, institutional culture, individual characteristics and educational experiences
{"title":"Inclusive assessment in health professions education: Balancing global goals and local contexts","authors":"Gabrielle M. Finn, Joanna Tai, Vishna Devi Nadarajah","doi":"10.1111/medu.15535","DOIUrl":"10.1111/medu.15535","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>In this article, we draw upon diverse and contextually different experiences of working on inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for health professions education (HPE) within universities. Instead of juxtaposing our views from three countries, we combine our perspectives to advocate for inclusive assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Creating an inclusive assessment culture is important for equitable education, even if priorities for inclusion might differ between contexts. We recognise challenges in the enactment of inclusive assessment, namely, the notion of lowering standards, harming reliability and robustness of assessment design and inclusion as a poorly defined and catchall term. Importantly, the lack of awareness that inclusion means recognising intersectionality is a barrier for well-designed inclusive assessments. This is why we offer considerations for HPE practitioners that can guide towards a unified direction of travel for inclusive assessments. This article highlights the importance of contextual prioritisation and initiatives to be considered at the global level to national, institutional, programme and the individual level. Utilising experience and literature from undergraduate, higher education contexts, we offer considerations with applicability across the assessment continuum.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>In this state of science paper, we were set the challenge of providing cross-cultural viewpoints on inclusive assessment. In this discursive article, we focus on inclusive assessment within undergraduate health professions education whilst looking to the wider higher education literature, since institutional policies and procedures frequently drive assessment decisions and influence the environment in which they occur. We explore our experiences of working in inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for HPE. Unlike other articles that juxtapose views, we all come from the perspective of supporting inclusive assessment.</p>\u0000 \u0000 <p>We begin with a discussion on what inclusive assessment is and then describe our contexts as a basis for understanding differences and broadening conversations. We work in the United Kingdom, Australia and Malaysia, having undertaken research, facilitated workshops and seminars on inclusive assessment nationally and internationally. We recognise our perspectives will differ as a consequence of our global context, institutional culture, individual characteristics and educational experiences","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 1","pages":"88-96"},"PeriodicalIF":4.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142216812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this article, Danquah explores the hidden impact of ethnicity categorisation in healthcare. He acknowledges the argument that data support justice through highlighting inequalities. However, he also discusses evidence that such efforts may be hampered by the data being not only ‘dodgy’, but also dehumanising. Danquah uses lived experience of filling in ethnicity data surveys as a person of ‘mixed’ heritage, arguing that it is the mixed category that most readily highlights the deficiencies in this approach. He goes on to discuss the tensions between mitigating the damage and dispensing with ethnicity categorisation altogether, before sharing ways to rehumanise the data and conceive of ourselves and those we serve more fully.