Karishma Sriram, Angela Zhu, Kathleen Timme, Jonathan G. Sawicki
Background
Resident-as-teacher (RaT) curricula are often time-limited experiences without opportunities to practice real-world teaching. We implemented a longitudinal RaT programme with self-study resources and opportunities for residents to engage in real-world teaching experiences.
Approach
We incorporated RaT curricula guidelines and grounded the programme in the theories of experiential learning and deliberate practice. We asked medical students and interns to evaluate residents' teaching skills using the teaching effectiveness instrument (TEI) on a monthly basis. We fit a repeated measures mixed linear model adjusting for residents' year of training to compare TEI scores over time for residents in the RaT programme and residents who were not enrolled. We stratified residents by year of training and used a Student's t-test to compare School of Medicine (SOM) evaluations across groups.
Evaluation
Twenty-eight residents took part in the study, 14 in each group. There was no significant increase in TEI scores of RaT residents (increase of 0.38 each quarter; 95% CI −1.41, 2.17; p = 0.42), and the change in TEI scores over time was no different than the comparison group (slope difference 0.26; 95% CI −2.34, 2.85; p = 0.85). PGY3 residents in the RaT group had higher SOM evaluation scores in the ‘Effectiveness’ and ‘Feedback’ domains.
Implication
RaT enrolment was not associated with a faster rate of change in TEI scores but was associated with higher SOM evaluations for PGY3 residents. The curricular and study design provides an example of how to implement and evaluate a longitudinal RaT programme centred on real-world teaching experiences with objective teaching measures.
{"title":"Impact of a Longitudinal Resident-as-Teacher Curriculum on Objective Measures of Teaching","authors":"Karishma Sriram, Angela Zhu, Kathleen Timme, Jonathan G. Sawicki","doi":"10.1111/tct.70283","DOIUrl":"10.1111/tct.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Resident-as-teacher (RaT) curricula are often time-limited experiences without opportunities to practice real-world teaching. We implemented a longitudinal RaT programme with self-study resources and opportunities for residents to engage in real-world teaching experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>We incorporated RaT curricula guidelines and grounded the programme in the theories of experiential learning and deliberate practice. We asked medical students and interns to evaluate residents' teaching skills using the teaching effectiveness instrument (TEI) on a monthly basis. We fit a repeated measures mixed linear model adjusting for residents' year of training to compare TEI scores over time for residents in the RaT programme and residents who were not enrolled. We stratified residents by year of training and used a Student's <i>t</i>-test to compare School of Medicine (SOM) evaluations across groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Evaluation</h3>\u0000 \u0000 <p>Twenty-eight residents took part in the study, 14 in each group. There was no significant increase in TEI scores of RaT residents (increase of 0.38 each quarter; 95% CI −1.41, 2.17; <i>p</i> = 0.42), and the change in TEI scores over time was no different than the comparison group (slope difference 0.26; 95% CI −2.34, 2.85; <i>p</i> = 0.85). PGY3 residents in the RaT group had higher SOM evaluation scores in the ‘Effectiveness’ and ‘Feedback’ domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implication</h3>\u0000 \u0000 <p>RaT enrolment was not associated with a faster rate of change in TEI scores but was associated with higher SOM evaluations for PGY3 residents. The curricular and study design provides an example of how to implement and evaluate a longitudinal RaT programme centred on real-world teaching experiences with objective teaching measures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Just as visual artists use triptychs to offer new insights by exploring a theme in three parts, these authors offer new insights into qualitative inquiry by exploring a qualitative whole that is much greater than the sum of its three parts [<span>1</span>]. In this summative commentary, we reflect on this series and offer our own triptych of what the papers in this series suggest qualitative inquiry <i>can be</i>.</p><p>First, this series surfaces the <i>layers</i> of considerations contributing to qualitative inquiry. The series itself is many-layered, stimulating our thinking about: the data we collect [<span>10</span>] and from whom [<span>4</span>]; rigour, whether related to transferability [<span>11</span>], considering our positionality as researchers [<span>12</span>], or raising issues of power and oppression [<span>3</span>]; the topics [<span>13</span>] and theories [<span>2</span>] that ground our research; and iterating our research across multiple time points [<span>5</span>]. But these authors point to other layers as well. The manuscripts by Shaffer et al. and Blalock et al. interpret meaning through layers of data over <i>time</i> [<span>14, 15</span>]. They seek to understand trajectories—of meaning and of researcher-participant relationship—as the research team bends and adjusts to the unfolding experiences of participants over time [<span>16</span>].