Pub Date : 2024-12-31Epub Date: 2024-02-07DOI: 10.1080/10872981.2024.2312713
Shahpar Najmabadi, Virginia Valentin, Joanne Rolls, Mary Showstark, Leigh Elrod, Carey Barry, Adam Broughton, Michael Bessette, Trenton Honda
Purpose: Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated.
Methods: Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours.
Results: In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results.
Conclusions: Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.
目的:有效沟通对患者护理至关重要。包括医生助理(PA)在内的多语种医疗服务提供者可以为改善英语水平有限的患者的医疗服务做出贡献;但是,这取决于多语种医疗服务提供者的预科情况。本研究调查了潜在申请者自我报告的英语作为第二语言(ESL)的状况与他们进入助理医师专业学习的可能性之间的关系:参与者包括 2012 年至 2020 年期间五个助理医师集中申请服务录取周期的申请人。在双变量和多变量回归模型中,采用逻辑回归法研究申请者的 ESL 状态与课程预科几率之间的关联。模型根据公民身份、本科平均成绩、性别、年龄、种族/民族、申请的项目数量和病人护理时间进行了调整:在未调整和调整后的模型中,ESL 状态与所有研究年份中较低的 PA 课程入学几率有关。在调整后的多变量模型中,2014-2015 年的相关性最强,在控制人口统计学、公民身份、病人护理经验和学业成绩的情况下,ESL 身份与入学几率降低 35% 相关(几率比 0.65,95% 置信区间 0.56,0.76)。在对(a)托福成绩≥100分的申请者和(b)没有托福成绩的ESL申请者进行的敏感性分析中,我们没有观察到结果的重要变化:结果表明,非英语母语的申请者进入 PA 项目的几率较低。入学几率的下降幅度很大,受混杂因素调整的影响很小,并且在不同年份持续存在。这些研究结果表明,专业录取过程可能会对母语非英语的申请者不利。虽然观察到的结果有可能是有原因的,但也值得关注。培养和培训与服务不足人群语言相通的助理医师是改善患者治疗效果的重要手段。
{"title":"Non-native English-speaking applicants and the likelihood of physician assistant program matriculation.","authors":"Shahpar Najmabadi, Virginia Valentin, Joanne Rolls, Mary Showstark, Leigh Elrod, Carey Barry, Adam Broughton, Michael Bessette, Trenton Honda","doi":"10.1080/10872981.2024.2312713","DOIUrl":"10.1080/10872981.2024.2312713","url":null,"abstract":"<p><strong>Purpose: </strong>Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated.</p><p><strong>Methods: </strong>Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours.</p><p><strong>Results: </strong>In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results.</p><p><strong>Conclusions: </strong>Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2312713"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-06-06DOI: 10.1080/10872981.2024.2363006
Guillaume Der Sahakian, Maxime de Varenne, Clément Buléon, Guillaume Alinier, Christian Balmer, Antonia Blanié, Bertrand Bech, Anne Bellot, Hamdi Boubaker, Nadège Dubois, Francisco Guevara, Erwan Guillouet, Jean-Claude Granry, Morgan Jaffrelot, François Lecomte, Fernande Lois, Mohammed Mouhaoui, Ollivier Ortolé, Méryl Paquay, Justine Piazza, Marie Pittaco, Patrick Plaisance, Dan Benhamou, Gilles Chiniara, Etienne Rivière
Background: Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities.
Methods: After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities.
Results: We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations.
Conclusion: We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.
{"title":"The 2024 French guidelines for scenario design in simulation-based education: manikin-based immersive simulation, simulated participant-based immersive simulation and procedural simulation.","authors":"Guillaume Der Sahakian, Maxime de Varenne, Clément Buléon, Guillaume Alinier, Christian Balmer, Antonia Blanié, Bertrand Bech, Anne Bellot, Hamdi Boubaker, Nadège Dubois, Francisco Guevara, Erwan Guillouet, Jean-Claude Granry, Morgan Jaffrelot, François Lecomte, Fernande Lois, Mohammed Mouhaoui, Ollivier Ortolé, Méryl Paquay, Justine Piazza, Marie Pittaco, Patrick Plaisance, Dan Benhamou, Gilles Chiniara, Etienne Rivière","doi":"10.1080/10872981.2024.2363006","DOIUrl":"10.1080/10872981.2024.2363006","url":null,"abstract":"<p><strong>Background: </strong>Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities.</p><p><strong>Methods: </strong>After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities.</p><p><strong>Results: </strong>We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations.</p><p><strong>Conclusion: </strong>We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2363006"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-08-27DOI: 10.1080/10872981.2024.2391631
Yan Jiang, Yan Cai, Xue Zhang, Cong Wang
Background: Patient safety incidents, such as adverse events and medical errors, are often caused by ineffective communication and collaboration. Interprofessional education is an effective method for promoting collaborative competencies and has attracted great attention in the context of patient safety. However, the effectiveness of interprofessional education interventions on patient safety remains unclear. This scoping review aimed to synthesize existing studies that focused on improving patient safety through interprofessional education interventions for healthcare professionals.