</p><p> <span>Danquah, A.</span> <span>Pigeonholes and Johari Windows: Rehumanising Ethnicity Categorisation in Healthcare</span>. <i>Med Educ.</i> <span>2024</span>; <span>58</span>(<span>10</span>): <span>1178</span>-<span>1184</span>. 10.1111/medu.15395.</p><p>Cleland and colleagues scrutinise how six new UK medical schools translated government policy on widening participation (WP) to medicine, to increase the diversity of medical students, into practice. Via semi-structured interviews with Deans and Admissions staff, they found similarities and differences across the six schools. For example, some schools found themselves increasingly subjected to local and extra-local rule systems. There were also tensions between the new medical schools and the medical education “establishment”. They concluded that different contexts seem to influence the enactment of WP to medicine even in medical schools established at the same time.</p><p> <span>Cleland, J</span>, <span>Buxton, J</span>, <span>Hughes, L</span>, <span>Patterson, F</span>. <span>Translating government policy into practice: How new UK medical schools enact widening participation</span>. <i>Med Educ.</i> <span>2024</span>; <span>58</span>(<span>10</span>): <span>1247</span>-<span>1256</span>. 10.1111/medu.15403.</p><p>This paper describes the experiences of female medical students and doctors in the clinical workplace in a Scottish hospital. The socio-cultural dynamics in the selected wards are revealed through an ethnographic exploration involving observations and interviews. The authors use Bourdieu's theory, with its core concepts of field, capital, and habitus to interpret the participants' experiences and perspectives. Despite constituting the majority demographic of medical school, female students and doctors struggle to gain capital, and the differential experiences contribute to transforming their habitus. Their role-models, however, contributed to building confidence and self-efficacy, which proved valuable in navigating the gendered social order.</p><p> <span>Gupta, S</span>, <span>Howden, S</span>, <span>Moffat, M</span>, <span>Pope, L</span>, <span>Kennedy, C</span>. <span>Girls in Scrubs: An ethnogra
在这篇文章中，Danquah 探讨了医疗保健中种族分类的隐性影响。他承认，数据可以通过强调不平等来支持正义。然而，他也讨论了一些证据，这些证据表明，数据不仅 "不可靠"，而且非人化，这可能会阻碍这些努力。丹夸利用自己作为 "混血 "后裔填写种族数据调查的亲身经历，认为混血类别最容易凸显这种方法的缺陷。他接着讨论了减轻损害与完全放弃种族分类之间的矛盾，然后分享了如何重新对数据进行人性化处理，以及如何更全面地看待我们自己和我们的服务对象。 Danquah, A. Pigeonholes and Johari Windows：医疗保健中的种族分类再人性化》。Med Educ. 2024; 58(10)： 1178-1184.10.1111/medu.15395.Cleland及其同事仔细研究了英国六所新医学院如何将政府关于扩大医学参与（WP）的政策转化为实践，以增加医学生的多样性。通过对院长和招生人员进行半结构化访谈，他们发现了六所学校的异同。例如，一些学校发现自己越来越受制于地方和地方外的规则体系。新医学院与医学教育 "体制 "之间也存在紧张关系。他们的结论是，即使在同一时间成立的医学院中，不同的环境似乎也会影响医学可持续发展方案的实施。 Cleland, J, Buxton, J, Hughes, L, Patterson, F. Translating Government policy into practice：新成立的英国医学院如何实施扩大参与。Med Educ. 2024; 58(10)： 1247-1256.10.1111/medu.15403.This paper describes the experiences of female medical students and doctors in the clinical workplace in a Scottish hospital.通过人种学的观察和访谈，揭示了所选病房的社会文化动态。作者运用布迪厄理论及其核心概念 "场域"、"资本 "和 "习性 "来解释参与者的经历和观点。尽管医学院的女生和医生占了大多数，但她们仍在为获得资本而奋斗，而不同的经历有助于改变她们的习惯。然而，她们的榜样却有助于建立自信和自我效能感，这在驾驭性别社会秩序方面被证明是非常有价值的。 Gupta, S, Howden, S, Moffat, M, Pope, L, Kennedy, C. Girls in Scrubs：临床学习环境的人种学探索。医学教育》，2024 年；58（10）： 1224-1234.10.1111/medu.15379.This paper discusses some of the problems that exist related to the unintended consequences of dominant culture in medical education.然后阐述了有助于更好地理解和研究这些问题的解决方案，并将批判性民族志作为一种研究方法。批判性民族志的目的是解读、识别和彰显不可见的东西。这种方法是对主流思维方式提出质疑，并在培训和实践中进行积极变革，以增强所有人的包容性和公平性。 Rashid, M, Goldszmidt, M. Critical Ethnography：医学教育研究与学术的意义》。Med Educ. 2024; 58(10)： 1185-1191.10.1111/medu.15401.
