Medical Education最新文献

Introduction: Mindsets have become an important focus in the fields of social and cognitive psychology. When holding a growth mindset, people appear more likely to engage in hard work and effort to foster success, seeing setbacks as necessary for learning. When holding a fixed mindset, in contrast, people tend to believe success comes from innate ability, seeing setbacks as evidence of inability. As such, mindsets affect students' learning, resilience and personal development. There is little empirical evidence, however, regarding how medical students perceive mindsets and the fundamental determinants of mindset formation, especially in non-Western contexts. This study investigated medical students' mindsets and perceptions of mindset formation with the aim of broadening the cross-cultural understanding of self-theories.

Methods: Using a convergent mixed-methods approach at a medical school in China, the authors conducted a survey and four focus groups with medical students in first to third years. Quantitatively, we used the Dweck Mindset Scale to describe medical students' mindsets in the domains of intelligence and talent. Qualitatively, we analysed focus group data using a grounded theory approach to develop a descriptive model.

Results: Survey results included 464 responses for quantitative analysis. Multivariable regression found that Year 3 students had more fixed mindsets for intelligence and talent (p < 0.05) compared with Year 1 students. Rural students reported a more mixed mindset for intelligence compared to urban students (p < 0.05). Qualitative analysis of focus group data yielded four major categories: beliefs about mindsets, conceptualization of mindsets, achievement motivation and source of mindset formation. We developed a Mindset Basis Model to depict connections among the factors students perceived to influence mindset formation-intra- and interindividual factors; contextual factors; and micro-, meso- and macro-system factors-and students' motivation regarding achievement.

Conclusion: The study describes medical students' mindsets for the domains of intelligence and talent and explores how they conceptualised these mindsets. The findings indicate that factors influencing mindsets do not operate in isolation but through intricate interactions among multilevel factors embedded within a context.

Introduction: Researchers who study acts of resistance largely focus on efforts when they are at their peak, giving the impression that those who resist are in a constant state of arousal. What is missing in such studies is the variable of time, which is theorised to be intimately connected to power and resistance. To explore this aspect, we followed a group of trainees engaged in professional resistance against social injustice over the period of 1 year to understand how their efforts shifted across time. This longitudinal approach was meant to capture the temporality of resistance, specifically how time affects resistance efforts.

Methods: Using a constructivist grounded theory approach for data collection and analysis, we conducted follow-up interviews with 13 trainees approximately 10 months apart. Interviews were analysed using holistic narrative analysis, in which we analysed contexts, subjectivities and interactions across the two time points. We then conducted a cross-case analysis and restoried the data to develop an understanding of how resistance shifts across time. Finally, we contextualised the data using the metaphor of open and zombie wildfires.

Results: The findings demonstrate that when trainees transition to new institutions or professional positions, their access to power and interactions with colleagues shift, thus making it challenging for them to resist in ways they had done so earlier. In transitions where trainees were given power, the flames of resistance continued to blaze visibly. In other cases, without an appreciable change in power, resistance resembled more of a 'zombie fire', smouldering quietly underfoot.

Discussion: Examining trainees' acts of resistance across time demonstrates that the work of advocacy and resistance is extremely taxing for trainees. Therefore, when they experience shifts in their context or subjectivity, they conserve energy and strategise their next move. This study provides new insight on the relationship between time and resistance.

Background: Qualitative realist analysis is gaining in popularity in health professions education research (HPER) as part of theory-driven program evaluation. Although realist approaches such as syntheses and evaluations typically advocate mixed methods, qualitative data dominate currently. Various forms of qualitative analysis have been articulated in HPER, yet realist analysis has not. Although realist analysis is interpretive, it moves beyond description to explain generative causation employing retroductive theorising. Ultimately, it attempts to build and/or 'test' (confirm, refute or refine) theory about how, why, for whom, when and to what extent programs work using the context-mechanism-outcome configuration (CMOC) heuristic. This paper aims to help readers better critique, conduct and report qualitative realist analysis.