</p><p>We also see layers of <i>analysis</i> in this series: Kerins and colleagues use multiple levels of template analysis to develop a ‘Rubik's cube’ of professional identity [<span>17</span>], while Hoffman and colleagues layer philosophies, principles and techniques to evaluate how a new medical school pursued a social mission [<span>7</span>].</p><p>Finally, the authors of Triptych 3 discuss layers as <i>dimensions</i> of transferability: Applicability, resonance and theoretical engagement [<span>18</span>], noting, for instance, how Trisukhon and colleagues' analysis of workplace learning in a Thai PICU communicated the applicability of residency training in Thailand to readers across the globe, the resonance of their themes through metaphors, and theoretical engagement through a workplace-based framework [<span>6</span>]. The data collected, the participants involved, the positionality of the researchers, the topics addressed, the theories harnessed, the longitudinal aspect of experience, the analytical possibilities and the dimensions of transferability: These are all considerations that layer into a qualitative study, shaping the insights developed therein. These are all illuminated in the manuscripts in this series.</p><p>Second, these papers highlight the ways <i>reflexive practice</i>—‘questioning how power shapes one's knowledge, assumptions, experiences and position in the world’ [<span>12</span>]—can be imagined in qualitative inquiry. Field and colleagues, for instance, argue for <i>positionality</i>—the researcher's ‘disciplined articulation’ of their location i
{"title":"Layers, Reflective Practice and Creative Play: Qualitative Inquiry Through the Lens of the How To Triptych Series","authors":"Abigail Konopasky, Lara Varpio","doi":"10.1111/tct.70255","DOIUrl":"10.1111/tct.70255","url":null,"abstract":"<p>Just as visual artists use triptychs to offer new insights by exploring a theme in three parts, these authors offer new insights into qualitative inquiry by exploring a qualitative whole that is much greater than the sum of its three parts [<span>1</span>]. In this summative commentary, we reflect on this series and offer our own triptych of what the papers in this series suggest qualitative inquiry <i>can be</i>.</p><p>First, this series surfaces the <i>layers</i> of considerations contributing to qualitative inquiry. The series itself is many-layered, stimulating our thinking about: the data we collect [<span>10</span>] and from whom [<span>4</span>]; rigour, whether related to transferability [<span>11</span>], considering our positionality as researchers [<span>12</span>], or raising issues of power and oppression [<span>3</span>]; the topics [<span>13</span>] and theories [<span>2</span>] that ground our research; and iterating our research across multiple time points [<span>5</span>]. But these authors point to other layers as well. The manuscripts by Shaffer et al. and Blalock et al. interpret meaning through layers of data over <i>time</i> [<span>14, 15</span>]. They seek to understand trajectories—of meaning and of researcher-participant relationship—as the research team bends and adjusts to the unfolding experiences of participants over time [<span>16</span>].</p><p>We also see layers of <i>analysis</i> in this series: Kerins and colleagues use multiple levels of template analysis to develop a ‘Rubik's cube’ of professional identity [<span>17</span>], while Hoffman and colleagues layer philosophies, principles and techniques to evaluate how a new medical school pursued a social mission [<span>7</span>].</p><p>Finally, the authors of Triptych 3 discuss layers as <i>dimensions</i> of transferability: Applicability, resonance and theoretical engagement [<span>18</span>], noting, for instance, how Trisukhon and colleagues' analysis of workplace learning in a Thai PICU communicated the applicability of residency training in Thailand to readers across the globe, the resonance of their themes through metaphors, and theoretical engagement through a workplace-based framework [<span>6</span>]. The data collected, the participants involved, the positionality of the researchers, the topics addressed, the theories harnessed, the longitudinal aspect of experience, the analytical possibilities and the dimensions of transferability: These are all considerations that layer into a qualitative study, shaping the insights developed therein. These are all illuminated in the manuscripts in this series.</p><p>Second, these papers highlight the ways <i>reflexive practice</i>—‘questioning how power shapes one's knowledge, assumptions, experiences and position in the world’ [<span>12</span>]—can be imagined in qualitative inquiry. Field and colleagues, for instance, argue for <i>positionality</i>—the researcher's ‘disciplined articulation’ of their location i","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/tct.70255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel G. Young, Lisa E. Herrmann, Oloruntosin Adeyanju, Stacy B. Ellen, Shelby C. White, Andrea Meisman, Francis J. Real
Background
We implemented a virtual reality (VR) communication curriculum, delivered via video teleconferencing, to fourth-year medical students entering paediatric residency. We aimed to assess the impact of a VR curriculum on attitudes and confidence around motivational interviewing (MI) competencies and measure implementation outcomes related to this novel modality of training.
