Medical Education Online最新文献

Purpose: To create medical school service regions and examine national in-region graduate retention patterns across the medical education continuum and into professional practice as one approach to advancing social accountability in medical education.

Methods: Medical school service regions were created in Canada using publicly available data and mapped using Geographic Information System (GIS) software. Population size and density for each service region were calculated using census data. Retrospective data of medical graduates who completed their medical degrees between 2001-2015 (n = 19,971) were obtained from a centralized data repository and used to analyze in-region retention rates by medical specialty across the training continuum and five years into professional practice.

Results: Spatial inequities were observed across medical school service regions. Graduate retention patterns also varied across service region groups and medical specialties. Quebec (86.5%) and Ontario (80.4%) had above-average retention rates across the medical education continuum. Family medicine had the highest retention rates from undergraduate to postgraduate training (81.9%), while psychiatry had the highest retention rate across the training continuum and into professional practice (71.2%). The Alberta and British Columbia service region group demonstrated high retention rates across the training continuum and into professional practice and medical specialties, except for retention from undergraduate to postgraduate medical education.

Conclusion: This study highlights the importance of considering both medical specialty and practice location of graduates when planning and retaining the physician workforce. The observed retention patterns among graduates are a critical aspect of addressing societal needs and represent an intermediate step towards achieving health equity. Furthermore, graduate retention patterns serve as an outcome measure for schools to demonstrate their commitment to social accountability. Tracking and monitoring graduate outcomes may lead schools to actively collaborate with government agencies responsible for healthcare policy, which may ultimately improve physician workforce planning and promote more equitable healthcare access.

Introduction: Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters.

Materials & methods: The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups.

Results: Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p < 0.001). They had higher scores in physical exam (83.3 vs. 50, p < 0.001) and interpersonal communication domains (95 vs. 85, p < 0.001) and lower scores in obtaining a history (73.3 vs. 80, p = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, p = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, p = 0.48).

Conclusion: The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments.

Background: The scholarship of teaching and learning (SoTL) is a field of academic research that focuses on improving learning through reflective and informed teaching. Currently, most SoTL-related work is faculty-driven; however, student involvement in SoTL has been shown to benefit both learners and educators. Our study aims to develop a framework for increasing medical students' interest, confidence, and engagement in SoTL.

Methods: A student-led SoTL interest group was developed and a year-round program of SoTL was designed and delivered by student leaders of the group under the guidance of a faculty advisor. Individual post-session surveys were administered to evaluate participants' perceptions of each session. Pre- and post-program surveys were administered to evaluate the program impact.

Results: The year-round SoTL program consistently attracted the participation of medical students and faculty. Survey responses indicated strong medical student interest in the program and positive impact of the program. Increased interest and confidence in medical education research were reported by the student participants. The program design provided opportunities for student participants to network and receive ongoing feedback about medical education research they were interested or involved in.

Conclusion: Our study provides insights for developing a framework that other institutions can reference and build upon to educate and engage students in SoTL.

Background: Understanding the hierarchy in medical education is considered one of the hidden curriculum agendas that help to guide the medical trainees throughout their careers in healthcare. However, many negative aspects to the hierarchy and a few positive aspects have been uncovered in recent years. The COVID-19 pandemic had a tremendous impact on the healthcare system, deploying healthcare workers, including trainees from their primary speciality training to help caring for COVID-19 patients. The effect of hierarchy on medical trainees in such situations has not been discussed before. This study aims to uncover whether the COVID-19 pandemic emergency had any impact on the hierarchical system among healthcare workers.

Methods: Individual semi-structured virtual interviews were conducted with six residents from different residency programs who were redeployed from their primary subspeciality to work with COVID-19 patients in different healthcare facilities across the country. The interviews aimed to uncover the resident's experience with the hierarchical structure while working in a diverse COVID-19 team. Responses were analysed qualitatively using an interpretive approach.