Realist analysis methods: We describe four fundamentals of qualitative realist analysis: (1) simultaneous data collection/analysis; (2) retroductive theorising; (3) configurational analysis (involving iterative phases of identifying CMOCs, synthesising CMOCs into demi-regularities and translating demi-regularities into program theory); and (4) realist analysis quality (relevance, rigour, richness). Next, we provide a critical analysis of realist analyses employed in 15 HPER outputs-three evaluations and 12 syntheses. Finally, drawing on our understandings of realist literature and our experiences of conducting qualitative realist analysis (both evaluations and syntheses), we articulate three common analysis challenges (coding, consolidation and mapping) and strategies to mitigate these challenges (teamwork, reflexivity and consultation, use of data analysis software and graphical representations of program theory).

Conclusions: Based on our critical analysis of the literature and realist analysis experiences, we encourage researchers, peer reviewers and readers to better understand qualitative realist analysis fundamentals. Realist analysts should draw on relevant realist reporting standards and literature on realist analysis to improve the quality and reporting of realist analysis. Through better understanding the common challenges and mitigation strategies for realist analysis, we can collectively improve the quality of realist analysis in HPER.

Introduction: Although primary care professionals often encounter difficulties when attending to patients in complex and challenging social situations (CCSS), little is known about how professionals cultivate an optimistic approach to caring for patients in CCSS. This study aims to recruit professionals who exhibit a passion for seeing patients in CCSS, to gain insights into their positive attitude.

Methods: We conducted a qualitative study in Japan of 30 primary care professionals: 15 physicians and 15 non-physician professionals (nurses, medical social workers and medical clerks). We performed online in-depth interviews and employed a thematic analysis utilising the framework approach to identify how the participants felt a passion for seeing patients in CCSS.

Results: Two themes emerged about the passion: (i) the joy derived from interacting with patients and (ii) the joy derived from professional growth or development. Participants expressed curiosity about their patients, found happiness in the journey with them and established irreplaceable relationships. Concurrently, participants noted professional growth as expert generalists, and their team developed collaboration and competency through accumulating experience and learning. These two domains of joy were intricately interconnected. In addition, several factors related to developing, maintaining and spreading the positive attitude were identified.

Discussion: This study described the positive attitude of primary care professionals towards engaging with patients in CCSS. Despite the inherent challenges, these professionals demonstrated vibrancy and pleasure in their interactions with patients and their professional development. Workplace culture including team-based support and continuous learning is important in fostering and maintaining such an attitude.

Introduction: The medical school selection literature comes mostly from a few countries in the Global North and offers little opportunity to consider different ways of thinking and doing. Our aim, therefore, was to critically consider selection practices and their sociohistorical influences in our respective countries (Brazil, China, Singapore, South Africa and the UK), including how any perceived inequalities are addressed.

Methods: This paper summarises many constructive dialogues grounded in the idea of he er butong () (harmony with diversity), learning about and from each other.

Results: Some practices were similar across the five countries, but there were differences in precise practices, attitudes and sociohistorical influences thereon. For example, in Brazil, South Africa and the UK, there is public and political acknowledgement that attainment is linked to systemic and social factors such as socio-economic status and/or race. Selecting for medical school solely on prior attainment is recognised as unfair to less privileged societal groups. Conversely, selection via examination performance is seen as fair and promoting equality in China and Singapore, although the historical context underpinning this value differs across the two countries. The five countries differ in respect of their actions towards addressing inequality. Quotas are used to ensure the representation of certain groups in Brazil and regional representation in China. Quotas are illegal in the UK, and South Africa does not impose them, leading to the use of various, compensatory 'workarounds' to address inequality. Singapore does not take action to address inequality because all people are considered equal constitutionally.

Discussion: In conclusion, medical school selection practices are firmly embedded in history, values, societal expectations and stakeholder beliefs, which vary by context. More comparisons, working from the position of acknowledging and respecting differences, would extend knowledge further and enable consideration of what permits and hinders change in different contexts.