Approach
Participants included fourth-year medical students enrolled in a paediatric intern-readiness bootcamp at four US medical schools in spring 2022. The VR curriculum was a 2-h mixed didactic/virtual simulation experience focused on practicing MI competencies in the context of addressing vaccine hesitancy and behavioural health counselling.
Evaluation
A retrospective pre/post Likert-scale survey measured learners' confidence related to curricular communication skills (0 = not at all confident, 4 = very confident). Paired t-tests compared changes in confidence ratings. Descriptive statistics assessed implementation outcomes including feasibility, acceptability, and appropriateness related to the delivery of remote VR simulations (1 = completely disagree, 5 = completely agree). Forty of 53 students (75%) completed the survey. Students' self-reported confidence significantly increased across all communication skills, including using reflection statements, using a presumptive announcement to introduce the influenza vaccine and providing evidence-based behavioural management strategies (all p < 0.01). Students agreed that the VR curriculum was highly feasible, acceptable and appropriate.
Implications
VR patient simulations via video teleconferencing may provide a feasible distanced platform for teaching MI skills to medical students. Such remote training may support standardised and equitable high-quality training across institutions.
{"title":"Remote VR Supports Medical Students' Communication","authors":"Daniel G. Young, Lisa E. Herrmann, Oloruntosin Adeyanju, Stacy B. Ellen, Shelby C. White, Andrea Meisman, Francis J. Real","doi":"10.1111/tct.70251","DOIUrl":"10.1111/tct.70251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We implemented a virtual reality (VR) communication curriculum, delivered via video teleconferencing, to fourth-year medical students entering paediatric residency. We aimed to assess the impact of a VR curriculum on attitudes and confidence around motivational interviewing (MI) competencies and measure implementation outcomes related to this novel modality of training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Participants included fourth-year medical students enrolled in a paediatric intern-readiness bootcamp at four US medical schools in spring 2022. The VR curriculum was a 2-h mixed didactic/virtual simulation experience focused on practicing MI competencies in the context of addressing vaccine hesitancy and behavioural health counselling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Evaluation</h3>\u0000 \u0000 <p>A retrospective pre/post Likert-scale survey measured learners' confidence related to curricular communication skills (0 = <i>not at all confident</i>, 4 = <i>very confident</i>). Paired <i>t</i>-tests compared changes in confidence ratings. Descriptive statistics assessed implementation outcomes including feasibility, acceptability, and appropriateness related to the delivery of remote VR simulations (1 = <i>completely disagree</i>, 5 = <i>completely agree</i>). Forty of 53 students (75%) completed the survey. Students' self-reported confidence significantly increased across all communication skills, including using reflection statements, using a presumptive announcement to introduce the influenza vaccine and providing evidence-based behavioural management strategies (all <i>p</i> < 0.01). Students agreed that the VR curriculum was highly feasible, acceptable and appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications</h3>\u0000 \u0000 <p>VR patient simulations via video teleconferencing may provide a feasible distanced platform for teaching MI skills to medical students. Such remote training may support standardised and equitable high-quality training across institutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mentorship as Microculture for Clinical Learning","authors":"Waseem Jerjes","doi":"10.1111/tct.70286","DOIUrl":"10.1111/tct.70286","url":null,"abstract":"","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew R. Carroll, Gal Barak, Tracy Byrne, Huma Farid
Professionalism in medicine reflects our ethos and commitment to the field. The American Board of Medicine defines professionalism in medicine as: ‘a normative belief system about how best to organize and deliver health care, which calls on group members to jointly declare (‘profess’) what the public and individual patients can expect regarding shared competency standards and ethical values and to implement trustworthy means to ensure that all medical professionals live up to these promises’ [1]. Professionalism is critical to the practice of medicine. Lapses in professionalism undermine physician-patient relationships, deteriorate team morale and hinder the efficiency of clinical care.
