Medical Education最新文献

Introduction: This study explored medical residents' experiences of redeployment during the COVID-19 pandemic. With the benefit of time and reflection, this study went beyond an 'educational deficit' perspective on redeployment and examined these experiences to better understand enduring tensions in medical education, prepare leaders for ongoing tensions and future crises, and to inform professional identity formation theory.

Methods: This was a qualitative, interpretive study informed by professional identity formation concepts related to work-identity integrity threats. Between April and November 2023, 15 residents from seven specialties at a large urban university in Canada were interviewed about redeployment processes and experiences. An abductive analysis approach was used to examine how residents made meaning of their profession, specialty and workplace in light of these experiences.

Results: The meaning participants made of redeployment processes depended on their interpretations of fairness, alignments with their perceived identity as a physician, and sense of usefulness during redeployment experiences. While participants noted a lack of socialisation and connection within their specialty as potentially disruptive to professional identity formation, broader sociopolitical dynamics (e.g. anti-vaccine movements) and local microcontexts (e.g. appreciative clinical teams) mattered most in their reflections. Experiences of redeployment elicited reflections on historical relationships between specialties. Some of those reflections were specific to the pandemic context, while others prompted broader reconsiderations of trends towards hyperspecialisation within the profession.

Discussion: These results provide insight into how future crises might be best approached, but also how wellness and resilience might be supported in non-crisis situations. This analysis also suggests a potential unfreezing of long-standing interspecialty tensions. The endurance of these shifting dynamics is worth exploring, particularly in light of policy imperatives towards more flexible and responsive systems. Theoretically, this analysis invites considerations of professional identity formation to better account for broader sociopolitical dynamics and the local dynamics of workplaces.

Background: In the English National Health Service, and other health care systems internationally, there have been growing numbers of doctors working on a short- or long-term temporary basis as 'locums'. Social environments and professional relationships are fundamental to learning in clinical contexts; however, locums are often positioned at the periphery of the organisation and the clinical team. An examination of locum learning and continuing professional development is vital to understanding the implications of temporary working for the growing numbers of mobile doctors, often working at the margins of the medical workforce, and whose career trajectories may diverge from traditional models.

Methods: Qualitative interview and focus group data were collected from 130 participants, including 88 professionals and 42 patients, between March 2021 and April 2022 in primary and secondary health care organisations in the English NHS. Participants included locums, patients, permanently employed doctors, nurses and other health care professionals with governance and recruitment responsibilities for locums. Data were analysed using reflexive thematic analysis and abductive analysis.

Results: Four themes were developed from the data: (1) exclusion from formal and informal learning opportunities; (2) self-directed learning and workarounds; (3) decline in knowledge and clinical skills; (4) effects on the professional development of the wider team. Locums were frequently excluded from feedback and learning opportunities because they were considered expensive and not the responsibility of the organisation and there to work, not to train. This meant that professional development was often the responsibility of the locum, self-directed and divorced from context. Locums often did not take on educational supervision roles for the wider team, meaning wider learning and development were disrupted or paused.

Conclusion: To address the challenges locum working might bring for learning and professional development, professional bodies should provide guidance for locum doctors highlighting the risks associated with taking on locum work before medical knowledge and experience are established. To improve quality and safety, organisational leaders should include locums in developmental opportunities. Finally, policy makers need to strike a balance between using locums to address short-term workforce quotas and the long-term impact on the knowledge and development of the workforce and patient safety.

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.

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.

Reid et al. respond to recent challenges to reliability norms in assessment by reinforcing the primacy of validity and reflecting on test length, assessment burden and implications for culture change.

Introduction: Acute care paediatric teams face ambiguous, dynamic patient care situations that demand adaptability to avoid patient harm. Team huddles and adaptation processes have shown promise in mitigating risk and reducing harm. One team process that may occur in huddles is team reflection (TR), defined as a team's capacity to consciously reflect on the group objectives or strategies to adapt to dynamic circumstances. Prior research on in-action TR during patient care episodes demonstrated improved team performance and learning. This study explored how interprofessional teams experience pre-action TR through a simulated huddle before patient arrival. A better understanding of pre-action TR behaviours may reveal an underutilized strategy for improving team function and patient outcomes.

Methods: The authors used simulation-primed qualitative inquiry to examine pre-action TR. Eleven multidisciplinary, interprofessional paediatric critical care teams (four to six members) participated in a simulation in which they were handed off a critically ill patient with imminent arrival time and instructed to plan care, immediately followed by focus groups to explore their experience of pre-action TR. A deductive then inductive approach to thematic analysis was applied using the TuRBO framework: (a) seeking information, (b) evaluating information, and (c) planning.

Results: Teams reported that pre-action TR behaviours fostered psychological safety, reduced barriers for sharing input, supported inclusive leadership, and enhanced shared mental model generation. These behaviours also enabled more effective and efficient planning. Importantly, participants described how pre-action TR behaviours both relied on and reinforced team dynamics such as team familiarity, trust, and psychological safety-highlighting their self-amplifying nature.

Conclusion: Pre-action TR behaviours promote team engagement and coordination, serving as a powerful tool in both training and practice. Integrating TR behaviours into huddles is a feasible strategy to strengthen team training, team dynamics and readiness. Future research should quantify its impact on team performance and patient outcomes.