Medical Teacher最新文献

Introduction: Questioning has, since Socrates, been touted as an effective teaching technique, but its use in health professions education is controversial due to the risk of inducing counterproductively negative trainee experiences. While much has been written on optimal methods of questioning, disconnects continue to arise between well-intentioned preceptors and how questioning is experienced. Thus, the authors explored if and how learners try signalling to preceptors when questioning leads to a positive learning experience and when it ceases to be educationally valuable.

Methods: The authors conducted semi-structured interviews with 12 senior internal medicine residents to elicit perspectives on how they try to signal their wishes to preceptors during questioning interactions. This was followed by one focus group with 5 additional participants. The methodology was constructivist grounded theory and rigour was enhanced through iterative data collection and analysis, constant comparison, and theoretical sampling.

Results: Signalling was confirmed to be an important concept in resident-preceptor interactions because comfort with questioning was not universally positive or negative. Rather, participants signalled their openness to questioning in context-dependent ways influenced by a variety of factors. In addition to their own signalling, participants reported recognizing and responding to signals from their juniors, peers and attendings, further highlighting the communicative nature of cues being sent.

Discussion: With a better understanding of the contextual factors to be considered before entering a questioning interaction and identification of cues that residents believe they offer as signals of encouraging or discouraging engagement in such interactions, attending physicians should be better able to navigate clinical teaching moments to optimize resident learning.

Purpose: The Master Adaptive Learner (MAL) is a model describing the collective skills of planning, learning, assessing, and adjusting that may translate into continually improving clinical proficiency. The objective of this study was to develop a MAL assessment instrument to measure these skills.

Method: 1,427 students completed the 36-item candidate MAL instrument. The authors performed exploratory factor analysis (EFA) on half of the dataset. The factors and items were determined by eigenvalues, structure, parsimony, and theoretical considerations. Once an appropriate factor structure was identified, confirmatory factor analysis (CFA) was used on the second dataset to confirm results and the global fit.

Results: The final CFA model consisted of four factors: two items in a resilience factor subscale, eight items in a MAL factor subscale, three items in a curiosity/exploration factor subscale, and three items in a motivation/mindset/challenge factor subscale. This model's scaled global fit statistics fit moderately well (CFI = 0.961, RMSEA = 0.041 (0.035, 0.047), SRMR = 0.037), indicating this was an adequate model.

Discussion: The resultant MAL instrument demonstrated sufficient internal structure validity evidence. The instrument may be useful for a variety of applications including assessment of practice-based learning competencies, coaching, and remediation activities.

The systematic alignment and analysis of educational content through curriculum mapping serves as a critical yet complex undertaking in developing, executing, and assessing medical education programs. In alignment with Kern's steps for curriculum development, the process of curriculum mapping consists of connecting curricular standards to learning objectives, educational strategies, and evaluation methods. Artificial Intelligence's (AI) Large Language Models are powerful tools for medical educators looking to optimize curriculum mapping. Following Kern's process, our twelve tips demonstrate how medical educators can harness the power of AI to enhance the efficiency and creativity of the curriculum mapping process while highlighting the limitations and boundaries of such tools.

As reviews become increasingly central to informing educational practice and guiding research in health professions education, the need for methodological clarity and quality has grown. This Commentary highlights three foundational principles - alignment, rigor, and transparency - that underpin high-quality reviews, regardless of type. We illustrate how these principles apply across commonly used review types, including systematic, scoping, realist, and narrative reviews. By aligning the research question with the appropriate review methodology, employing rigorous processes for evidence collection and synthesis, and maintaining transparency in methodological reporting, review teams can produce credible, transferable, and dependable findings. Embracing these principles not only enhances the trustworthiness of reviews but also supports stakeholders in applying synthesized knowledge effectively, ultimately advancing evidence-informed decision-making in health professions education.

Background: To date, advancing social justice in medical education has largely focused on recruitment and numerical representation of equity deserving groups. However, students recruited to diversify the profession often find themselves in an exclusionary environment that overlooks their multiple identities. The aim of this study was to illuminate underrepresented students' experiences of medical school to inform supports for these deserving students.

Methods: This meta-ethnography followed the seven steps developed by Noblit and Hare. Databases were systematically searched for peer-reviewed qualitative articles published between 2000 and late 2024 that described underrepresented students' experiences of medical school. Participants' and authors' concepts were collected and synthesized to develop new overarching concepts.

Results: Forty-nine qualitative studies met the inclusion criteria. Four overarching concepts were developed: working ten times harder; embodying the 'ideal' doctor; invisibility and hypervisibility; and survival strategies.