A study of University of California San Francisco graduates who faced the California Medical Board over a 10-year period, 95% of disciplinary actions were due to deficiencies in professionalism, and obstetrician-gynaecologists were overly represented in those (14% of all those who faced disciplinary action but only 4% of grads) [2]. These behaviours did not simply emerge during practice; the physicians who were disciplined by the Board for unprofessional behaviour were twice as likely as graduates in the control group to have received negative comments regarding professionalism during medical school. This association between early challenges with professionalism and subsequent state medical board disciplinary actions suggests that medical educators may be unable to effectively remediate professionalism concerns in a way that alters subsequent behaviour as clinical faculty.
In the clinical learning environment, providing constructive feedback and correction to learners, primarily residents and medical students, is crucial to their development and success as physicians. Medical educators have consistently identified unprofessional behaviour as a common reason for learner remediation [3], yet providing feedback on professionalism remains a significant challenge. Barriers to providing constructive feedback in an objective and timely manner include lack of time, fear of learners' responses and lack of clear goals and objectives in training programs [4]. In addition, learners may perceive feedback on professionalism as subjective and may feel targeted by the feedback; it may be perceived as criticism of character or personality traits [5]. Due to the uncomfortable nature of this type of feedback, many clinical faculty opt to note these concerns only on summative written evaluations rather than addressing them in real time. Thus, program directors and clerkship directors often find themselves providing feedback to learners on behaviours that they did not directly observe and that may have happened several weeks prior.
Using our varied experiences as teaching faculty, clerkship leadership and residency program leaders and the best available data we designed a novel framework for approach
医学专业反映了我们的精神和对该领域的承诺。美国医学委员会（American Board of Medicine）将医学专业主义定义为：“一种关于如何最好地组织和提供医疗保健的规范性信念体系，它呼吁团体成员共同声明（‘承认’）公众和患者个人对共同的能力标准和道德价值观的期望，并实施值得信赖的手段，以确保所有医疗专业人员都能兑现这些承诺。”专业精神对行医至关重要。专业精神的缺失会破坏医患关系，恶化团队士气，阻碍临床护理的效率。一项针对加州大学旧金山分校（University of California San Francisco）毕业生的研究显示，在过去10年里，95%的纪律处分是由于专业能力不足，其中妇产科医生的比例过高（在所有面临纪律处分的毕业生中占14%，但在毕业生中仅占4%）。这些行为不是简单地在练习中出现的；因不专业行为而受到委员会处罚的医生在医学院期间收到有关专业精神的负面评论的可能性是对照组毕业生的两倍。早期对专业精神的挑战与随后国家医学委员会的纪律行动之间的这种联系表明，医学教育工作者可能无法有效地纠正专业精神问题，从而改变临床教师的后续行为。在临床学习环境中，向学习者（主要是住院医生和医学生）提供建设性的反馈和纠正，对他们作为医生的发展和成功至关重要。医学教育工作者一直认为不专业的行为是学习者补习的一个常见原因，但提供专业反馈仍然是一个重大挑战。以客观和及时的方式提供建设性反馈的障碍包括缺乏时间，害怕学习者的反应以及在培训计划中缺乏明确的目标和目的。此外，学习者可能会认为对专业精神的反馈是主观的，并可能感到被反馈所针对；它可能被认为是对性格或人格特征的批评。由于这种类型的反馈令人不舒服的本质，许多临床教师选择只在总结性书面评估中注意到这些问题，而不是实时处理它们。因此，项目主管和见习主管经常发现，他们自己对学习者的行为提供反馈，而这些行为可能是他们没有直接观察到的，而且可能是几周前发生的。利用我们作为教师、见习领导和住院医师项目负责人的各种经验，以及现有的最佳数据，我们设计了一个新颖的框架，以专业行为、行动、沟通和时间轴（PACT）为中心，解决专业精神方面的失误。我们提供了一个工具箱，以告知和促进PACT框架的实施，以改善教育领导者对不专业的正式反馈，并借鉴我们与不同学习者群体的个人经验，帮助其他人考虑如何最好地促进现代医学时代的专业精神。通过对专业失误采取统一的方法进行早期识别和干预，我们希望减少卫生专业学习者未来的复发。学员从同伴、教师和其他榜样那里学习专业精神，而教师和榜样对专业精神的破坏可能意味着接受不专业的行为。一项研究表明，所有的学习者都观察到教师的不专业行为，从严厉的言论到不必要的挑逗。这种消极的角色模仿本质上有助于学习者对专业精神的基本理解。各院校都有专业标准，但这些标准在多大程度上传达给不同层次的学习者是不同的。