Medical Education最新文献

{"title":"Virtual education strategies in the context of sustainable health care and medical education: A topic modelling analysis of four decades of research","authors":"Jihyun Lee,&nbsp;Hyeongjo Kim,&nbsp;Frederick Kron","doi":"10.1111/medu.15202","DOIUrl":"10.1111/medu.15202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The growing importance of sustainability has led to the current literature being saturated with studies on the necessity of, and suggested topics for, education for sustainable health care (ESH). Even so, ESH implementation has been hindered by educator unpreparedness and resource scarcity. A potential resolution lies in virtual education. However, research on the strategies needed for successfully implementing virtual education in the context of sustainable health care and medical education is sparse; this study aims to fill the gap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Topic modelling, a computational text-mining method for analysing recurring patterns of co-occurring word clusters to reveal key topics prevalent across the texts, was used to examine how sustainability was addressed in research in medicine, medical education, and virtual education. A total of 17 631 studies, retrieved from Web of Science, Scopus and PubMed, were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sustainability-related topics within health care, medical education and virtual education provided systematic implications for Sustainable Virtual Medical Education (SVME)–ESH via virtual platforms in a sustainable way. Analyses of keywords, phrases, topics and their associated networks indicate that SVME should address the three pillars of environmental, social and economic sustainability and medical practices to uphold them; employ different technologies and methods including simulations, virtual reality (VR), artificial intelligence (AI), cloud computing, distance learning; and implement strategies for collaborative development, persuasive diffusion and quality assurance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This research suggests that sustainable strategies in virtual education for ESH require a systems approach, encompassing components such as learning content and objectives, evaluation, targeted learners, media, methods and strategies. The advancement of SVME necessitates that medical educators and researchers play a central and bridging role, guiding both the fields of sustainable health care and medical education in the development and implementation of SVME. In this way, they can prepare future physicians to address sustainability issues that impact patient care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"47-62"},"PeriodicalIF":6.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167037","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}

{"title":"From luddite to luminary: Implementing technology in healthcare education","authors":"Stacey Kassutto,&nbsp;Suzana Tsao,&nbsp;Nadia L. Bennett","doi":"10.1111/medu.15245","DOIUrl":"10.1111/medu.15245","url":null,"abstract":"<p>The potential for technology to transform healthcare education is boundless. Here, Kassutto, Tsao, and Bennett offer thoughts on how we must engage and embrace the possibility of change rather than ignore it.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"11-13"},"PeriodicalIF":6.0,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41142577","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":"We the system: A call for a perspective shift towards systems agency in trainees","authors":"Arden Azim,&nbsp;Matt Sibbald","doi":"10.1111/medu.15242","DOIUrl":"10.1111/medu.15242","url":null,"abstract":"&lt;p&gt;In their paper ‘Constraints and affordances for UK doctors-in-training to exercise agency: a dialogical analysis’, Mattick et al call for urgent work to enhance agency for doctors-in-training.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Agency can be understood as trainees' ability to act independently within the system and make decisions about their educational trajectory, professional development and patient care.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; As a trainee impacted by COVID-19, the challenges of learning to navigate agency were exacerbated by a system under strain. While this study was conducted at the height of the pandemic, the health workforce crisis continues to threaten workplace affordances of agency.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Trainees must navigate a landscape where educational and care delivery processes are increasingly centralised, and top-down crisis responses challenge agentic behaviour.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Mattick et al call for ‘urgent work […] to provide medical trainees with greater agency and favourable workplaces’.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The authors highlight learners feeling ‘disengaged [and] resigned’ and their ‘perceived powerlessness to influence a wider agenda’.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Addressing trainees' perceived lack of agency to change the system is crucial. Maximising systems agency will mitigate disengagement and leverage changes that trainees are uniquely positioned to make. We see this paper not only as a call for greater workplace affordances but also as a call for a perspective shift on learner agency. Establishing greater workplace affordances for agency without empowering learners to recognise their position as active agents within the system will leave a critical aspect of agency unaddressed.