Methods: Six databases, including Medline (via PubMed), Embase, Cochrane Library, CINAHL (via EBSCO), Scopus and Web of Science, were last searched on 20 December 2023. The search records were independently screened by two researchers. The Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies was used for quality appraisal. The data were extracted by two researchers and cross-checked. Finally, a narrative synthesis was performed. The protocol for this scoping review was not registered.
Results: Thirteen quasi-experimental studies with moderate methodological quality were included. The results revealed that the characteristics of current interprofessional education interventions were diverse, with a strong interest in simulation-based learning strategies and face-to-face delivery methods. Several studies did not assess the reduction in patient safety incidents involving adverse events or medical errors, relying instead on the improvements in healthcare professionals' knowledge, attitude or practice related to patient safety issues. Less than half of the studies examined team performance, based primarily on the self-evaluation of healthcare professionals and observer-based evaluation. There is a gap in applying newer tools such as peer evaluation and team-based objective structured clinical evaluation.
Conclusion: Additional evidence on interprofessional education interventions for improving patient safety is needed by further research, especially randomized controlled trials. Facilitating simulation-based interprofessional education, collecting more objective outcomes of patient safety and selecting suitable tools to evaluate teamwork performance may be the focus of future studies.
背景:不良事件和医疗事故等患者安全事件往往是由无效沟通和协作造成的。跨专业教育是促进协作能力的有效方法,在患者安全方面备受关注。然而,跨专业教育干预对患者安全的影响仍不明确。本范围综述旨在综合现有的研究,这些研究侧重于通过对医护人员进行跨专业教育干预来改善患者安全:2023 年 12 月 20 日对 Medline(通过 PubMed)、Embase、Cochrane Library、CINAHL(通过 EBSCO)、Scopus 和 Web of Science 等六个数据库进行了最后一次检索。搜索记录由两名研究人员独立筛选。乔安娜-布里格斯研究所(Joanna Briggs Institute)的 "准实验研究批判性评估工具"(Critical Appraisal Tool for Quasi-Experimental Studies)用于质量评估。两名研究人员提取数据并进行交叉核对。最后,进行叙述性综合。本次范围界定综述的方案未注册:共纳入 13 项方法学质量中等的准实验研究。结果表明,当前跨专业教育干预措施的特点多种多样,其中以模拟学习策略和面对面授课方法最受关注。有几项研究没有评估涉及不良事件或医疗差错的患者安全事故的减少情况,而是依赖于医护人员在患者安全问题相关知识、态度或实践方面的改进情况。只有不到一半的研究考察了团队的表现,主要基于医护人员的自我评价和基于观察者的评价。在应用同行评价和基于团队的客观结构化临床评价等新工具方面还存在差距:结论:需要通过进一步研究,特别是随机对照试验,获得更多有关跨专业教育干预措施的证据,以改善患者安全。促进以模拟为基础的跨专业教育、收集更多有关患者安全的客观结果以及选择合适的工具来评估团队合作绩效,可能是未来研究的重点。
{"title":"Interprofessional education interventions for healthcare professionals to improve patient safety: a scoping review.","authors":"Yan Jiang, Yan Cai, Xue Zhang, Cong Wang","doi":"10.1080/10872981.2024.2391631","DOIUrl":"10.1080/10872981.2024.2391631","url":null,"abstract":"<p><strong>Background: </strong>Patient safety incidents, such as adverse events and medical errors, are often caused by ineffective communication and collaboration. Interprofessional education is an effective method for promoting collaborative competencies and has attracted great attention in the context of patient safety. However, the effectiveness of interprofessional education interventions on patient safety remains unclear. This scoping review aimed to synthesize existing studies that focused on improving patient safety through interprofessional education interventions for healthcare professionals.</p><p><strong>Methods: </strong>Six databases, including Medline (via PubMed), Embase, Cochrane Library, CINAHL (via EBSCO), Scopus and Web of Science, were last searched on 20 December 2023. The search records were independently screened by two researchers. The Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies was used for quality appraisal. The data were extracted by two researchers and cross-checked. Finally, a narrative synthesis was performed. The protocol for this scoping review was not registered.