Medical Teacher最新文献

Despite increasing acknowledgment of racism in both the curricular and clinical spaces, it continues to pervade the medical field, with clear detrimental impacts to the health of our patients. The introduction of anti-racism bystander training (ARBT) may provide a unique opportunity to reduce inequitable care and health disparities that occur secondary to racism in healthcare. ARBT, in its various forms, has been shown to be an effective method to increase participants' confidence and efficacy in intervening on observed racist encounters. This training can take numerous forms, and the authors provide one successful template used with medical students at their own institution. If medical centers, educators, and leaders in the field of medicine truly hope to mitigate the individual racist behaviors that remain in healthcare, ARBT must be employed to a much wider degree in medical education.

Introduction: Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes.

Method: We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645).

Results: When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach.

Conclusion: Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.

Purpose: This study aims to understand what is known about the high performing or exceptional learner in medical education. There is a rich literature about learners in difficulty, yet little is known about those performing at the high end, also known as exceptional learners.

Methods: A qualitative study was undertaken whereby 15 faculty members at the University of Toronto were interviewed to explore their experiences with these learners.

Results: Based on the findings, we developed a framework to categorize characteristics of exceptional learners by differentiating them as either 'Being' (a pre-existing attribute or set of values that the learner possesses from the start of training) or 'Doing' (demonstrable characteristics that can be observed or measured). Using this framework, we identified five characteristics in the category of 'Being', five in the category of 'Doing', and two that could be situated in either or both.

Conclusion: Utilizing this framework to describe exceptional learners will aid teachers in identifying them early in their training so that their training experience can be enhanced. This novel approach contributes to our knowledge of the exceptional medical learner. The optimization of the training experience will maximize the opportunity to ensure that these learners reach their full potential to contribute to the healthcare system.

Purpose: Coaching in medical education facilitates learners' growth and development through feedback, goal-setting and support. This study explored how coaching relationships evolve throughout medical school and the impact of longitudinal coaching relationships on medical students' approach to feedback and goal setting in the clinical years.

Method: In this qualitative study using a constructivist paradigm, authors purposively sampled 15 senior medical students at University of California, San Francisco, to participate in individual semi-structured interviews (October-November 2021). The authors used an inductive approach to thematic analysis.

Results: The authors identified four themes: First, the student-coach relationship deepened over the course of medical school. Second, students identified factors that sustained and strengthened the student-coach relationship over time: a strong foundation to the relationship, the non-evaluative nature of the relationship, coach supportiveness and responsiveness, and coach knowledge of the institutional landscape. Third, coaches provided individualized advice, assessed trajectory, and guided feedback interpretation. Lastly, students applied skills of soliciting and responding to feedback and creating learning goals, originally learned through coaching experience.

Conclusions: Coaching relationships, grounded in trust, evolve to meet students' changing needs as they grow into physicians. Students apply feedback and goal-setting skills learned with the coach in clinical settings with other supervisors.

An internship with the Association for Medical Education in Europe (AMEE) Faculty Development (FacDev) Committee has proven to be a useful approach to engaging and supporting emerging faculty developers through social learning and communities of practice. An essential aspect of this internship process is to expand the membership of the faculty development team, fostering the individual and collective capabilities required to navigate the complexity of implementing AMEE faculty development goals.

Purpose: We have evaluated the final-year Psychiatry and Addiction Medicine (PAM) summative Objective Structured Clinical Examination (OSCE) examinations in a four-year graduate medical degree program, for the previous three years as a baseline comparator, and during three years of the COVID-19 pandemic (2020-2022).

Methods: A de-identified analysis of medical student summative OSCE examination performance, and comparative review for the 3 years before, and for each year of the pandemic.

Results: Internal reliability in test scores as measured by R-squared remained the same or increased following the start of the pandemic. There was a significant increase in mean test scores after the start of the pandemic compared to pre-pandemic for combined OSCE scores for all final-year disciplines, as well as for the PAM role-play OSCEs, but not for the PAM mental state examination OSCEs.