Result: Interviews yielded data broadly covered the aspects of 1. The impact of hierarchy during the pandemic on the resident's training in the absence of academic and clinical teaching and the limited exposure to clinical cases where the primary focus was treating COVID-19 patients. 2. The functional and dysfunctional impact of hierarchy on team dynamic before the COVID-19 pandemic from the residents 'perspective when they worked with different teams before the pandemic. 3. The functional and dysfunctional impact of hierarchy on team dynamic during the COVID-19 pandemic where some aspects of hierarchy, like mentorship, were prominent among teams. 4. The resident personal experience with the COVID-19 team during the pandemic in terms of team diversity and the war zone experience. The trainees described in a narrative approach the hierarchy impact on their experience during the COVID-19 pandemic.

Conclusions: The COVID-19 pandemic impacted the hidden curriculum of medical hierarchy in both functional and dysfunctional ways. This period underscored positive hierarchical elements, such as role clarity and team leadership, which were often overlooked pre-pandemic, while also exposing limitations that hindered flexibility and inclusivity.

Background: Assessment of residents' ability to address unmet health-related social needs to promote social accountability remains subjective and difficult. Existing approaches rely on self-assessment surveys of residents' knowledge, skills, and attitudes following social determinants of health training, with few studies explicitly measuring clinical practice. We aimed to characterize social accountability using resident referrals to a food pantry embedded in a pediatric primary care center as an objective measure of resident ability to address unmet health-related social needs in clinical practice.

Methods: This retrospective observational study occurred from 1 January 2019, to 30 June 2020, at an urban, pediatric primary care center with an embedded food pantry. All pediatric residents received social accountability education during a 2-week Advocacy rotation intern year. During clinic visits, pediatric residents were expected to act on results of a standardized social screen that included two food insecurity questions. Food pantry referral was the primary outcome. Food pantry referral data were extracted from food pantry logs.

Results: During the 18-month study period, the pediatric primary care center food pantry was accessed at 1,031 visits. Of the 860 physician-based visits that resulted in pantry referral, 63% (n = 545) were initiated by residents. Eighty-six percent of residents (134/156) made ≥ 1 referral. Across all years, residents placed a mean of 3 (range 1-16) food pantry referrals.

Conclusions: During our study, most residents placed at least one pantry referral in response to identifying food insecurity either via the screen or during conversation with the family. Referral to a primary care embedded food pantry, one way to address acute food insecurity may serve as a measurable proxy to assess residents' ability to address unmet health-related social needs and promote social accountability in healthcare delivery.

Introduction: The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking.

Methods: We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made.

Results: A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school.

Discussion: Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits ('easing in') but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.

To develop and assess the preliminary effectiveness of Ontological Coaching Intervention for nursing undergraduates. Design: A pilot randomized controlled trial with a two-group pre-test and post-test followed by process-evaluation qualitative interviews. An Ontological Coaching Intervention was developed through an integration of prior literature and the collective the research team's experience, consisting of 4-6 sessions over 6-months, each lasting 30-60 minutes. Sessions encompassed exploring ontological coaching concepts, empowering nursing undergraduates to choose topics, and tailoring sessions to individual needs. Sixty undergraduates were recruited; ten were excluded for not completing the baseline questionnaires. Twenty-one nursing undergraduates were randomly assigned to the intervention group and twenty-nine undergraduates to the control group (standard academic support only). Primary (psychological well-being) and secondary (social support quantity and satisfaction, goal-setting, resilience) outcomes were measured at baseline, 3-months, and 6-months. Semi-structured interviews captured post-intervention experiences. Between-group analyses revealed a significant difference in goal-setting scores at 3-months (U = 325.5, p = 0.013), favoring the intervention group (median = 70.50, IQR = 64.25, 76.75). At 6-months, a significant difference in social support satisfaction scores (U = 114.5, p = 0.028) was found between the intervention (median = 33.00, IQR = 29.50, 35.25) and control (median = 30.00, IQR = 30.00, 35.00) groups. However, no significant between-group differences were noted in other outcome measures. Significant within-group differences were found in goal-setting scores at 3- and 6-months in the intervention group and social support quantity scores at 3- and 6-months in the control group. However, no significant within-group differences were noted in other outcome measures. Three themes were identified: Enhanced Holistic Development, Keys to Successful Coaching, and Future Directions for Successful Coaching. There is urgent need to advance research on Ontological Coaching Intervention, particularly, enhancing study rigor, broadening examinations to diverse healthcare student populations and cultural contexts, and addressing identified limitations.