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Reframing trainee perspective on systems agency requires answering two questions. First, we must consider ‘agency for what’—whether agency is directed towards personal trajectories or advancing health outcomes. Learner agency is often conceptualised as directed towards learners' own professional development, which can be in tension with system needs.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Cultural historical activity theory (CHAT), which positions agency as negotiated between various elements of an activity system including the learner, workplace, institution and context, provides a helpful lens to understand tensions between the objectives of agency.&lt;span&gt;&lt;sup&gt;2, 6, 7&lt;/sup&gt;&lt;/span&gt; Mattick et al suggest that learners' perceived lack of agency can arise from a shift away from the patient as the object of the activity towards systems-level issues.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; If learners also perceive agency primarily as the ability to influence their personal trajectory, learners may therefore perceive the shift from individual to systems issues as a lack of agency. Agency may be better interpreted as directed at activities spanning clinical care, research and learning, bridging the gap between the individual and th","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"57 12","pages":"1176-1178"},"PeriodicalIF":6.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15242","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41134217","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}

{"title":"Why we should view the decision of medical trainees to cheat as the product of a person-by-situation interaction","authors":"Sarah Weeks,&nbsp;Janeve Desy,&nbsp;Kevin McLaughlin","doi":"10.1111/medu.15239","DOIUrl":"10.1111/medu.15239","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cheating during medical training is a delicate subject matter with varying opinions on the prevalence, causes and gravity of cheating during training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Proposed framework</h3>\u0000 \u0000 <p>In this article, the authors suggest that the decision to cheat is best viewed as the product of a person-by-situation interaction rather than indicating inherent dishonesty and/or extrinsic motivation in those who participate in cheating. This framework can explain why individuals who would typically default to honesty may participate in cheating if there is perceived justification for cheating and where situational variables, such as ease of cheating, rewards for cheating and perceived risk associated with cheating, make the decision to cheat appear rational.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>They discuss why the impression that there is a culture of cheating can provide perceived justification for medical trainees to cheat if they have the opportunity. They then describe how aspects of medical training and assessment may enable or hinder cheating by trainees. Consistent with the person-by-situation interaction framework, they contend that our response to cheating should include interventions directed at both the person who cheated and situational variables that enabled cheating. Recognising that some forms of cheating may be widespread, difficult to detect and contentious (such as the creation and use of exam reconstructs), their proposal for dealing with suspected and pervasive cheating is to identify and target enabling variables such that the decision to cheat becomes less rational. Their hope is that in so doing, we can gradually nudge trainees and the culture of medical training towards honesty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 5","pages":"499-506"},"PeriodicalIF":6.0,"publicationDate":"2023-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41122342","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":"Interactive training in managing aggression using forum theatre","authors":"Graham Easton,&nbsp;Abigail Swerdlow,&nbsp;Sonya Rudra,&nbsp;Carly Annable-Coop","doi":"10.1111/medu.15231","DOIUrl":"10.1111/medu.15231","url":null,"abstract":"&lt;p&gt;During the COVID-19 pandemic, we were unable to deliver our usual small group face to face training in managing aggression for final-year medical students, due to restrictions on in-person contact and a reduction in available clinical faculty. We needed to shift this vital teaching online and reach large groups of students, some of whom were overseas, whilst still encouraging student engagement, interaction and stimulating critical reflection.