{"title":"October In This Issue","authors":"","doi":"10.1111/medu.15493","DOIUrl":"https://doi.org/10.1111/medu.15493","url":null,"abstract":"<p>In this article, Danquah explores the hidden impact of ethnicity categorisation in healthcare. He acknowledges the argument that data support justice through highlighting inequalities. However, he also discusses evidence that such efforts may be hampered by the data being not only ‘dodgy’, but also dehumanising. Danquah uses lived experience of filling in ethnicity data surveys as a person of ‘mixed’ heritage, arguing that it is the mixed category that most readily highlights the deficiencies in this approach. He goes on to discuss the tensions between mitigating the damage and dispensing with ethnicity categorisation altogether, before sharing ways to rehumanise the data and conceive of ourselves and those we serve more fully.</p><p>\u0000 <span>Danquah, A.</span> <span>Pigeonholes and Johari Windows: Rehumanising Ethnicity Categorisation in Healthcare</span>. <i>Med Educ.</i> <span>2024</span>; <span>58</span>(<span>10</span>): <span>1178</span>-<span>1184</span>. 10.1111/medu.15395.</p><p>Cleland and colleagues scrutinise how six new UK medical schools translated government policy on widening participation (WP) to medicine, to increase the diversity of medical students, into practice. Via semi-structured interviews with Deans and Admissions staff, they found similarities and differences across the six schools. For example, some schools found themselves increasingly subjected to local and extra-local rule systems. There were also tensions between the new medical schools and the medical education “establishment”. They concluded that different contexts seem to influence the enactment of WP to medicine even in medical schools established at the same time.</p><p>\u0000 <span>Cleland, J</span>, <span>Buxton, J</span>, <span>Hughes, L</span>, <span>Patterson, F</span>. <span>Translating government policy into practice: How new UK medical schools enact widening participation</span>. <i>Med Educ.</i> <span>2024</span>; <span>58</span>(<span>10</span>): <span>1247</span>-<span>1256</span>. 10.1111/medu.15403.</p><p>This paper describes the experiences of female medical students and doctors in the clinical workplace in a Scottish hospital. The socio-cultural dynamics in the selected wards are revealed through an ethnographic exploration involving observations and interviews. The authors use Bourdieu's theory, with its core concepts of field, capital, and habitus to interpret the participants' experiences and perspectives. Despite constituting the majority demographic of medical school, female students and doctors struggle to gain capital, and the differential experiences contribute to transforming their habitus. Their role-models, however, contributed to building confidence and self-efficacy, which proved valuable in navigating the gendered social order.</p><p>\u0000 <span>Gupta, S</span>, <span>Howden, S</span>, <span>Moffat, M</span>, <span>Pope, L</span>, <span>Kennedy, C</span>. <span>Girls in Scrubs: An ethnogra","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 10","pages":"1137"},"PeriodicalIF":4.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15493","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel J. Schumacher, Abigail Martini, Catherine Michelson, David A. Turner, Ariel S. Winn, Benjamin Kinnear
Purpose
Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.
Methods
The authors conducted a realist inquiry to better understand how CCC prospective entrustment decision-making is carried out in paediatric residency programs. They conducted four CCC meeting observations and 18 interviews with CCC members at eight sites in an effort to confirm, disconfirm, and elaborate an existing theory that was based on a literature synthesis.
Results
The literature-based theory held up well against the empiric data collected in this study. Therefore, the authors did not modify that theory and instead developed three new demi-regularities (recurring patterns in data when conducting realist work) that add detail and nuance to their previous understanding of this model. These new demi-regularities focus on (i) expounding on how deliberate actions of CCCs focus more on resident development than on resident entrustment; (ii) elucidating that effortful work is not only about reconciling a paucity of data or incongruent data but also working hard to ‘do the right thing’ for residents; and (iii) describing how programs consider bias, equity and fairness, with a wide range of intentionality from being reactive to being proactive.
Conclusion
This study offers evidence of deliberate CCC efforts to support resident development. Moving forward, a similar focus should be more consistently placed on equitable entrustment and advancement decisions to balance both of these foundational goals.