New residents are often unprepared to respond to medical emergencies. To address this gap, we implemented a simulated cross-cover paging curriculum. All senior medical students enrolled in a required specialty-specific (internal medicine, procedures, emergency medicine [EM], obstetrics and gynecology [OBGYN], family medicine and pediatrics) residency preparation course (RPC) in 2020-2021 participated. Students received 3-6 specialty-specific pages that represented an urgent change in clinical status about a simulated patient. For each page, students first called a standardized registered nurse (SRN) to ask additional questions, then recommended next steps in evaluation and management. The SRNs delivered immediate verbal feedback, delayed written feedback, and graded clinical performance using a weighted rubric. Some items were categorized as 'must do,' which represented the most clinically important actions. Trends in clinical performance over time were analyzed using the Jonckheere-Terpstra test. Of the 315 eligible students, 265 (84.1%) consented for their data to be included in the analysis. Clinical performance improved from a median (interquartile range) of 59.4% (46.9%, 75.0%) on case 1 to 80.0% (68.0%, 86.7%) on case 6 (p < .001). The percentage of 'must do' items improved significantly, from 69.2% (53.8, 81.8%) to 80.0% (66.7%, 88,9%) (p < .001). Scores improved over time for all specialty courses except for EM and OB/GYN. Surveyed students largely found this to be a valuable addition to the RPC curriculum with a 4.4 overall rating (1 = poor to 5 = excellent). This novel curriculum fills important gaps in the educational transition between medical school and residency. The simulated paging platform is adaptable and generalizable to learners entering different residency specialties.

Many medical schools in the United States (US) have employed policies and programming to prevent mistreatment and encourage students to report mistreatment events. Yet, there is little evidence showing a large-scale decrease in mistreatment behaviors overall, and, in many cases, mistreatment events go unreported. This study examines views from medical students and faculty for preventing mistreatment during medical training, as well as strategies for encouraging learners to report mistreatment events when they occur. We conducted in-depth interviews and focus groups with students and faculty (n = 25) and compared and contrasted perspectives. To prevent mistreatment, both students and faculty recommended institutional-level guidance and behavioral expectations during training, while faculty suggested educational programming focused on clarifying mistreatment definitions and cultivating awareness. To encourage reporting of mistreatment events, students and faculty emphasized: access to an array of reporting mechanisms, institutional processes for maintaining anonymity or confidentiality, and follow-up procedures to address reported mistreatment. Our results suggest that students' and faculty's role in medical education may shape their perceptions of strategies to prevent mistreatment. These results can inform the development and customization of interventions for preventing mistreatment and encouraging mistreatment reporting.

In this rapid communication, accelerated undergraduate medical education is examined using prior literature as well as experiences of those who have completed or are in the process of completing accelerated medical curricula. The Consortium of Accelerated Medical Pathway Programs (CAMPP) hosts an annual multi-institutional conference for all its members. During the meeting in July 2023, a virtual panel was convened from multiple constituent programs (N = 4) including medical students (N = 2), resident physicians (N = 4), and faculty (N = 2). Panel participants represented current learners or graduates from accelerated pathways of varying specialties (N = 5) to share firsthand experiences about acceleration to an audience representing over 25 medical schools. Five key themes were identified for accelerated students and trainees: Reduced debt as motivating factor to accelerate, Feeling prepared for residency, Ideal accelerated students are driven, Ability to form early professional relationships, and Less time for additional clinical experiences. Discourse from the CAMPP panel can inform current and developing accelerated programs at institutions looking to create or improve accelerated learning.