Conclusions: This meta-ethnography deepens our understanding of historically excluded students' experiences of medical school. The default ideal of the (cis, white, wealthy, male, non-disabled) physician created an exclusionary environment that underrepresented students were forced to manage through additional cognitive, emotional, and embodied effort. This synthesis provides valuable strategies and considerations for medical educators and administrators committed to social justice initiatives grounded in underrepresented student voices.

Purpose: Remediation programs in postgraduate medical education aim to help struggling residents successfully complete their training and graduate. Research has mostly focused on educators' and program directors' perspectives on the development and quality of remediation programs. However, little is known about the experience of being remediated. This investigation aimed to understand how practicing family physicians who underwent remediation during their residency experienced their remediation program.

Materials and methods: In this Interpretative Phenomenological Analysis (IPA) study, we purposively sampled six family medicine practitioners who underwent successful remediation as residents in a Canadian medical school. We individually interviewed them in-depth, one to six years after graduation. For data analysis, we combined IPA thematic and narrative techniques.

Results: While each participant had a unique experience of remediation, we identified a common longitudinal process of four consecutive periods: pre-remediation, remediation, and early and late post-remediation. All participants experienced the remediation announcement as shocking, surprising, and disruptive, as most were unaware that they were not reaching the expected competency standards. This triggered the hot-cognition learning process that characterized the initial phases of their remediation experience. During remediation, they went through a progressive reorganization of a self-coherent professional identity formation process, mediated by the interactions with their educators. In the early post-remediation phase, most participants accepted their teachers' and institution's educational evaluations and expectations. Some, however, started developing a dissonant professional identity vis-à-vis their community of practice. In the late post-remediation phase, most participants viewed their remediation experiences as beneficial to their career development, but others felt lasting harm, evidenced by less career satisfaction and practice advancement.

Discussion: The experience of being remediated in postgraduate medical education is an emotionally charged one. It is modulated by a variety of personal factors and surrounding features. The quality of interactions between residents who need remediation and their remediators appears to be a critical element in the success of a remediation program. Remediation, even when successful, is a shocking and emotionally challenging educational experience for those who undergo it, with important and lasting implications.

Purpose: Gossip is pervasive in residency programs and may play a key role in resident development. In this study, conducted from a constructivist vantage point, we aim to explore residents' experience of gossip in the residency workplace.

Materials and methods: Constructivist grounded theory was used to iteratively conduct and analyze interviews with 16 resident participants from pediatric, internal medicine, obstetrics-gynecology, and psychiatry programs located in the United States and the Netherlands. Interview questions focused on residents' personal experiences with gossip in training.

Results: We found that gossip has multiple emotional impacts on participants, while also helping them navigate the learning environment. Gossip participation itself must be navigated, but how participants do so varies, with each following a different map, or unspoken rules surrounding gossip etiquette, often routed by social connectivity and trust.

Conclusions: We theorize gossip as a social resource in residency training. Gossip influences residents' emotions and, through gossip, residents learn what is expected of them and from others. However, gossip is not uniformly available. Residents likely experience differential emotional support and requisite information gained through gossip. Program leaders should be aware of the influence of gossip and seek to understand social connectivity in their programs.

Purpose: Cross-cultural care competence (CCC) is vital for patient-centered care and reducing health disparities. This study explored medical trainees' perceptions of CCC education, highlighting gaps, attitudes, preparedness, skills, and challenges in curriculum integration.

Methods: Extending from a more extensive, mixed methods study that assessed Taiwanese medical students' preparedness for diverse patient groups, we invited 89 medical trainees across different training years from two medical schools to participate in 19 in-depth interviews and 14 focus groups, respectively. We conducted a deductive thematic analysis to collate codes into sub-themes and themes.

Results: Ten sub-themes that were categorized into three main themes, including (1) attitudes and awareness of CCC: knowledge, attitude toward different health beliefs, biases, and stereotypes; (2) preparedness for diverse groups, including LGBT, Indigenous, immigrant, alternative medicine users, and those with language barriers; and (3) perceptions of CCC educational environment: exposure and experiential learning, and suggestions for improvement. Trainees valued learning about diverse groups and health beliefs, but still aimed to treat all patients equally, sometimes relying on stereotypes as memory aids for disease associations. Concerns included biased teaching and role-modeling that may reinforce stereotypes. While most struggled to recall explicit CCC training, they agreed it deserved more attention despite a packed curriculum. Trainees favored integrating CCC into general education, valuing experiential learning and community engagement, though they found clinical training provided more opportunities to develop the skills.

Conclusions: Our study amplifies medical trainees' voices and provides insights into their attitudes, preparedness, and CCC learning environment in an increasingly diverse society. The findings highlight the need to develop structural competence and implement targeted interventions in faculty development, as well as to design explicit, implicit, and longitudinal CCC curricula.