Medical Education最新文献

Introduction: Interviews are central to many qualitative studies in health professions education (HPE). However, researchers often struggle to elicit rich data and engage diverse participants who may find this strategy exclusionary. Elicitation techniques are strategies tailored to address these challenges, enhancing oral conversations through other forms of interaction-for example, participant photography and neighbourhood walks. These strategies are tailored to elicit the rich data needed to address complex problems and meaningfully engage participants. Unfortunately, guidance on these techniques is scattered across literatures from diverse fields. In this synthesis, we offer an overview of the elicitation techniques available and advice about how to choose between them.

Methods: We conducted an integrative review, drawing on methodological literature from across the health and social sciences. Our interdisciplinary searches yielded 3056 citations. We included 293 citations that were methodologically focused and discussed elicitation techniques used in interviews with adults. We then extracted specific elicitation techniques, summarising each technique to capture key features, as well as strengths and weaknesses. From this, we developed a framework to help researchers identify challenges in their interview-based research and to select elicitation techniques that address their challenges.

Results: To enrich data, researchers might seek to shift conversations away from participants' entrenched narratives, to externalise conversations on sensitive topics, or to elicit affect, tacit knowledge or contextual details. When empowering participants, researchers might seek to increase equity between the researcher and participant or foster interview accessibility across diverse participant populations.

Discussion: When chosen with study goals in mind, elicitation techniques can enrich interview data. To harness this potential, we need to re-conceptualise interviews as co-production of knowledge by researcher(s) and participant(s). To make interviews more equitable and accessible, we need to consider flexibility so that each participant can engage in ways that best suit their needs and preferences.

Introduction: Immersive simulations can evoke a range of emotions in students. However, little is known about how facilitators recognise and respond to students' emotions during simulations. This study aims to understand how simulation facilitators perceive and respond to students' emotions during simulation-in order to optimise learning.

Methods: We conducted semi-structured interviews with 10 simulation facilitators who had varying experiences in simulation-based practice. We explored their experiences of students' emotions in simulations and reactions to these perceived emotional states. Applying an Interpretive Descriptive methodology, drawing upon control-value theory, we iteratively and reflexively developed themes to address our research question. Based on a contrasting analysis, we used the concept of 'crafted stories' to represent our findings.

Results: We identified three recurring issues and crafted these into stories: (1) facilitators that recognise emotions and adjust the complexity of the simulation in order to dampen intense negative emotions and 'preserve learning'; (2) those that recognise mainly negative emotions and argue that it is better to let them feel the 'heat' in order to prepare them for the realities of clinical practice; (3) those that recognise both negative and positive emotions but let the simulation run as planned for all learners and attend to emotional responses during debriefing.

Conclusion: Simulation facilitators become aware of students' emotional responses through a range of cues. While some facilitators continually move and react to students' emotions, others intentionally hold back from attempting to alter students' emotional responses. Facilitators' beliefs about how to optimise learning mediate how they react to students' emotional states. Beliefs about learning are predominantly shaped by their experiences in both teaching and real-world clinical practice. By understanding the delicate balancing act of students' emotional states and altering the complexity of a simulation, we have the opportunity to inform facilitator training in order to enhance learning.

Background/objective: In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will "monitor and advise" residents. We sought to clarify how AA-resident dyads collaboratively interpret assessment data from multiple sources, co-create learning goals and action plans and attempt to enhance residents' SRL skills.

Methods: Shortly after each of their six meetings during two years of Internal Medicine residency, we conducted individual, brief interviews with AAs (N = 10) and residents (N = 10). We analysed transcripts using an abductive framework with theory-based and evidence-based sensitizing concepts.

Results: We collected 49 residents and 36 AA 'meeting debriefs', which produced rich data on how dyads variably engaged in SRL and Co-RL. Residents and AAs adopted "learning stances" that oriented their perceptions and approaches to Co-RL. Their stances did not always align within dyads. We found unique patterns in how stances evolved or devolved over time, and in how these changes impacted dyads' Co-RL processes. While some dyads evolved to engage in proactive co-regulation, most stayed consistent or oscillated reactively in their relationships, with little apparent Co-RL focused on helping residents to develop clinical competencies through SRL. We catalogued multiple influential sources of regulation of learning.

