Medical Teacher最新文献

Purpose: Near-peer teaching (NPT) is widely used to substitute faculty in undergraduate clinical skills training. However, little is known about which educational design choices are made when incorporating NPT, prompting the following research questions: What were course directors' design choices when incorporating near-peers into clinical skills courses? And, what were the reasons for these design choices?

Materials and methods: This descriptive qualitative study carried out 25 semi-structured interviews with course directors from 12 countries who had recently published on NPT, complemented by other, recognized NPT experts. Reflexive thematic analysis of the transcribed interviews combined inductive and deductive approaches. Cognitive Apprenticeship informed the deductive analysis.

Results: Course directors appointed near-peers to teach standardisable skills to small groups of beginners in courses without patients - complemented by faculty supervision. Some directors involved near-peers in co-designing education, co-assessments, or co-facilitating transition to clinical practice. Course directors justified their choices based on near-peers' limited content expertise, but also their adherence to teaching scripts, cognitive congruence with students, social proximity, digital/technical literacy and low costs.

Conclusions: Course directors' design choices were mainly inspired by working around near-peers' limitations. Some courses capitalised on near-peers' unique perspectives, extending near-peer roles to co-designing education and co-facilitating transitions to practice.

Background: In medical training, learning typically involves individuals interacting asymmetrically: instructors who explain and demonstrate and learners who follow these instructions. However, there are also moments when learners lead the interaction, for example by pointing out unclear connections. This shifting 'dance of leadership' manifests in measurable patterns of visual attention, whose impact on learning is not well understood.

Methods: Using dual mobile eye-tracking methodology, we explored the joint eye movements of 29 teacher-student pairs (mean age = 24 years ± 3; 16 females) during a simulated sonography training in an OR environment. Using diagonal cross-recurrence analysis, we computed the gaze lag time for one person to couple the other's gaze pattern, which we used as a proxy for leader-follower behaviors. Afterward, we quantified the relative frequency of leading behaviors across distinct regions within the training environment and examined their relationship to learning performance metrics.

Results: We found that leader-follower behavior varied substantially. Teachers consistently led attention on the sonography monitor, showing tight coupling and minimal variation, reflecting its role as the procedural core. Students more frequently initiated gaze toward anatomical references and during interpersonal interactions. Importantly, only teacher-led guidance toward anatomical references was positively correlated with learning outcomes (r = .50, p < .01).

Conclusions: This study reveals that visual leadership during sonography training follows a two-tiered structure: instructor-dominated domains for technical execution and learner-engaged zones for exploration and social interaction. These insights about leader-follower dynamics could be used for targeted analysis and adaptation of clinical teaching situations.

Purpose: Creating clinically complex Multiple Choice Questions (MCQs) for medical assessment can be time-consuming . Large language models such as GPT-4, a type of generative artificial intelligence (AI), are a potential MCQ design tool. Evaluating the psychometric properties of AI-generated MCQs is essential to ensuring quality.

Methods: A 120-item mock examination was constructed, containing 40 human-generated MCQs at novice item-writer level, 40 at expert level, and 40 AI-generated MCQs. int. All examination items underwent panel review to ensure they tested higher order cognitive skills and met a minimum acceptable standard. The online mock examination was administered to Australian medical students, who were blinded to each item's author.

Results: 234 medical students completed the examination. Analysis showed acceptable reliability (Cronbach's 0.836). There were no differences in item difficulty or discrimination between AI, Novice, and Expert items. The mean item difficulty was 'easy' and mean item discrimination 'fair' across all groups. AI items had lower distractor efficiency (39%) compared to Novice items (55%, p = 0.035), but no difference to Expert items (48%, p = 0.382).

Conclusions: The psychometric properties of AI-generated MCQs are comparable to human-generated MCQs at both novice and expert level. Item quality can be improved across all author groups. AI-generated items should undergo human review to enhance distractor efficiency.

Purpose: As academic medical leaders, we aimed to improve the workplace by promoting joy at work. Unlike deficit-based approaches that focus on burnout or disengagement, joy is a strength-based approach. Nurturing joy increases productivity, creativity, and happiness. To achieve our aim, we performed a scoping review on how leaders can better support joy at work for individuals in the academic medical setting.

Methods: We searched seven databases, including peer-reviewed studies, books, book chapters, conference abstracts, and dissertations with no restriction on study design or country. Initial screen was abstract and title. Two reviewers screened, two extracted information, and a third reviewed entries. Discrepancies were resolved by consensus.

Results: 4649 publications were found (2465 after duplicate removal), 123 had full-text review, 25 met the inclusion criteria and were published between 1997 and 2023, conducted in the United States (n = 22), the United Kingdom (n = 2), and Canada (n = 1). Themes included shifting to a strengths-based focus on joy at work, implementing programs to prioritize it, and the key role of leaders in championing joy.

Conclusions: Making system-level changes and adopting evidence-based programs that promote joy at work for academic physicians is effective. Ensuring that leaders are competent in using evidence-based approaches to improve joy is key.

Introduction: Despite challenges, interprofessional education during clinical placements offers well documented benefits. Interprofessional learning remains underutilised and under-researched in primary care practice-based settings. Sydney Medical School, Australia, implemented a program placing medical students in diverse primary care health professions. Grounded in bounded relativism and social constructivism, This study explored students' perceptions of the educational value of these placements.

Methods: Data from second year medical student survey responses (n=299) from 2021-2023 and ten student written reflections and interviews (2021-2022) were triangulated. We employed situated learning theory as a theoretical framework which envisioned student learning across various health professions representing different communities of practice (CoPs). These form a complex social learning system, creating an intricate landscape of practice.

Results: We derived four themes: (1) A real-world understanding of primary care (2) Reaching a broader understanding of roles (3) Broadening clinical expertise and (4) Boundary crossing and navigating barriers.

Discussion: While their engagement with other health professions was peripheral, students reported considerable benefits from interprofessional learning in primary care. Using the landscape of practice model, this study highlighted how boundary objects impacted students' learning as they navigated various CoPs. These insights align with situated learning theory, emphasising the value of interprofessional experiences beyond traditional medical training.