{"title":"A realist evaluation of prospective entrustment decisions in paediatric residency clinical competency committees","authors":"Daniel J. Schumacher, Abigail Martini, Catherine Michelson, David A. Turner, Ariel S. Winn, Benjamin Kinnear","doi":"10.1111/medu.15530","DOIUrl":"10.1111/medu.15530","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Making entrustment decisions (granting more responsibility, advancement and graduation) are important actions in medical training that pose risks to trainees and patients if not done well. A previous realist synthesis of the existing literature revealed that clinical competency committees (CCCs) do not typically make deliberate entrustment decisions, instead defaulting to the promotion and graduation of trainees in the absence of red flags. This study sought further understanding of these areas through empirical data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The authors conducted a realist inquiry to better understand how CCC prospective entrustment decision-making is carried out in paediatric residency programs. They conducted four CCC meeting observations and 18 interviews with CCC members at eight sites in an effort to confirm, disconfirm, and elaborate an existing theory that was based on a literature synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The literature-based theory held up well against the empiric data collected in this study. Therefore, the authors did not modify that theory and instead developed three new demi-regularities (recurring patterns in data when conducting realist work) that add detail and nuance to their previous understanding of this model. These new demi-regularities focus on (i) expounding on how deliberate actions of CCCs focus more on resident development than on resident entrustment; (ii) elucidating that effortful work is not only about reconciling a paucity of data or incongruent data but also working hard to ‘do the right thing’ for residents; and (iii) describing how programs consider bias, equity and fairness, with a wide range of intentionality from being reactive to being proactive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study offers evidence of deliberate CCC efforts to support resident development. Moving forward, a similar focus should be more consistently placed on equitable entrustment and advancement decisions to balance both of these foundational goals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"59 3","pages":"292-301"},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Managing an electronic health record (EHR) inbox is a task required of most practicing physicians regardless of specialty. With the increased adoption of EHRs, the volume of material getting routed to clinician inboxes has increased, making this task ever more challenging. No clear standards exist for how to teach inbox management to trainees such as medical residents. Internal medicine residents report challenges with inbox management and cite it as a source of frustration. Not all faculty are facile with the EHR and prepared to teach this topic to learners.</p><p>To address this problem, our institution created a support infrastructure to guide residents in inbox management. In addition to pre-clinic conference sessions teaching inbox management to learners, we created a series of screen-casted videos to demonstrate to residents how to perform various inbox management tasks. For these videos, we used a training environment in our EHR with faculty voice-over guidance to explain how to perform various tasks while displaying task completion in real time on the screen. These videos covered various topics including managing results, patient calls and prescription refill requests, to name a few. We housed the videos on the password-protected website that contains reference material and resources for all residency rotations to protect proprietary EHR information. In subsequent years, we expanded video use with incorporation of the videos into pre-clinic conference teaching sessions.</p><p>In prior years, teaching on EHR navigation had been done by any faculty member supervising in resident clinic, regardless of their own degree of skill in navigating the EHR used primarily by residents. While this allowed for flexibility in the teaching schedule, the teaching may have been suboptimal if done by someone with less EHR experience. It also created the potential for inconsistencies in expectations since different faculty teachers may have presented material and expectations slightly differently. The creation of videos allowed us to use this material both for on-demand reference and for formal teaching sessions. During teaching sessions, faculty play the videos and facilitate a discussion with residents while further honing their own EHR skills such that they become better positioned to guide residents in EHR navigation during clinic sessions. Using the videos in our teaching has created greater uniformity of expectations which is essential for skills like EHR use and documentation. Despite the high quality of the videos and feedback on their utility, residents often forgot they existed and rarely accessed them on their own without prompting. This makes it essential to re-visit material in formal teaching or to disseminate reminders regarding the availability of useful reference material. Additionally, with frequent updates to the EHR, it is important to re-visit and update content on a regular basis to ensure material presented remains up to date.</p><p