&lt;/p&gt;&lt;p&gt;We co-designed a novel online session with an arts organisation [Performing Medicine], about managing aggression. We used forum theatre, an interactive theatrical method rooted in critical pedagogy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; In forum theatre, audience members become active participants in the performance; a scenario is presented, which is then discussed and debated, followed by a replay with audience members invited to intervene and change the outcome. First, in a series of developmental workshops with a clinician and artists, we developed an authentic scenario of a junior doctor dealing with angry patients and relatives. Then, in a 1-hour live-streamed forum theatre session, more than a hundred students were invited by expert artist-facilitators to stop the action, hear the characters' perspectives, discuss and then modify the characters' behaviours in a series of re-runs of the scenario. The forum theatre session was followed by an introduction to a five-step model for thinking about the key skills and approaches in managing aggression, illustrative stories of dealing with aggression and violence from clinical practice, and 20 minutes reflecting on self-care following such incidents, including a brief guided meditation. The session was co-facilitated by artists, the communication skills faculty and clinical education teaching fellows training in psychiatry.&lt;/p&gt;&lt;p&gt;Survey feedback was positive with 98% of respondents saying they would recommend the session to fellow students and 82% rating the session as enjoyable or very enjoyable. The text comments highlighted the value of active involvement in the forum theatre (‘I really liked being able to tweak things and then see it happen again in real life. I feel like I've lived the experience …’) and that this interactive process was much more engaging than traditional large group online formats. Students welcomed the opportunity for meditation and self-care and the reflection on learning through the five-step model.&lt;/p&gt;&lt;p&gt;High-quality technical support was critical to the online delivery of this session—without a skilled audio-visual technician and high-quality cameras, lighting and audio equipment, it would not have been such a smooth experience for students or faculty. We also learned the importance of a dedicated facilitator to monitor the online chat and gather feedback for characters performed by the artist-facilitators and to manage breakout rooms for brief student discussions. The scenario can be upsetting for students, so we give a trigger warnin","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"57 11","pages":"1130"},"PeriodicalIF":6.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15231","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41155181","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}

{"title":"Fit for purpose: Ensuring robust, contextually appropriate global accreditation practices","authors":"Carrie Cartmill,&nbsp;Mohammed Ahmed Rashid,&nbsp;Cynthia R. Whitehead","doi":"10.1111/medu.15238","DOIUrl":"10.1111/medu.15238","url":null,"abstract":"&lt;p&gt;Medical school accreditation has become an increasingly popular tool for ensuring high quality training of medical doctors across the globe, with global systems of accreditation being strongly encouraged by the World Health Assembly, World Medical Association and the World Federation for Medical Education (WFME).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Despite this growing trend towards standardisation, medical school accreditation has only recently become a topic of research inquiry.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The article by You et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; in this issue adds important data to the accreditation evidence base. After localising the WFME standards to the Chinese context, You et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; conclude that first-round accreditation improves pass rates on China's Medical Licensing Examination. We commend You et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; for the breadth and scope of their work, which included 105 medical programmes across three ‘tiers’ of schools in China, and for being cautious in assuming that an improvement in licensing exam pass rates will continue beyond the first round of accreditation. You et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; provide an example of accreditation research that accounts for the unique sociopolitical context of medical education in China. We applaud accreditation research that accounts for historical, social, political and economic contexts. We further propose that as accreditation research expands, both within North America and in geographies with newly acquired accreditation systems, researchers make use of methodologies, tools and metrics that are meaningful and valid; account for political and power dynamics within accreditation systems; and explore the unintended consequences of accreditation.&lt;/p&gt;&lt;p&gt;You et al.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; make comparisons between countries, like their own, that are newly adopting systems of accreditation, and North America, which they describe as having a ‘mature’ accreditation system. The development of accreditation in the United States is described as ‘one of the greatest chapters in the history of the profession’. While we agree that North American accreditation is mature in the sense that it has a longer history than in most countries, accreditation and accreditation research in North America are not without their own challenges. Within North America, there has historically been minimal medical education accreditation scholarship. A 2019 scoping review identified only 203 articles from inception until 2019 on accreditation, with only 36 of these representing rigorous scholarship.