考虑到培训期间可能出现的普遍的专业问题，分享这些期望是至关重要的。在回顾全国妇产科住院医师项目的整改情况时，85%的项目将住院医师纳入了整改计划，最常见的整改原因是违反了专业准则。Sullivan等人发现了不专业的行为，包括旷工、迟到、不尊重的语言、缺乏问责和职业不当行为。这些行为沿着一个连续体存在（方框1），作者将这些行为按严重程度和需要补救的紧迫性[8]分级。 我们框架的第一个方面侧重于确保学习者对行为进行客观和离散的观察，因为非特定和主观的反馈不能提供明确的改进路径。此外，标准化的专业化方法减轻了隐性偏见，使医学教育者能够公平客观地对待补救措施。多项研究表明，在对住院医生，特别是外科住院医生的评估中存在性别偏见的可能性，我们认为，统一的方法关注客观数据可能有助于减轻这种情况[9,10]。领导者应该熟悉研究生医学教育认证委员会（ACGME）、美国妇产科医师学会（ACOG）和其他专业组织提供的识别和减轻偏见的资源。认识到专业发展和医疗保健系统质量改进（QI）努力之间的相似之处，我们开始构建框架，假设所有临床学习环境中的学习者和工作人员都有最好的意图，我们还注意到医院是一个压力很大的领域，对所有参与者都有认知要求bb0。根据我们的经验，使用这种技术有助于减轻学习者在接触有关专业的反馈时经常感到的受迫害感。承认和认识导致不专业行为的因素对于调查专业问题也至关重要，因为它们为指导和有针对性的干预提供了机会（方框2）。例如，一位员工表现得不专业，可能是对消极的职场文化做出的反应，或者是对被暗示为可接受的行为做出的反应。最终，这两个问题都需要得到解决，以充分管理有关不专业的报道。最终，当考虑到促进专业精神类似于QI努力时，目标是寻求改进的方法，而不是在承认个人责任和系统挑战的同时责怪他人。在QI中，案例审查和数据分析过程导致通过计划、执行、研究、行动（PDSA）循环实施顺序变更，并创建一个支持循证决策的系统。对于学习者的发展和补救，个人支持和成长反馈应该与促进专业行为的文化变革相结合。当领导者接近调查步骤时，他们可以识别导致这种行为的各种压力，以及解决这些压力的方法，以及一个连续的、迭代的过程，以改善学习者的“结果”。本地项目，如针对医学生和临床能力委员会（CCC）的中期反馈，以及针对住院医生的半年度评估，为领导者提供了了解他们在急性问题之外的临床学习环境的机会。建设性的反馈虽然对学习和成长至关重要，但往往受到时间限制、对报复的恐惧、对补救措施的担忧以及对学习者心理伤害的恐惧的阻碍。特别是对专业精神的批判性反馈，往往会挑战一个人的自我观，因为它与学习者的身份密切相关。虽然专业精神是本科和研究生阶段医学教育的核心能力，但客观评估专业精神可能具有挑战性，因为即使是现有的量表也往往只涉及专业精神的一个方面。现有的方法不足以识别专业问题，并且在如何识别和报告失误方面存在重大差异。教育工作者可以从各种来源获得反馈，包括患者、护士或不直接从事教学的教员，也可以通过专业报告渠道匿名获得反馈，这是学术医疗中心为满足监管准则而通常采用的方式。然后，教育领导者就有责任向学习者提供关于不专业的形成性反馈，而由于报告的行为没有被领导者自己观察到，这种反馈进一步加剧了。最佳做法是在临床环境中提供反馈；无论是在临床环境还是在行政环境中，这些核心原则都可以转化为专业反馈。对行为进行客观的、基于表现的描述，并明确解释它如何偏离现有的专业指导方针或期望，这是任何关于不专业的反馈会议的重要起点。教育工作者应确保学习者能够分享他们的观点，并反思影响他们行为的因素。这一步不仅引出了围绕事件的另一种观点（你没有亲眼目睹），而且可以作为可能包含偏见的专业报告的保障。 教育者应该通过制定学习者承诺的一致行动计划来确保学习者理解并接受反馈。利用这些核心原则以及与专业相关的最佳实践，并借鉴我们自己的经验，我们创建了一个示例脚本，供教育领导者使用（方框3）[16]。在与学习者交流时，教育者可以使用脚本来帮助保持对客观行为的关注，并推动对话，这一点尤其重要，因为充满情感的反馈不仅会给接受和给予带来压力。解决专业问题的另一个常见障碍是缺乏统一的补救办法。虽然医学知识和程序技能的补救通常是通过针对缺陷领域的时间表修改来解决的，但专业水平的缺陷往往更广泛，需要细致入微的干预。事实上，80%的急诊医学项目主任认为，由
{"title":"Promoting Professionalism in Medical Education: A Toolbox for Effective Feedback and Remediation","authors":"Matthew R. Carroll, Gal Barak, Tracy Byrne, Huma Farid","doi":"10.1111/tct.70244","DOIUrl":"10.1111/tct.70244","url":null,"abstract":"<p>Professionalism in medicine reflects our ethos and commitment to the field. The American Board of Medicine defines professionalism in medicine as: ‘a normative belief system about how best to organize and deliver health care, which calls on group members to jointly declare (‘profess’) what the public and individual patients can expect regarding shared competency standards and ethical values and to implement trustworthy means to ensure that all medical professionals live up to these promises’ [<span>1</span>]. Professionalism is critical to the practice of medicine. Lapses in professionalism undermine physician-patient relationships, deteriorate team morale and hinder the efficiency of clinical care.</p><p>A study of University of California San Francisco graduates who faced the California Medical Board over a 10-year period, 95% of disciplinary actions were due to deficiencies in professionalism, and obstetrician-gynaecologists were overly represented in those (14% of all those who faced disciplinary action but only 4% of grads) [<span>2</span>]. These behaviours did not simply emerge during practice; the physicians who were disciplined by the Board for unprofessional behaviour were twice as likely as graduates in the control group to have received negative comments regarding professionalism during medical school. This association between early challenges with professionalism and subsequent state medical board disciplinary actions suggests that medical educators may be unable to effectively remediate professionalism concerns in a way that alters subsequent behaviour as clinical faculty.