管理电子健康记录 (EHR) 收件箱是大多数执业医师（无论专业）都必须完成的一项任务。随着电子病历采用率的提高，发送到临床医生收件箱的材料数量也随之增加，使这项任务变得更具挑战性。对于如何向住院医师等受训人员传授收件箱管理知识，目前还没有明确的标准。内科住院医师报告了收件箱管理方面的挑战，并将其视为沮丧的根源。并不是所有的教师都能熟练掌握电子病历，并准备好向学员教授这一主题。为了解决这一问题，我们的机构创建了一个支持基础设施，以指导住院医师进行收件箱管理。除了在临床前会议上向学员传授收件箱管理知识外，我们还制作了一系列截屏视频，向住院医师演示如何执行各种收件箱管理任务。在这些视频中，我们使用了电子病历中的培训环境，通过教师的画外音指导来解释如何执行各种任务，同时在屏幕上实时显示任务完成情况。这些视频涵盖了各种主题，包括管理结果、病人来电和处方续订请求等。我们将这些视频放在有密码保护的网站上，该网站包含所有住院医师轮转的参考资料和资源，以保护电子病历的专有信息。在随后的几年里，我们扩大了视频的使用范围，将视频纳入了门诊前会议的教学环节。在之前的几年里，EHR 导航教学是由任何一位指导住院医师门诊的教师完成的，无论他们自己在导航住院医师主要使用的 EHR 方面有多熟练。虽然这样可以灵活安排教学时间，但如果由电子病历经验较少的人授课，教学效果可能会不理想。此外，由于不同的教师在介绍材料和期望值时可能会略有不同，这也有可能造成期望值的不一致。视频的制作使我们能够将这些材料用于点播参考和正式教学课程。在教学过程中，教师会播放视频，与住院医生进行讨论，同时进一步提高自己的电子病历技能，以便在门诊过程中更好地指导住院医生使用电子病历。在我们的教学中使用这些视频能使期望值更加统一，这对电子病历的使用和记录等技能至关重要。尽管视频质量很高，而且对其实用性的反馈也很好，但住院医生往往忘记了它们的存在，也很少在没有提示的情况下自行访问它们。因此，在正式教学中重温材料或传播有关有用参考材料可用性的提醒信息至关重要。此外，随着电子病历的频繁更新，定期重新访问和更新内容以确保所提供的材料始终是最新的也很重要。
{"title":"Supporting resident inbox management with screen-casted videos","authors":"Jessica E. Murphy, Mindy Sobota","doi":"10.1111/medu.15521","DOIUrl":"10.1111/medu.15521","url":null,"abstract":"<p>Managing an electronic health record (EHR) inbox is a task required of most practicing physicians regardless of specialty. With the increased adoption of EHRs, the volume of material getting routed to clinician inboxes has increased, making this task ever more challenging. No clear standards exist for how to teach inbox management to trainees such as medical residents. Internal medicine residents report challenges with inbox management and cite it as a source of frustration. Not all faculty are facile with the EHR and prepared to teach this topic to learners.</p><p>To address this problem, our institution created a support infrastructure to guide residents in inbox management. In addition to pre-clinic conference sessions teaching inbox management to learners, we created a series of screen-casted videos to demonstrate to residents how to perform various inbox management tasks. For these videos, we used a training environment in our EHR with faculty voice-over guidance to explain how to perform various tasks while displaying task completion in real time on the screen. These videos covered various topics including managing results, patient calls and prescription refill requests, to name a few. We housed the videos on the password-protected website that contains reference material and resources for all residency rotations to protect proprietary EHR information. In subsequent years, we expanded video use with incorporation of the videos into pre-clinic conference teaching sessions.</p><p>In prior years, teaching on EHR navigation had been done by any faculty member supervising in resident clinic, regardless of their own degree of skill in navigating the EHR used primarily by residents. While this allowed for flexibility in the teaching schedule, the teaching may have been suboptimal if done by someone with less EHR experience. It also created the potential for inconsistencies in expectations since different faculty teachers may have presented material and expectations slightly differently. The creation of videos allowed us to use this material both for on-demand reference and for formal teaching sessions. During teaching sessions, faculty play the videos and facilitate a discussion with residents while further honing their own EHR skills such that they become better positioned to guide residents in EHR navigation during clinic sessions. Using the videos in our teaching has created greater uniformity of expectations which is essential for skills like EHR use and documentation. Despite the high quality of the videos and feedback on their utility, residents often forgot they existed and rarely accessed them on their own without prompting. This makes it essential to re-visit material in formal teaching or to disseminate reminders regarding the availability of useful reference material. Additionally, with frequent updates to the EHR, it is important to re-visit and update content on a regular basis to ensure material presented remains up to date.</p><p","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1410-1411"},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15521","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kiran Malhotra, Christine P. Beltran, Magdalena J. Robak, Nicholas Genes
