Medical Education最新文献

Ashley and Hope analyze the term "widening participation", indicating that nuanced approaches are needed to balance inclusivity with meaningful impact.

Introduction: Qualitative approaches have flourished in medical education research. Many research articles use the term 'lived experience' to describe the purpose of their study, yet we have noticed contradictory uses and misrepresentations of this term. In this conceptual paper, we consider three sources of these contradictions and misrepresentations: (1) the conflation of perspectives with experiences; (2) the conflation of experience with lived experience; and (3) the conflation of researching lived experience with phenomenology. We offer suggestions to facilitate more precise use of terminology.

Argument: Our starting point is to free researchers from unnecessary shackles: Not every problem in medical education should be studied through experience, nor should every study of experience be phenomenological. Data based on participants' perceptions, beliefs, opinions and thoughts, while based on reflections of experiences, are not in and of themselves accounts of experience. Lived experiences are situated, primal and pre-reflective; perspectives are more abstract. Lived experience-as opposed to experiences as such-deeply attune to bodies, relationality, space and time. There is also a difference between experiences as lived, how a person makes sense of these and what the researcher interprets and represents. Phenomenology is a meaningful approach to the study of lived experience, but other approaches, such as narrative inquiry and self-study, can also offer useful avenues for undertaking this type of research.

Discussion: We aim to broaden researchers' scope with this paper and equip researchers with the information they need to be clear about the meaning and use of the terms experience and lived experience. We also hope to open new methodological possibilities for researching experiences as lived and, through highlighting tensions, to prompt researchers of lived experience to strive for ontological closeness and resonance.

Introduction: Patient feedback is relevant information for improvement of health care professionals' performance. Engaging patients in feedback conversations can help to harness patient feedback as a powerful tool for learning. However, health care settings may prevent patients and health care professionals to effectively engage in a feedback dialogue. To advance our understanding of how feedback conversations may support learning in and from practice, we sought to explore patients' and health care providers' perspectives on engaging patients in feedback conversations as informal learning opportunities.

Methods: For this qualitative study, we used a pragmatic approach and conducted semi-structured interviews with 12 health care providers and 10 patient consultants. We applied an inductive approach to thematic analysis to understand interviewees' perceptions regarding patient feedback for workplace learning.

Results: Participants attributed importance to patient feedback and described how the feedback may improve treatment relationships, professionals' performance and care processes on the team level and the organisational level. Participants experienced conflicting roles as patient and educator or expert and learner, respectively. Changing relationships, feelings of vulnerability and perceived power dynamics in treatment relationships would affect participants' engagement in feedback conversations. Patients and professionals alike saw a role for themselves in giving or inviting feedback but often missed the tools for engaging in feedback conversations.

Discussion: Patient feedback can contribute to professionals' practice-based learning but requires navigating tensions around conflicting roles and power dynamics in the treatment relationship. Both patients and health care professionals need to embrace vulnerability and may need facilitation and guidance to use patient feedback effectively. Attention to power dynamics, if not a shift towards collaborative relationships, is however crucial to engage patients in feedback conversations, thereby capitalising the power patients posses.

Nelson uses mechanisms of memory, Cognitive Load Theory, and Desirable Difficulty Theory to propose a nuanced understanding of Ryan et al’s observations of workplace-based assessment

Background: Social connections between medical students provide a key basis for learning and support. These connections, and associated social identity, may be patterned by ethnicity, and students often perform similarly academically to those they connect with. The mechanisms that underpin the formation of these connections and the role that they play are not fully understood. This study explored how medical students connect with each other, and the potential impact of this on their academic attainment and well-being, with a focus on students with minoritised ethnic identities.

Methods: A mixed methods study combining (1) a survey to establish the number and strength of connections formed by Years 1 and 2 medical students with both minoritised and non-minoritised ethnicities and (2) semi-structured interviews to understand how connections were formed, whether this was shaped by ethnicity and the role of connections in supporting students with their learning and well-being.

Results: One hundred fifty-one students (15.5% response rate) completed the survey. Students connected regularly with three to four peers with the goal of supporting learning and 71.9% of students reported a sense of social identification with this group. There was no statistical difference between ethnically minoritised and White students on either of these measures (t = 0.1, p = 0.92, χ²  = 2.9, p = 0.56). Interviews with 19 students found that social connections were shaped by perceptions of their self-identity and the need to find 'equilibrium' by forming relationships with compatible others. The education environment, including its ethnic diversity, impacted on the opportunities to make connections. Students who were ethnically minoritised reported encountering challenges, especially in the clinical environment, and described the burden of these for them.