</p><p>In the clinical learning environment, providing constructive feedback and correction to learners, primarily residents and medical students, is crucial to their development and success as physicians. Medical educators have consistently identified unprofessional behaviour as a common reason for learner remediation [<span>3</span>], yet providing feedback on professionalism remains a significant challenge. Barriers to providing constructive feedback in an objective and timely manner include lack of time, fear of learners' responses and lack of clear goals and objectives in training programs [<span>4</span>]. In addition, learners may perceive feedback on professionalism as subjective and may feel targeted by the feedback; it may be perceived as criticism of character or personality traits [<span>5</span>]. Due to the uncomfortable nature of this type of feedback, many clinical faculty opt to note these concerns only on summative written evaluations rather than addressing them in real time. Thus, program directors and clerkship directors often find themselves providing feedback to learners on behaviours that they did not directly observe and that may have happened several weeks prior.</p><p>Using our varied experiences as teaching faculty, clerkship leadership and residency program leaders and the best available data we designed a novel framework for approach","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://asmepublications.onlinelibrary.wiley.com/doi/epdf/10.1111/tct.70244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leanne Hall, Florence Berlot, Mike Tweed, Clare Heal
Background
Standard setting is essential for assessing medical students to ensure they meet required competencies for clinical practice. Various methods exist, but no gold standard has been universally adopted. This study aimed to identify the methods of standard setting used in Australian medical schools, and their benefits, limitations and challenges with implementation, to inform a proposal to change standard-setting methods at James Cook University.
Methods
A survey designed to gather detailed information on current standard-setting methods, challenges and satisfaction levels related to exit-level written assessments was sent to the assessment leads of all 21 Australian medical schools with graduating students. Survey data were analysed using descriptive statistics and thematic analysis.
Results
All 21 schools participated. Standard-setting methods included Cohen/Modified Cohen (n = 10), Angoff (n = 4), Ebel (n = 4), Hofstee (n = 2) and Objective Borderline method (n = 1). Satisfaction with the most popular method, Cohen/Modified Cohen, was high with a mean of 83% (range 69%–100%), and three additional schools indicated a plan to implement this method in coming years. Common challenges of standard setting in schools using methods other than Cohen/Modified Cohen included panel recruitment, resource management and maintaining assessment quality. Thematic analysis showed stakeholder involvement and the need for additional resources as necessities in implementing effective standard-setting methods.