<p>As telemedicine becomes a vital aspect of patient care, incorporating it into medical training has necessitated adapting traditional Objective Structured Clinical Examinations (OSCEs), which typically assess clinical and communication skills through face-to-face interactions, to include telehealth scenarios. However, students have critiqued telehealth OSCEs as lacking the fidelity of dynamic electronic health records (EHR) navigation and documentation, thus diminishing the practical training aspect of diagnosing and managing patient care effectively in a real-world setting.<span><sup>1</sup></span></p><p>To address the limitations of telehealth OSCEs, our institution integrated a comprehensive simulated patient record into our existing EHR system, Epic (Verona, WI). Utilizing Epic's tools for facilitating training, we crafted detailed patient profiles complete with extensive medical histories, prior documentation, vital signs and laboratory data. We then cloned these profiles, creating 120 unique instances—one for each student—within a dedicated Epic training environment. This allowed each student to conduct thorough pre-encounter reviews, mirroring the complexity of real clinical settings. The system not only facilitated more authentic patient interactions but also enhanced students' proficiency with real-world EHR chart navigation and clinical documentation, as we repurposed the virtual urgent care's standard documentation template. Students were given a primer with their login information, their individual patient's name and an appointed testing time to log into the Epic training environment. They were given 10 minutes to review the chart, 10 minutes to interact with the patient and 13 minutes to document a note. The students received feedback from the SP and debriefed with peers and faculty. This initiative required a collaborative effort among IT specialists, clinical educators and informaticists to ensure seamless integration and operability within the test environment, including a Webex Teams chat space for coordinating the sessions, and a drop-in Zoom channel for student technical support.</p><p>The implementation of a simulated EHR environment was well-received by students, who valued how the realism in electronic chart review and the use of structured telehealth documentation templates sourced from real-world clinics, effectively mirrored real-life scenarios and thus improved the fidelity of the OSCEs. Many felt that this helped improve clinical decision-making.</p><p>Challenges included ensuring students could remotely access the EHR environment (two were unable to, and five initially logged into the wrong environment) and in managing the timely coordination between student groups and standardised patients. Despite these hurdles, the positive feedback has encouraged us to consider integrating the Epic training environment into other simulations and to streamline the process of creating individual patient profiles.</p><p>Using standa
随着远程医疗成为病人护理的一个重要方面，将其纳入医学培训就必须调整传统的客观结构化临床考试 (OSCE)，这种考试通常通过面对面的互动来评估临床和沟通技能，并将远程医疗场景纳入其中。然而，学生们批评远程医疗 OSCE 缺乏动态电子病历 (EHR) 导航和记录的真实性，从而削弱了在真实世界环境中有效诊断和管理患者护理的实践培训方面。1 为解决远程医疗 OSCE 的局限性，我们的机构将一个综合模拟病历集成到现有的 EHR 系统 Epic（威斯康星州维罗纳）中。利用 Epic 促进培训的工具，我们制作了详细的病人档案，其中包括大量病史、先前的记录、生命体征和实验室数据。然后，我们克隆了这些档案，在专门的 Epic 培训环境中创建了 120 个独特的实例，每个学生一个。这样，每个学生都可以进行全面的诊前审查，以反映真实临床环境的复杂性。该系统不仅促进了更真实的患者互动，还提高了学生对真实 EHR 图表导航和临床文档的熟练程度，因为我们重新使用了虚拟紧急护理的标准文档模板。学生们收到了一份包含登录信息、个人患者姓名和指定测试时间的入门资料，以便登录 Epic 培训环境。他们有 10 分钟的时间查看病历，10 分钟的时间与患者交流，13 分钟的时间记录笔记。学生们收到了 SP 的反馈，并与同学和教师进行了汇报。这一举措需要信息技术专家、临床教育工作者和信息学家的通力合作，以确保测试环境的无缝集成和可操作性，包括用于协调会话的 Webex Teams 聊天空间，以及为学生提供技术支持的 Zoom 频道。模拟电子病历环境的实施受到了学生的欢迎，他们非常重视电子病历审查的真实性，以及使用来自真实世界诊所的结构化远程医疗文档模板，这些都有效地反映了真实场景，从而提高了 OSCE 的真实性。挑战包括确保学生能够远程访问电子病历环境（有两名学生无法访问，有五名学生最初登录了错误的环境），以及管理学生小组和标准化病人之间的及时协调。尽管存在这些障碍，但积极的反馈鼓励我们考虑将 Epic 培训环境整合到其他模拟中，并简化创建单个患者档案的流程。使用标准的 Epic 篮式消息传递工具，我们能够从 EHR 中提取笔记，并使用自动的、先前验证过的工具进行笔记评分。这种高保真远程医疗 OSCE 为研究学生对电子病历系统的使用和分析他们的大规模文档记录实践提供了新的机会：构思；数据整理；正式分析；写作-原稿；项目管理；写作-审阅和编辑；监督；方法论；软件。克里斯蒂娜-贝尔特兰（Christine P. Beltran）：概念化；数据整理；形式分析；撰写-原稿；项目管理；撰写-审阅和编辑；方法论。马格达莱纳-J-罗巴克概念化；数据整理；正式分析；撰写-原稿；项目管理；撰写-审阅和编辑；监督；调查；方法学。基兰-马尔霍特拉（Kiran Malhotra）：构思；数据整理；正式分析；撰写-原稿；项目管理；撰写-审阅和编辑；方法学。本项目符合纽约大学格罗斯曼医学院的质量改进认证标准，而非基于自我认证流程的人类研究项目（可提供已完成的审查），该流程证明数据的收集并非出于研究目的，项目的主要目标是改进教育，不包含可识别个人身份的数据，不存在超过最低风险的风险，数据的收集是教育和培训所需的一部分。