Discussion: Curriculum designers should consider the time and space that is afforded to student interaction during course development, as finding compatible others with whom students can socially connect is important to balancing well-being with academic performance.

Medicine always takes place within a cultural and ethical context which necessitates trainees to develop an understanding of the health humanities. Art education has been included in medical school curricula to introduce medical students to new ways of fostering communication, empathy, curiosity, flexible thinking, observational skills and awareness of personal bias. Yet a survey conducted on first-year medical students at Queen's University identified that while most respondents had a working knowledge of equity, diversity, inclusion (EDI) principles, many felt inadequately trained and would benefit from a more interdisciplinary and interdepartmental approach in this realm. The purpose of this study was to address this gap within medical education and augment the existing curricula on EDI through an interdisciplinary art-based intervention.

The Art of Observation programme at the Agnes Etherington Centre at Queen's University was delivered to a small group of first-year students in the School of Medicine as a multi-session programme, taking place over two, 2-hour sessions, spread over two weeks. During the first session, students engaged in transmediation by participating in a body scan meditation and later translating the sensations experienced during the meditation into sculptures using clay medium. Through this mindful art making process, students were offered a modality to consider their own embodiment and further explore self-expression, inclusivity and diversity. The second session focused on art observation and visual analysis skills. Using culturally diverse artwork from various regions of the world, such as Canadian Indigenous communities, East India and the African continent, students worked through inquiry-based learning approaches to perform visual analyses of the selected art works. The overall aims of both sessions were for students to become more aware of personal assumptions and biases within the context of EDI, enhance their ability to perceive details and interpret emotional language, and improve their verbal communication and description skills. The research team conducted pre- and post-tests for each session to measure the impact of these sessions on student's attitudes towards art and its ability to be utilised as an augmentative tool to address principles of EDI within the medical curriculum. The pre- and post-tests for each session were analysed using qualitative methods of Likert scales and thematic analysis.

Overall, post-test results from both sessions demonstrated an improvement in attitudes towards using art not only to foster self-expression but also to further express and explore issues of EDI. This improvement was found to be stronger with the meditation and sculpting session compared with the art observation session. Respondents also strongly agreed that each session was interactive, understandable, useful and applicable. These views were again stronger after the meditation and sculpture session. Mo

Operative video review is important to the growth of surgical trainees, with demonstrated efficacy of one-on-one video-based coaching.¹ While in-the-moment feedback is necessary, asynchronous coaching accompanying video review offers control of learning tempo and cognitive load in a setting without constraints and distractions imposed by the operating room. This allows for meaningful self-reflection, guidance and retained learning. However, barriers to video review are frequently cited that prevent its optimal use. Residents within our general surgery program requested more operative feedback but seldom reviewed their own videos or pursued coaching due to time and effort required.

A monthly, in-person collaborative learning experience in an operative video review program, ‘Film Club’, was created to decrease the burden of video coaching and engage more residents in the practice. The conference benefits from peer learning while remaining under the expert guidance of two attending facilitators/coaches. Program leadership or resident volunteers record operations for the group to review. During each session, one to two operative videos are viewed, with constructive feedback and open discussion from residents and facilitators throughout.

Current engagement in Film Club is high. However, early attendance waned as the novelty of the program wore off. With recommendations from residents, time and location have been changed to those most convenient for them. Leadership has worked to gain buy-in from senior residents, who lead their services and set the tone for allowing and encouraging attendance. We believe these changes stimulated our recent improvement in engagement.

Our first rule of film club was to create a psychologically safe environment. It can be an uncomfortable experience for others to watch one's surgical videos, particularly through the critical lens required of this conference. We have participants sign an agreement that conversation does not leave the room and ground rules are set around constructive language in discussing operative skill and decision making. We made all videos anonymous, but discussions would often lead to questions and comments that could only be addressed by someone familiar with the case. We learned that after our establishment of a safe environment, we were able to progress and make videos identifiable. Our current format first occurred naturally, when the resident operating in the video volunteered background and insight throughout the operation. Coaching for the operating resident and the overall discussion were rich and informed. Residents requested that this change continue. These livelier discussions have also improved meaningful peer learning.

Film Club offers a feasible, efficient group setting for operative video review to impact many learners, who note it as a meaningful, valued educational experience. An indirect benefit of individual residents privately rev