Conclusions: Changing to online OSCEs during the pandemic was related to an increase in scores for some but not all domains of the tests. This is in line with a nascent body of literature on medical teaching and examination following the start of the pandemic. Further research is needed to optimise teaching and examination in a post-pandemic medical school environment.

Introduction: Health professions education (HPE) should help students to competently self-regulate their learning, preparing them for future challenges. This study explored the perspectives of expert self-regulated learning (SRL) researchers and practitioners on the practical integration of SRL theories into teaching.

Methods: An exploratory qualitative research study was conducted involving semi-structured interviews with acknowledged research leaders in the field of SRL and/or experienced professionals dedicated to teaching SRL strategies for complex skills in different disciplines. The data were analyzed using an iterative thematic approach guided by a six-step framework.

Results: Fifteen interviews were conducted with experts from six countries representing diverse contexts, cultures, and disciplines. We identified five themes related to translating theory to practice for teaching SRL in HPE: theoretical issues, cultural aspects, stakeholders' participation, teaching complexity, assessment, and feedback.

Conclusions: This study presents a useful starting point for teaching SRL. The experts suggest a supportive learning environment with the guidance of competent teachers by using general and task-specific teaching and learning strategies, as well as sufficient sources and cycles of feedback, all tailored to the culture and context. These findings call for a shift in faculty development programs to foster teachers to support second-order scaffolding in HPE.

Background: It is unclear whether alternating placements during clinical clerkship, without an explicit emphasis on clinical competencies, would bring about optimal educational outcomes.

Methods: This is an explanatory sequential mixed-methods research. We enrolled a convenience sample of 41 eight-year programme medical students in Sun Yat-sen University who received alternating placements during clerkship. The effects of competence-based approach (n = 21) versus traditional approach (n = 20) to clerkship teaching were compared. In the quantitative phase, course satisfaction was measured via an online survey and academic performance was determined through final scores on summative assessment. Then, in the qualitative phase, students were invited for semi-structured interviews about their learning experiences, and the transcripts were used for thematic analysis.

Results: Quantitative findings showed that students in the study group rated high course satisfaction and performed significantly better in their final scores compared with those in the control group. Qualitative findings from thematic analysis showed that students were relatively neutral about their preference on placement models, but clearly perceived, capitalised, and appreciated that their competencies were being cultivated by an instructor who was regarded as a positive role model.

Conclusion: A competence-based approach to clerkship teaching resulted in better course satisfaction and academic performance, and was perceived, capitalised, and appreciated by students.

Medical trainee well-being is often met with generalized solutions that overlook substantial individual variations in mental health predisposition and stress reactivity. Precision medicine leverages individual environmental, genetic, and lifestyle factors to tailor preventive and therapeutic interventions. In addition, an exclusive focus on clinical mental illness tends to disregard the importance of supporting the positive aspects of medical trainee well-being. We introduce a novel precision well-being framework for medical education that is built on a comprehensive and individualized view of mental health, combining measures from mental health and positive psychology in a unified, data-driven framework. Unsupervised machine learning techniques commonly used in precision medicine were applied to uncover patterns within multidimensional mental health data of medical students. Using data from 3,632 US medical students, clusters were formulated based on recognized metrics for depression, anxiety, and flourishing. The analysis identified three distinct clusters. Membership in the 'Healthy Flourishers' well-being phenotype was associated with no signs of anxiety or depression while simultaneously reporting high levels of flourishing. Students in the 'Getting By' cluster reported mild anxiety and depression and diminished flourishing. Membership in the 'At-Risk' cluster was associated with high anxiety and depression, languishing, and increased suicidality. Nearly half (49%) of the medical students surveyed were classified as 'Healthy Flourishers', whereas 36% were grouped into the 'Getting-By' cluster and 15% were identified as 'At-Risk'. Findings show that a substantial portion of medical students report diminished well-being during their studies, with a significant number struggling with mental health challenges. This novel precision well-being framework represents an integrated empirical model that classifies individual medical students into distinct and meaningful well-being phenotypes based on their holistic mental health. This approach has direct applicability to student support and can be used to evaluate the effectiveness of personalized intervention strategies stratified by cluster membership.