Conclusions
Cohen method of standard setting is most commonly used for exit-level written examinations at Australian medical schools and is preferred for its efficiency and adaptability. Transitioning to Cohen/Modified Cohen could align JCU practices with those of most other medical schools in Australia.
{"title":"Cohen's Method and Its Variations in Standard Setting for Medical Examinations: An Australian Multi-Institutional Analysis","authors":"Leanne Hall, Florence Berlot, Mike Tweed, Clare Heal","doi":"10.1111/tct.70250","DOIUrl":"10.1111/tct.70250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standard setting is essential for assessing medical students to ensure they meet required competencies for clinical practice. Various methods exist, but no gold standard has been universally adopted. This study aimed to identify the methods of standard setting used in Australian medical schools, and their benefits, limitations and challenges with implementation, to inform a proposal to change standard-setting methods at James Cook University.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A survey designed to gather detailed information on current standard-setting methods, challenges and satisfaction levels related to exit-level written assessments was sent to the assessment leads of all 21 Australian medical schools with graduating students. Survey data were analysed using descriptive statistics and thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All 21 schools participated. Standard-setting methods included Cohen/Modified Cohen (<i>n</i> = 10), Angoff (<i>n</i> = 4), Ebel (<i>n</i> = 4), Hofstee (<i>n</i> = 2) and Objective Borderline method (<i>n</i> = 1). Satisfaction with the most popular method, Cohen/Modified Cohen, was high with a mean of 83% (range 69%–100%), and three additional schools indicated a plan to implement this method in coming years. Common challenges of standard setting in schools using methods other than Cohen/Modified Cohen included panel recruitment, resource management and maintaining assessment quality. Thematic analysis showed stakeholder involvement and the need for additional resources as necessities in implementing effective standard-setting methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Cohen method of standard setting is most commonly used for exit-level written examinations at Australian medical schools and is preferred for its efficiency and adaptability. Transitioning to Cohen/Modified Cohen could align JCU practices with those of most other medical schools in Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lene Holst Andersen, Rune Dall Jensen, Mads Skipper, Ilona Davodian, Johanne Kolind Bech, Lone Winther Lietzen, Kristian Krogh, Bo Løfgren
Introduction
Ward rounds are essential to clinical practice, yet structured training for residents remains limited in managing older patients with frailty. This feasibility study explored the implementation of a cognitive aid and examined the experiences of residents, patients and caregivers.
Methods
A controlled before-and-after study of Internal Medicine residents was conducted in a teaching hospital, introducing the cognitive aid to the intervention group through lectures, simulation sessions and podcasts. Implementation was documented through field notes. Residents' use and acceptability of the aid were assessed through self-reported data and video ratings by independent, blinded raters, using a 7-point Likert scale. Patient and caregiver perspectives were gathered through interviews and surveys.
Results
Fourteen residents participated, achieving a median rating of 5 out of 7 on cognitive aid items, with no difference between groups. All intervention group participants attended the lecture and simulation, but podcast usage was modest. Self-reported non-use was attributed to aid density, insufficient feedback and a limited perceived need for behavioural change. Patients expressed satisfaction with ward rounds but often hesitated to provide genuine feedback, attributing communication difficulties to themselves, such as language barriers. Caregivers were present during 3 of the 28 ward rounds.
Conclusion
The intervention was only partially delivered, and the cognitive aid was not used in practice. Residents found it too complex and lacked follow-up. Patient feedback was characterised by deference and self-blame, and caregiver input remained minimal. Future efforts must streamline the aid, embed training into supervision and rethink how feedback from patients and caregivers is collected.