</p><p><strong>Results: </strong>Thirteen quasi-experimental studies with moderate methodological quality were included. The results revealed that the characteristics of current interprofessional education interventions were diverse, with a strong interest in simulation-based learning strategies and face-to-face delivery methods. Several studies did not assess the reduction in patient safety incidents involving adverse events or medical errors, relying instead on the improvements in healthcare professionals' knowledge, attitude or practice related to patient safety issues. Less than half of the studies examined team performance, based primarily on the self-evaluation of healthcare professionals and observer-based evaluation. There is a gap in applying newer tools such as peer evaluation and team-based objective structured clinical evaluation.</p><p><strong>Conclusion: </strong>Additional evidence on interprofessional education interventions for improving patient safety is needed by further research, especially randomized controlled trials. Facilitating simulation-based interprofessional education, collecting more objective outcomes of patient safety and selecting suitable tools to evaluate teamwork performance may be the focus of future studies.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2391631"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11351354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-03-22DOI: 10.1080/10872981.2024.2331852
Thomas Soroski, Kuda Hove, Lisa Steblecki, Jaime C Yu
Background: Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met.
Methods: A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient.
Results: A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R2 = 0.25).
Conclusions: Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.
背景:模拟病例被广泛应用于医学教育中,以培养临床推理技能和讨论有关病人护理的关键话题。此类病例提供了一个机会,展示现实世界中不同患者和医疗服务提供者的身份、社会和结构性健康决定因素的影响,并展示解决问题的通才方法。然而,尽管很多人呼吁医学院采取行动,更好地融入公平、多样性和包容性(EDI)以及通才主义,但仍然很难评估这些目标的实现情况:方法:在一所医学院完成了一项质量改进项目,以评估临床前课程模拟病例中的通识性和 EDI 领域。采用多伦多通识评估工具(T-GAT)对通识进行评估。EDI使用当地开发的一种新型工具进行评估。分析包括描述性统计和皮尔逊相关系数:共审查了 49 个模拟病例。12个通性项目和5个EDI项目采用5点李克特量表进行评分,分数越高,表明病例中的通性或EDI表现越好。所有病例的通用性平均得分为 45.6/60。所有案例的平均 EDI 得分为 11.7/25。只有 21/49 个案例包含一个或多个不同身份类别的代表。最常见的多元化身份是非白人种族/族裔,最少的多元化身份是语言流利程度。通用性与 EDI 分数呈弱正相关(R2 = 0.25):使用特定的通用性和 EDI 评分工具对模拟案例进行定量评估,成功地深入了解了案例教学的改进领域。这种方法确定了案例改进的关键内容领域,以及目前在教学案例中代表性不足的身份。其他医学院校也可以采用类似的方法来改进教学病例或其他课程材料中的通识性和EDI。
{"title":"Evaluating the domains of generalism and equity, diversity and inclusion in preclinical simulated cases for targeted curricular improvements.","authors":"Thomas Soroski, Kuda Hove, Lisa Steblecki, Jaime C Yu","doi":"10.1080/10872981.2024.2331852","DOIUrl":"10.1080/10872981.2024.2331852","url":null,"abstract":"<p><strong>Background: </strong>Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met.</p><p><strong>Methods: </strong>A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient.</p><p><strong>Results: </strong>A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R<sup>2</sup> = 0.25).</p><p><strong>Conclusions: </strong>Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2331852"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-03-25DOI: 10.1080/10872981.2024.2333618
Ann-Kathrin Schindler, Mareike Schimmel, Melissa Oezsoy, Thomas Rotthoff
Background: Teacher identity is defined as a continuum of a person's self-conviction ('Identity is something I have') and a context-dependent action ('Identity is something I do in a context') (Lankveld et al. 2021). It has been identified a relevant contributor to physicians' teaching commitment. In this study, we further improve the currently only existing questionnaire instrument (37 items) measuring physicians' teacher identity.