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; &lt;i&gt;BMC Medical Education&lt;/i&gt; published a supplement in 2020 on ‘Current themes and challenges facing Health Professions Education (HPE) accreditation in the 21st century’.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In those six articles, only three countries were represented on the authorship teams (all from the Global North), and only one paper was empirical. This small body of literature o","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 2","pages":"180-182"},"PeriodicalIF":6.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15238","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41126528","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}

{"title":"Paediatric residents painting 3D congenital heart disease models","authors":"Jared A. Sheridan,&nbsp;George Slim,&nbsp;Jessica L. Foulds,&nbsp;Carolina A. Escudero","doi":"10.1111/medu.15210","DOIUrl":"10.1111/medu.15210","url":null,"abstract":"&lt;p&gt;Congenital heart defects (CHDs) are the most common congenital anomaly affecting 1% of newborns, with 8% of CHDs having only one effective or ‘single’ ventricle. It is critical that paediatricians and paediatric residents understand cardiac defects, both anatomically and physiologically, as these lesions are commonly encountered in clinical practice. CHDs can be complex and challenging to understand. Many current educational tools for learning about CHDs have limited interactive qualities and may not support kinesthetic learning preferences.&lt;/p&gt;&lt;p&gt;3D printing technology is increasingly affordable, accessible, and can create highly accurate models of CHDs from CT or MRI scans.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; We printed 3D models of the three stages of single ventricle palliation (Stage 1: Norwood procedure for hypoplastic left heart syndrome, Stage 2: Glenn procedure, Stage 3: Fontan procedure), which are anatomically complex CHDs. These defects were chosen as each stage demonstrates significant changes in physiology which correspond to clinical manifestations in patients. We printed the models using a white firm plastic material (polylactic acid or PLA) suitable for acrylic paint application. We provided a 1 hour teaching session starting with a 20-minute didactic portion orienting the learners to the 3D models and demonstrating the cardiac anatomy via presentation by a paediatric cardiologist, followed by a 40-minute interactive portion where groups of three residents each painted a 3D model corresponding to one of the stages of the single ventricle palliation with red, blue and purple paint. Residents were instructed to use paint to demonstrate relative oxygen saturations of the blood in the different areas of the heart: red for oxygenated blood, blue for deoxygenated blood, and purple for mixed or partially oxygenated blood. Digital versions of the 3D model with the corresponding red, blue, and purple colouring (Stage 1: https://skfb.ly/otyZA; Stage 2: https://skfb.ly/otAUX; Stage 3: https://skfb.ly/oAOyV) and physical models with this colouring (Vero material using Stratasys J750 printer) were provided as guides. Two paediatric cardiology fellows circulated to answer questions and guide individual residents. Residents were encouraged to discuss their models within their groups to compare the different stages of the single ventricle palliation and could keep their painted model. Thirty-eight residents participated.&lt;/p&gt;&lt;p&gt;We found that this novel method of interactive teaching was feasible and appeared enjoyable and informative for paediatric trainees. Many residents remained beyond the allotted time to continue their conversations or to finish painting their model, suggesting that this was an interesting educational session for the residents and that an increased time allotment for the painting activity would be valuable. We observed resident engagement via discussions within their groups, comparison of the models of different stages, and resident","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"57 11","pages":"1152-1153"},"PeriodicalIF":6.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104407","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}

{"title":"‘Don't run before you can walk’: Rethinking interprofessional education for medical students","authors":"Ashley V. Simpson,&nbsp;Robyn J. Canham","doi":"10.1111/medu.15237","DOIUrl":"10.1111/medu.15237","url":null,"abstract":"","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 4","pages":"464"},"PeriodicalIF":6.