{"title":"Implementing a Cognitive Aid for Ward Rounds for Older Patients With Frailty: Lessons Learned and Future Directions","authors":"Lene Holst Andersen, Rune Dall Jensen, Mads Skipper, Ilona Davodian, Johanne Kolind Bech, Lone Winther Lietzen, Kristian Krogh, Bo Løfgren","doi":"10.1111/tct.70245","DOIUrl":"10.1111/tct.70245","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ward rounds are essential to clinical practice, yet structured training for residents remains limited in managing older patients with frailty. This feasibility study explored the implementation of a cognitive aid and examined the experiences of residents, patients and caregivers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A controlled before-and-after study of Internal Medicine residents was conducted in a teaching hospital, introducing the cognitive aid to the intervention group through lectures, simulation sessions and podcasts. Implementation was documented through field notes. Residents' use and acceptability of the aid were assessed through self-reported data and video ratings by independent, blinded raters, using a 7-point Likert scale. Patient and caregiver perspectives were gathered through interviews and surveys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen residents participated, achieving a median rating of 5 out of 7 on cognitive aid items, with no difference between groups. All intervention group participants attended the lecture and simulation, but podcast usage was modest. Self-reported non-use was attributed to aid density, insufficient feedback and a limited perceived need for behavioural change. Patients expressed satisfaction with ward rounds but often hesitated to provide genuine feedback, attributing communication difficulties to themselves, such as language barriers. Caregivers were present during 3 of the 28 ward rounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The intervention was only partially delivered, and the cognitive aid was not used in practice. Residents found it too complex and lacked follow-up. Patient feedback was characterised by deference and self-blame, and caregiver input remained minimal. Future efforts must streamline the aid, embed training into supervision and rethink how feedback from patients and caregivers is collected.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine Otto Chebly, Kathryn Havranek, Jeffrey Wilhite, Michael Shen, Hadas Reich
Introduction
Poor social connection is a risk factor for mortality comparable to smoking or obesity. Expert recommendations encourage clinicians to identify and address isolation, loneliness and absent social support; however, screening and documentation norms remain unstandardised in graduate medical education (GME) social determinants of health (SDOH) curricula. We assessed the knowledge, attitudes, and behaviours (KAB) of internal medicine resident physicians in a large, urban, academic medical centre regarding screening for and documenting social connection.
Methods
Between October 2022 and February 2023, a voluntary, anonymous mixed-methods survey was disseminated to assess resident physicians' KAB about social connection as a SDOH. Quantitative data were analysed descriptively. Qualitative responses underwent content analysis. An electronic medical record (EMR) chart review of resident notes corroborated survey data.
Results
Sixty-three residents of an eligible 153 responded to the survey (41% participation). Sixty-five per cent reported never receiving formal GME about social connection as a SDOH. Familiarity with validated screening tools was low. Although 51% of respondents reported often/always documenting patients' social support systems, few chart notes explicitly mentioned social contacts. Respondents agreed that physicians are responsible for assessing and documenting social connection and noted key challenges of time constraints, inadequate screening and documentation norms and EMR navigation difficulty. Targeted didactics, EMR improvements and interdisciplinary learning opportunities were identified as potential solutions.
Conclusions
This study identified notable gaps in resident physician KAB to address social connection as a SDOH. Challenges could be addressed with standardised screening and documentation norms and skill development in patient communication and interdisciplinary teamwork.
{"title":"Social Connection as a Determinant of Health: A Mixed-Methods Assessment of Resident Physician Knowledge, Attitudes and Behaviours","authors":"Katherine Otto Chebly, Kathryn Havranek, Jeffrey Wilhite, Michael Shen, Hadas Reich","doi":"10.1111/tct.70246","DOIUrl":"10.1111/tct.70246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Poor social connection is a risk factor for mortality comparable to smoking or obesity. Expert recommendations encourage clinicians to identify and address isolation, loneliness and absent social support; however, screening and documentation norms remain unstandardised in graduate medical education (GME) social determinants of health (SDOH) curricula. We assessed the knowledge, attitudes, and behaviours (KAB) of internal medicine resident physicians in a large, urban, academic medical centre regarding screening for and documenting social connection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between October 2022 and February 2023, a voluntary, anonymous mixed-methods survey was disseminated to assess resident physicians' KAB about social connection as a SDOH. Quantitative data were analysed descriptively. Qualitative responses underwent content analysis. An electronic medical record (EMR) chart review of resident notes corroborated survey data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-three residents of an eligible 153 responded to the survey (41% participation). Sixty-five per cent reported never receiving formal GME about social connection as a SDOH. Familiarity with validated screening tools was low. Although 51% of respondents reported often/always documenting patients' social support systems, few chart notes explicitly mentioned social contacts. Respondents agreed that physicians are responsible for assessing and documenting social connection and noted key challenges of time constraints, inadequate screening and documentation norms and EMR navigation difficulty. Targeted didactics, EMR improvements and interdisciplinary learning opportunities were identified as potential solutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study identified notable gaps in resident physician KAB to address social connection as a SDOH. Challenges could be addressed with standardised screening and documentation norms and skill development in patient communication and interdisciplinary teamwork.</p>\u0000 </section>\u0000 </div>","PeriodicalId":47324,"journal":{"name":"Clinical Teacher","volume":"22 6","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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