{"title":"Enhancing telehealth Objective Structured Clinical Examination fidelity with integrated Electronic Health Record simulation","authors":"Kiran Malhotra, Christine P. Beltran, Magdalena J. Robak, Nicholas Genes","doi":"10.1111/medu.15525","DOIUrl":"10.1111/medu.15525","url":null,"abstract":"<p>As telemedicine becomes a vital aspect of patient care, incorporating it into medical training has necessitated adapting traditional Objective Structured Clinical Examinations (OSCEs), which typically assess clinical and communication skills through face-to-face interactions, to include telehealth scenarios. However, students have critiqued telehealth OSCEs as lacking the fidelity of dynamic electronic health records (EHR) navigation and documentation, thus diminishing the practical training aspect of diagnosing and managing patient care effectively in a real-world setting.<span><sup>1</sup></span></p><p>To address the limitations of telehealth OSCEs, our institution integrated a comprehensive simulated patient record into our existing EHR system, Epic (Verona, WI). Utilizing Epic's tools for facilitating training, we crafted detailed patient profiles complete with extensive medical histories, prior documentation, vital signs and laboratory data. We then cloned these profiles, creating 120 unique instances—one for each student—within a dedicated Epic training environment. This allowed each student to conduct thorough pre-encounter reviews, mirroring the complexity of real clinical settings. The system not only facilitated more authentic patient interactions but also enhanced students' proficiency with real-world EHR chart navigation and clinical documentation, as we repurposed the virtual urgent care's standard documentation template. Students were given a primer with their login information, their individual patient's name and an appointed testing time to log into the Epic training environment. They were given 10 minutes to review the chart, 10 minutes to interact with the patient and 13 minutes to document a note. The students received feedback from the SP and debriefed with peers and faculty. This initiative required a collaborative effort among IT specialists, clinical educators and informaticists to ensure seamless integration and operability within the test environment, including a Webex Teams chat space for coordinating the sessions, and a drop-in Zoom channel for student technical support.</p><p>The implementation of a simulated EHR environment was well-received by students, who valued how the realism in electronic chart review and the use of structured telehealth documentation templates sourced from real-world clinics, effectively mirrored real-life scenarios and thus improved the fidelity of the OSCEs. Many felt that this helped improve clinical decision-making.</p><p>Challenges included ensuring students could remotely access the EHR environment (two were unable to, and five initially logged into the wrong environment) and in managing the timely coordination between student groups and standardised patients. Despite these hurdles, the positive feedback has encouraged us to consider integrating the Epic training environment into other simulations and to streamline the process of creating individual patient profiles.</p><p>Using standa","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1375-1376"},"PeriodicalIF":4.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Improving equity, diversity and inclusion (EDI) within health profession education is a global priority. In this issue of <i>Medical Education</i>, Lam et al.<span><sup>1</sup></span> review EDI literature in postgraduate medical education (PGME) focusing on how discrimination is conceptualised and addressed. They find that while learner representation and gender inequities are recognised, systemic racism and power dynamics are often overlooked, limiting the effectiveness of current reforms. They emphasise the need for critical, intersectional approaches and re-examining educational processes to truly advance equity in learning environments for marginalised groups.</p><p>One educational process to re-examine is workplace-based assessment (WBA), a significant challenge in advancing EDI within PGME. Since the introduction of Competency-Based Medical Education (CBME), WBA has been increasingly adopted for competence assessments and workplace learning.<span><sup>2</sup></span> WBA is inherently subjective, influenced by individual judgement and existing workplace structures and hierarchies and thus susceptible to racism and inequity through implicit and explicit biases in direct observation, performance interpretations, coaching and feedback and supervisor–trainee power dynamics. The lack of diverse perspectives and inadequate supervisor training on EDI principles can exacerbate inequities in assessments, disadvantaging marginalised trainees. Yet, CBME principles can help advance EDI by centring the trainee and providing individualised resources to navigate barriers and ensure fair learning and assessment opportunities.<span><sup>3</sup></span></p><p>One approach that has gained significant attention over recent years in aligning WBA with CBME is the use of Entrustable Professional Activities (EPAs). EPAs are units of professional practice, defined as tasks entrusted to trainees for unsupervised execution once they demonstrate sufficient competence.<span><sup>4</sup></span> Assessment through EPAs involves entrustment decision-making, which requires evaluating a trainee's competence and determining their readiness to take on more responsibility or autonomy with less supervision. Whether EPAs can reduce bias in WBA is a complex and multifaceted question. While entrustment decision-making offers a new rating approach, it is not immune to bias and could potentially introduce new biases related to how supervisors conceptualise or experience trust. For instance, studies comparing traditional proficiency scales with entrustment–supervision scales have shown that the latter offer more reliable performance estimates with less inter-rater variability, suggesting that entrustment could be less influenced by performance-irrelevant trainee characteristics.<span><sup>5, 6</sup></span> However, considerable variability in supervisors' willingness to grant trust has been reported.<span><sup>7</sup></span></p><p>One advantage offered by the EPA model is its expli