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41119502","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":"To prove or improve? Examining how paradoxical tensions shape evaluation practices in accreditation contexts","authors":"Betty Onyura,&nbsp;Abigail J. Fisher,&nbsp;Qian Wu,&nbsp;Shrutikaa Rajkumar,&nbsp;Sarick Chapagain,&nbsp;Judith Nassuna,&nbsp;David Rojas,&nbsp;Latika Nirula","doi":"10.1111/medu.15218","DOIUrl":"10.1111/medu.15218","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Although programme evaluation is increasingly routinised across the academic health sciences, there is scant research on the factors that shape the scope and quality of evaluation work in health professions education. Our research addresses this gap, by studying how the context in which evaluation is practised influences the type of evaluation that can be conducted. Focusing on the context of accreditation, we critically examine the types of paradoxical tensions that surface as evaluation-leads consider evaluation ideals or best practices in relation to contextual demands associated with accreditation seeking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our methods were qualitative and situated within a critical realist paradigm. Study participants were 29 individuals with roles requiring responsibility and oversight on evaluation work. They worked across 4 regions, within 26 academic health science institutions. Data were collected using semi-structured interviews and analysed using framework and matrix analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three overarching themes: (i) <i>absence of collective coherence about evaluation practice</i>, (ii) <i>disempowerment of expertise</i> and (iii) <i>tensions as routine practice</i>. Examples of these latter tensions in evaluation work included (i) resourcing accreditation versus resourcing robust evaluation strategy (<i>performing paradox</i>), (ii) evaluation designs to secure accreditation versus design to spur renewal and transformation (<i>performing–learning paradox</i>) and (iii) public dissemination of evaluation findings versus restricted or selective access (<i>publicising paradox</i>). Sub-themes and illustrative data are presented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our study demonstrates how the high-stakes context of accreditation seeking surfaces tensions that can risk the quality and credibility of evaluation practices. To mitigate these risks, those who commission or execute evaluation work must be able to identify and reconcile these tensions. We propose strategies that may help optimise the quality of evaluation work alongside accreditation-seeking efforts. Critically, our research highlights the limitations of continually positioning evaluation purely as a method versus as a socio-technical practice that is highly vulnerable to contextual influences.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 3","pages":"354-362"},"PeriodicalIF":6.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15218","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132696","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}

{"title":"Assertiveness in physicians' interpersonal professional encounters: A scoping review","authors":"Maayan Gutgeld-Dror,&nbsp;Nathaniel Laor,&nbsp;Orit Karnieli-Miller","doi":"10.1111/medu.15222","DOIUrl":"10.1111/medu.15222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Good relationships between physicians, patients, families and the healthcare team are essential for high-quality care. Medical encounters are sometimes challenging. They may include conflicts, requiring physicians to be assertive: that is to share and protect their needs, rights and values while preserving those of others. Whereas assertiveness has been studied in patients and nursing staff (those with less power in healthcare), physicians' assertiveness, which must be mindful of these power differences, lacks a comprehensive review. Thus, this scoping review focuses on assertive communication in physicians' encounters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search of four online databases: MEDLINE, Embase, PsycINFO and WoS, seeking articles on physicians' assertiveness as a communication style published until February 2022. The Joanna Briggs Institute approach and the Preferred Reporting Items for Systematic Reviews checklist underpinned the review protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1513 articles relating to assertiveness, reviewed 153 full-text articles and selected 22 for full review, 68% from the last decade. The articles focused mainly on assertive communication and relationships with medical staff, with 54% focusing on bottom-up power relations. In 40% of the articles, no clear definition of assertiveness was included. Definitions included had varied focus: on self, on the other or both. Overall, assertiveness measures varied widely, precluding a methodical comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the growing interest in physicians' assertiveness, a clearer definition and in-depth exploration of assertiveness are needed alongside development of valid measures of assertiveness appropriate to physicians. Based on the review, we offer a relational definition of assertiveness as the capacity to communicate one's views, concerns, rights and needs while respecting others and preserving therapeutic, collegial and educational professional alliances. This definition may serve to expand research in the field while offering a professional alternative to problematic communication styles—passive and self-denying or paternalistic and aggressive —that obfuscate and thus undermine physician–patient relationships.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 4","pages":"392-404"},"PeriodicalIF":6.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135802","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}