Methods: Survey data on 147 clinicians at a German university hospital were (1) analyzed by confirmatory factor analysis (CFA). We tested (a) the model fits of the originally suggested scales and (b) potential for improvement of model fits by item reduction. As this could not reveal satisfactory fits for all scales, we (2) applied a principal axis factoring as an exploratory approach. Last, we combined findings from (1) and (2) with a theoretical item content discussion and suggest (3) reassembled scales which were again checked using CFA.
Findings: (1a) Two scales from the original instrument were successfully confirmed. (1b) Some scales benefited from item reduction. (2) The exploratory analysis identified three factors that explained at least 5% variance. (3) By integrating confirmatory and exploratory findings with a content analysis of the items, we propose a partially rearranged questionnaire instrument, comprising seven scales: (1) Feeling intrinsic satisfaction from teaching; (2) Feeling responsibility to teach; (3) Exchange of teaching experience; (4) Identification and enjoyment of the teaching role; (5) Development of teaching; (6) Teaching self-concept of ability; (7) Desired rewards for teaching. Four items were kept as single items.
Conclusion: We suggest that when assessing teacher identity in physicians, all items should be constructed to allow for responses, even from physicians who are presently not actively involved in teaching. The scales benefited from categorizing items based on the continuum of teacher identity as outlined by van Lankveld et al. (2021).
{"title":"Measuring teacher identity of physicians - a validation study of a questionnaire instrument.","authors":"Ann-Kathrin Schindler, Mareike Schimmel, Melissa Oezsoy, Thomas Rotthoff","doi":"10.1080/10872981.2024.2333618","DOIUrl":"10.1080/10872981.2024.2333618","url":null,"abstract":"<p><strong>Background: </strong>Teacher identity is defined as a continuum of a person's self-conviction ('Identity is something I have') and a context-dependent action ('Identity is something I do in a context') (Lankveld et al. 2021). It has been identified a relevant contributor to physicians' teaching commitment. In this study, we further improve the currently only existing questionnaire instrument (37 items) measuring physicians' teacher identity.</p><p><strong>Methods: </strong>Survey data on 147 clinicians at a German university hospital were (1) analyzed by confirmatory factor analysis (CFA). We tested (a) the model fits of the originally suggested scales and (b) potential for improvement of model fits by item reduction. As this could not reveal satisfactory fits for all scales, we (2) applied a principal axis factoring as an exploratory approach. Last, we combined findings from (1) and (2) with a theoretical item content discussion and suggest (3) reassembled scales which were again checked using CFA.</p><p><strong>Findings: </strong>(1a) Two scales from the original instrument were successfully confirmed. (1b) Some scales benefited from item reduction. (2) The exploratory analysis identified three factors that explained at least 5% variance. (3) By integrating confirmatory and exploratory findings with a content analysis of the items, we propose a partially rearranged questionnaire instrument, comprising seven scales: (1) Feeling intrinsic satisfaction from teaching; (2) Feeling responsibility to teach; (3) Exchange of teaching experience; (4) Identification and enjoyment of the teaching role; (5) Development of teaching; (6) Teaching self-concept of ability; (7) Desired rewards for teaching. Four items were kept as single items.</p><p><strong>Conclusion: </strong>We suggest that when assessing teacher identity in physicians, all items should be constructed to allow for responses, even from physicians who are presently not actively involved in teaching. The scales benefited from categorizing items based on the continuum of teacher identity as outlined by van Lankveld et al. (2021).</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2333618"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-10-07DOI: 10.1080/10872981.2024.2408842
Mary A Dolansky, Elizabeth A Edmiston, Anton Vehovec, Andrew Harris, Mamta K Singh
Problem: Quality Improvement (QI) is interprofessional by nature; however, most academic QI programs occur in silos and do not leverage the opportunity to bring interprofessional learners together.
Intervention: To evaluate QI competencies of physician, nursing, pharmacy, behavioral health, and social work residents after participating in a longitudinal QI curriculum. Lessons learned are shared to guide educators in developing QI curriculum for interprofessional learners.
Context: Cohorts of graduate students over 5 years participated in a QI curriculum that aligned with each professions' core quality competencies. Residents engaged in didactics and experiential learning in primary care clinics.
Impact: All learners (N = 74) demonstrated improvement in QI knowledge measured by the QIKAT-R and applied their skills demonstrated by completion of a QI project presented at the Institute for Healthcare Improvement annual forums. Participation in QI curriculum resulted in knowledge and skill improvement.