{"title":"Equity, diversity, and inclusion in entrustable professional activities based assessment","authors":"Marije P. Hennus, H. Carrie Chen","doi":"10.1111/medu.15526","DOIUrl":"10.1111/medu.15526","url":null,"abstract":"<p>Improving equity, diversity and inclusion (EDI) within health profession education is a global priority. In this issue of <i>Medical Education</i>, Lam et al.<span><sup>1</sup></span> review EDI literature in postgraduate medical education (PGME) focusing on how discrimination is conceptualised and addressed. They find that while learner representation and gender inequities are recognised, systemic racism and power dynamics are often overlooked, limiting the effectiveness of current reforms. They emphasise the need for critical, intersectional approaches and re-examining educational processes to truly advance equity in learning environments for marginalised groups.</p><p>One educational process to re-examine is workplace-based assessment (WBA), a significant challenge in advancing EDI within PGME. Since the introduction of Competency-Based Medical Education (CBME), WBA has been increasingly adopted for competence assessments and workplace learning.<span><sup>2</sup></span> WBA is inherently subjective, influenced by individual judgement and existing workplace structures and hierarchies and thus susceptible to racism and inequity through implicit and explicit biases in direct observation, performance interpretations, coaching and feedback and supervisor–trainee power dynamics. The lack of diverse perspectives and inadequate supervisor training on EDI principles can exacerbate inequities in assessments, disadvantaging marginalised trainees. Yet, CBME principles can help advance EDI by centring the trainee and providing individualised resources to navigate barriers and ensure fair learning and assessment opportunities.<span><sup>3</sup></span></p><p>One approach that has gained significant attention over recent years in aligning WBA with CBME is the use of Entrustable Professional Activities (EPAs). EPAs are units of professional practice, defined as tasks entrusted to trainees for unsupervised execution once they demonstrate sufficient competence.<span><sup>4</sup></span> Assessment through EPAs involves entrustment decision-making, which requires evaluating a trainee's competence and determining their readiness to take on more responsibility or autonomy with less supervision. Whether EPAs can reduce bias in WBA is a complex and multifaceted question. While entrustment decision-making offers a new rating approach, it is not immune to bias and could potentially introduce new biases related to how supervisors conceptualise or experience trust. For instance, studies comparing traditional proficiency scales with entrustment–supervision scales have shown that the latter offer more reliable performance estimates with less inter-rater variability, suggesting that entrustment could be less influenced by performance-irrelevant trainee characteristics.<span><sup>5, 6</sup></span> However, considerable variability in supervisors' willingness to grant trust has been reported.<span><sup>7</sup></span></p><p>One advantage offered by the EPA model is its expli","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1426-1428"},"PeriodicalIF":4.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah E. Fleet, Alan M. Leichtner, Katie A. Greenzang
{"title":"‘Blood and guts’: Interleaving gastroenterology and haematology physiology","authors":"Sarah E. Fleet, Alan M. Leichtner, Katie A. Greenzang","doi":"10.1111/medu.15518","DOIUrl":"10.1111/medu.15518","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1393-1394"},"PeriodicalIF":4.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"AI-assisted learning for systems thinking in resolving ill-structured problems among healthcare students","authors":"Pingmei Zhang, Honghe Li, Jiaxi Tan","doi":"10.1111/medu.15509","DOIUrl":"10.1111/medu.15509","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 11","pages":"1413-1414"},"PeriodicalIF":4.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142109200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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