Medical Education最新文献

Introduction: The mental health workforce needs to grow to meet increased service demand. Mental health placements are central in building students' mental health capabilities and motivation for mental health careers. Although previous literature reviews have begun to explore mental health placements, they fail to examine how they work (or not), for whom and under what circumstances and why.

Methods: We conducted a realist synthesis of the mental health placement literature employing 29 databases (e.g., Medline, PsycINFO, CINAHL, Scopus and ProQuest) exploring programmes globally and for different health care professions. Employing the five realist review stages (clarifying scope; searching for evidence; study selection and appraisal; data extraction; and synthesis of evidence), we identified repeated context-mechanism-outcome configurations (CMOCs) to develop and refine programme theory.

Results: With 51 papers representing hospital (n = 20), community (n = 16), and therapeutic recreation-based (n = 15) mental health placements, we identified repeated CMOCs: hospital (n = 6), community (n = 8) and therapeutic recreation-based (n = 5). Although all three settings could generate positive outcomes, our cross-category analysis demonstrated settings affording unique contexts triggering different mechanisms. For example, hospital-based mental health placements afforded contexts triggering student reflection generating improved student capabilities, community-based mental health placements afforded contexts triggering positive student-supervisor relationships generating improved student wellbeing and orientation to mental health, and recreation-based mental health placements afforded contexts triggering positive perceptions of the learning environment generating improved student-consumer relationships.

Discussion: We discuss three novel modified programme theories based on our results and make original recommendations to educators to better tailor their placements to the student outcomes they seek (e.g., optimising positive student outcomes in community-based mental health settings through exposure, student-supervisor interactions and student-placement interactions). Realist evaluations are now needed to develop programme theory in Global South countries and non-nursing student groups and to explore educator and consumer outcomes.

Background/purpose: Providers who identify as Underrepresented in Medicine (URiM) are disproportionately affected by the trauma resulting from systemic bigotry and injustice. This ethno-racial trauma (ERT) has been characterised by discrimination, obstacles to career advancement and leadership roles, and a lack of mentorship and representation. In this review, we sought to bring together the existing literature on ERT and its influence on the well-being of attending physicians in the USA, while also examining how different aspects of well-being are shaped using the PERMA (Positive emotions, Engagement, Relationships, Meaning and Accomplishment) conceptual framework for flourishing and well-being.

Methods: This scoping review was conducted according to the JBI Manual for Evidence Synthesis: Scoping Reviews Chapter. A literature search of six bibliographic databases and one grey literature source was conducted in 2023 and updated in 2024, without time restriction applied. All English language studies conducted in the USA that assessed the impact of ERT on physicians and/or physician trainees were included.

Results: Of the 4656 manuscripts identified for initial screening, 534 studies underwent full-text review, and 94 studies met inclusion criteria, with 29 studies focused on physicians alone and 18 focused on both physicians and physician trainees. Physicians most frequently described ERT in the form of devaluation of work, discrimination, explicit and implicit bias, inadequate support, professional isolation and microaggressions. Reported sources of ERT included patients, peers, other practitioners and institutional leadership. Also, ERT was consistently associated with heightened burnout, stress and isolation and was linked to diminished career advancement, reduced job satisfaction and impaired emotional well-being. Across studies in this review, all domains of the PERMA framework were adversely impacted.

Conclusion: Current evidence demonstrates that ERT profoundly undermines physicians' well-being. Urgent interventional research is needed to identify, implement and evaluate strategies that mitigate ERT's effects and promote a more equitable professional environment.

Introduction: Research on educational change consistently shows that the success of any implementation process depends on the involvement of stakeholders. The Change Laboratory (CL) is a method that involves stakeholders in co-creating their work practice. Its application in medical education has been proven to result in improvement of learning environments. The aim of this study is to explore participants' perceptions on how the use of the CL impacts their commitment to change.

Methods: We conducted a qualitative study to explore participants' experiences with a CL intervention focused on redesigning a workplace-based assessment program in postgraduate medical training in Oman. Semi-structured interviews with nine participants (residents, faculty and administrators) were conducted to examine how the CL process influenced their commitment to change, focusing on learning and agency. Data collection and analysis followed an iterative process. We used a reflexive thematic analysis approach and constructed a model of how the CL intervention resulted in transformative changes at the individual, team and organization levels.

Results: Participants' intrinsic motivation to actively engage in assessment re-design was driven by perceptions of a shared understanding of tensions in the assessment system and the realization that, as a group, they would be able to initiate meaningful change. Three shifts experienced by participants while progressing through the CL were identified: from individual learning to collective competence; from individual responsibility to collective agency; and, from collective agency to organizational learning, reflecting engagement in change processes beyond participants' residency training program.

Conclusion: By illustrating how a CL intervention fosters transformative shifts in learning and agency, at individual, collective and organizational levels, this study extends prior work on participatory design in medical education. It provides empirical evidence that co-creation supports both personal and professional development, fostering stakeholders' competencies to collaboratively navigate and lead educational change processes.

Introduction: The field of health professions education has seen growing emphasis on inclusive pedagogies and learner diversity. Universal Design for Learning (UDL) offers a framework for designing educational experiences that accommodate diverse learning needs. Applying this principle to research, we must consider not only what we research but also how we research. Dyslexia is one example where traditional research practices may unintentionally marginalise participant voices. Conventional research interviews-especially those relying heavily on verbal recall and heavy question-answer formats-may not be the most accessible or inclusive method for gathering rich data with participants who are dyslexic. However, recent research reports that those with dyslexia excel at visualisation, creative thinking, identifying patterns and oral communication. In response to these characteristics and challenges, we adopted journey mapping to create a more inclusive research experience.

Methods: We explored the learning journeys of health professions educators who have dyslexia. We conducted six semi-structured online interviews utilising participant-created journey maps as a creative and inclusive method for data construction. The maps were used as a visual prompt and a reflection tool before and during the interviews. Data were analysed using reflexive thematic analysis.

Results: The mapping provided participants with an enjoyable, engaging, autonomous means of reflection, enabling them to structure and tell their stories in a personally meaningful way. It supported verbal articulation during interviews by offering visual scaffolding and helped reduce cognitive load by allowing time to reflect, plan and organise responses in advance.

Discussion: Adapting research methods to ensure a more inclusive approach has the potential to create more authentic, rich data and a fun and engaging experience for participants. The visual nature of mapping is a key advantage; however, researchers must mitigate the potential harm to participants elicited through the depth of reflection of negative experiences. Clear instructions and reassurance relating to creative confidence are key to executing this approach.