Lessons learned: An experiential QI curriculum is a natural place to bring diverse post-graduate learners together to improve QI knowledge and skills. Successful QI curriculum goals are to (a) align projects with institutional and stakeholder goals, (b) include coaches to promote teamwork and project management, (c) narrow project scope, (d) develop an improvement mindset that failures are learning opportunities, and (e) address needs for data access.
{"title":"An interprofessional postgraduate quality improvement curriculum: results and lessons learned over a 5-year implementation.","authors":"Mary A Dolansky, Elizabeth A Edmiston, Anton Vehovec, Andrew Harris, Mamta K Singh","doi":"10.1080/10872981.2024.2408842","DOIUrl":"10.1080/10872981.2024.2408842","url":null,"abstract":"<p><strong>Problem: </strong>Quality Improvement (QI) is interprofessional by nature; however, most academic QI programs occur in silos and do not leverage the opportunity to bring interprofessional learners together.</p><p><strong>Intervention: </strong>To evaluate QI competencies of physician, nursing, pharmacy, behavioral health, and social work residents after participating in a longitudinal QI curriculum. Lessons learned are shared to guide educators in developing QI curriculum for interprofessional learners.</p><p><strong>Context: </strong>Cohorts of graduate students over 5 years participated in a QI curriculum that aligned with each professions' core quality competencies. Residents engaged in didactics and experiential learning in primary care clinics.</p><p><strong>Impact: </strong>All learners (<i>N</i> = 74) demonstrated improvement in QI knowledge measured by the QIKAT-R and applied their skills demonstrated by completion of a QI project presented at the Institute for Healthcare Improvement annual forums. Participation in QI curriculum resulted in knowledge and skill improvement.</p><p><strong>Lessons learned: </strong>An experiential QI curriculum is a natural place to bring diverse post-graduate learners together to improve QI knowledge and skills. Successful QI curriculum goals are to (a) align projects with institutional and stakeholder goals, (b) include coaches to promote teamwork and project management, (c) narrow project scope, (d) develop an improvement mindset that failures are learning opportunities, and (e) address needs for data access.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2408842"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-11-04DOI: 10.1080/10872981.2024.2420440
Daniel Söderberg, Anna Kiessling, Anna Freyschuss
There is a compelling need to improve all physicians' knowledge on lifestyle medicine (LM). This training needs to start early during medical education. This case report describes the feasibility and effects of integrating LM into an existing core curriculum of a Swedish undergraduate medical programme. A curriculum development project was organized using a six-step model: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation. New learning objectives regarding health, prevention and lifestyle medicine were formulated throughout the five-and-a-half-year programme. Learning activities and examinations were integrated in all courses with a structured progression and with focus on preventive activities in the workplace learning. The project was evaluated using student surveys of curricular quality, teacher survey of curricular content and integration in 2020, and an external review of adherence to the national qualitative target on preventive medicine. The project was executed during 2017-2018. Course evaluations and exit poll at graduation showed an overall high-quality student rating of education in prevention and in lifestyle counselling: on average, a score of 4.1/5 and 4.1/6, respectively. The teacher survey showed that over 70% of courses had a lasting increase in LM curricular content and that this content was to a large extent integrated into the existing course material. The external review concluded that the topic was well covered and integrated into the curriculum. LM could be successfully integrated into an existing medical programme curriculum with positive effects on student learning.