Conclusion: The conceptually ideal form of Co-RL was not consistently achieved in this well-intended implementation of AA-resident dyads. To better translate 'coaching over time' from intention to practice, we recommend that residency programmes use Co-RL principles to refine CBME processes, including refining assessment tools, resident orientation sessions and faculty development practices.

Introduction: Health professions training programmes face increasing reports of professionalism lapses, which can delay, or end, trainee progression. How programmes respond to professionalism lapses to facilitate professional identity development has not been clarified. The objective of this study is to identify factors that facilitate and impair transformations around professionalism lapses in health professions training programmes.

Methods: We conducted a qualitative study interviewing 5 faculty and 20 trainees with firsthand or secondhand experience with professionalism lapses from a range of health professions training programmes at McMaster University. Using reflexive thematic analysis, we coded verbatim transcripts informed by the lenses of social and transformative learning theories. We constructed themes through iterative and comparative analysis, seeking meaningful variation across professions and triangulating faculty and trainee perspectives.

Results: Four themes were constructed. First, lapses are in the eye of the beholder with personal definitions intersecting with institutional and situation norms. Difficulties exist in recognising and convincing trainees to respond to lapses that are perceived to be minor or subject to interpretation. Second, responses to professionalism lapses occurred within power hierarchies, which impacted how trainees reacted to the remediation process, risked superficial trainee responses to concerns and led to concerns around inequitable treatment in how standards were applied. Third, fostering transformation involves building trainee confidence, agency, trust and engagement. Focused support and advocacy for trainees can empower and promote agency in tackling disorienting lapses. Fourth, perspective shifts involve deep engagement over time, including but not limited to self-reflection, structured discussion and seeking support.

Discussion: Identifying and addressing professionalism lapses is complex and requires nuanced and contextual exploration of personal, institutional and situational dynamics at play. By fostering environments that promote genuine reflection and dialogue and focus on building trainee confidence, agency, trust and engagement, health professions training programmes can better support trainees in navigating these complex situations and contribute to the broader goal of socialising to a professional culture and practice.

Introduction: Research on feedback has shifted emphasis away from its 'delivery' to consideration of the interaction between individual learners and their 'feedback provider'. The complexity inherent in determining whether feedback is perceived as valuable by learners, however, can quickly overwhelm educators if every interaction must be considered completely idiosyncratic. We, therefore, require a better understanding of variability in the ways in which feedback is perceived. To that end, we ran a discrete choice experiment aimed at determining residents' preferences and whether discernible patterns exist across learners regarding factors that influence perceptions of feedback's learning value.

Methods: We performed a discrete choice experiment in which respondents were asked to read a clinical case and select repetitively between two feedback scenarios that differed according to six attributes identified from the literature as influencing feedback credibility: Dialogue, Focus, Relationship, Situation, Source and Valence. By systematically varying the levels of each attribute contained in the scenarios and asking residents to choose which from each pair they deemed more valuable for learning, a mixed logit model and latent class analysis could be applied to determine learners' feedback preferences and whether clusters of preference exist.

Results: Ninety-five elderly care medicine residents in the Netherlands completed the questionnaire. Their responses indicated that Valence, Dialogue, Relationship and Focus each accounted for about 20% of their preferences regarding the type of feedback perceived to offer the most learning value. Source and Situation were less influential, each accounting for 11% of the choices made. A latent class model with three clusters of respondents best accounted for the heterogeneity in feedback preferences. A total of 62% of respondents could be assigned to one of the three profiles with at least 80% probability. None of the respondents' characteristics (seniority, residency programme nor sex) were related to the feedback preference profile.

Discussion: Our findings suggest that 'how' feedback is provided has a greater influence on perceived learning value than who provides it. That said, variability exists in resident perceptions with no evidence (as yet) of factors that predict individual preferences. As such, tailoring to the needs and reactions of individual learners is likely to require open and ongoing conversations, and we recommend using the learner profiles generated through this study as a starting point because they provide classifications that could facilitate effective connections for the majority of residents.