{"title":"Education in lifestyle medicine for future physicians - a strategy to reduce the burden of cardiovascular disease.","authors":"Daniel Söderberg, Anna Kiessling, Anna Freyschuss","doi":"10.1080/10872981.2024.2420440","DOIUrl":"10.1080/10872981.2024.2420440","url":null,"abstract":"<p><p>There is a compelling need to improve all physicians' knowledge on lifestyle medicine (LM). This training needs to start early during medical education. This case report describes the feasibility and effects of integrating LM into an existing core curriculum of a Swedish undergraduate medical programme. A curriculum development project was organized using a six-step model: general needs assessment, targeted needs assessment, goals and objectives, educational strategies, implementation, and evaluation. New learning objectives regarding health, prevention and lifestyle medicine were formulated throughout the five-and-a-half-year programme. Learning activities and examinations were integrated in all courses with a structured progression and with focus on preventive activities in the workplace learning. The project was evaluated using student surveys of curricular quality, teacher survey of curricular content and integration in 2020, and an external review of adherence to the national qualitative target on preventive medicine. The project was executed during 2017-2018. Course evaluations and exit poll at graduation showed an overall high-quality student rating of education in prevention and in lifestyle counselling: on average, a score of 4.1/5 and 4.1/6, respectively. The teacher survey showed that over 70% of courses had a lasting increase in LM curricular content and that this content was to a large extent integrated into the existing course material. The external review concluded that the topic was well covered and integrated into the curriculum. LM could be successfully integrated into an existing medical programme curriculum with positive effects on student learning.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2420440"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11548798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-08-18DOI: 10.1080/10872981.2024.2392428
Kye-Yeung Park, Ye Ji Kang, Hoon-Ki Park, Hwan-Sik Hwang
Background: Video-recordings review of patient encounters is reported to improve the clinical performance of medical students. However, evidence on specific remediation strategies or outcomes are lacking. We aimed to implement videorecording-based remediation of standardized patient encounters among medical students, combined with preceptor one-on-one feedback or peer group discussion, and evaluate the effectiveness of the two remediation methods using objective structured clinical examination (OSCE).
Methods: Following standardized patient encounters, 107 final-year medical students were divided into two groups based on different remediation methods of video review: (1) precepted video review with preceptor feedback (N = 55) and (2) private video review and subsequent peer group discussion under supervision (N = 52). All students underwent twelve-stations of OSCE both before and after the video review. Students' pre- and post-remediation OSCE scores, self-efficacy level in patient encounters, and level of educational satisfaction with each method were assessed and compared between different video-based remediation methods to evaluate their respective effects.
Results: After remediation, the total and subcomponent OSCE scores, such as history taking, physical examination, and patient - physician interaction (PPI), among all students increased significantly. Post-remediation OSCE scores showed no significant difference between two remediation methods (preceptor module, 79.6 ± 4.3 vs. peer module, 79.4 ± 3.8 in the total OSCE score). Students' self-efficacy levels increased after remediation in both modules (both p-value <0.001), with no difference between the two modules. However, students' satisfaction level was higher in the preceptor module than in the peer module (80.1 ± 17.7 vs. 59.2 ± 25.1, p-value <0.001). Among students with poor baseline OSCE performance, a prominent increase in PPI scores was observed in the preceptor-based module.
Conclusion: Video-based remediation of patient encounters, either through preceptor review with one-on-one feedback or through private review with peer discussion, was equally effective in improving the OSCE scores and self-efficacy levels of medical students. Underperforming students can benefit from precepted video reviews for building PPI.
{"title":"Exploring effective video-review strategies of patient encounters for medical students: precepted review versus peer discussion.","authors":"Kye-Yeung Park, Ye Ji Kang, Hoon-Ki Park, Hwan-Sik Hwang","doi":"10.1080/10872981.2024.2392428","DOIUrl":"10.1080/10872981.2024.2392428","url":null,"abstract":"<p><strong>Background: </strong>Video-recordings review of patient encounters is reported to improve the clinical performance of medical students. However, evidence on specific remediation strategies or outcomes are lacking. We aimed to implement videorecording-based remediation of standardized patient encounters among medical students, combined with preceptor one-on-one feedback or peer group discussion, and evaluate the effectiveness of the two remediation methods using objective structured clinical examination (OSCE).</p><p><strong>Methods: </strong>Following standardized patient encounters, 107 final-year medical students were divided into two groups based on different remediation methods of video review: (1) precepted video review with preceptor feedback (<i>N</i> = 55) and (2) private video review and subsequent peer group discussion under supervision (<i>N</i> = 52). All students underwent twelve-stations of OSCE both before and after the video review. Students' pre- and post-remediation OSCE scores, self-efficacy level in patient encounters, and level of educational satisfaction with each method were assessed and compared between different video-based remediation methods to evaluate their respective effects.</p><p><strong>Results: </strong>After remediation, the total and subcomponent OSCE scores, such as history taking, physical examination, and patient - physician interaction (PPI), among all students increased significantly. Post-remediation OSCE scores showed no significant difference between two remediation methods (preceptor module, 79.6 ± 4.3 vs. peer module, 79.4 ± 3.8 in the total OSCE score). Students' self-efficacy levels increased after remediation in both modules (both p-value <0.001), with no difference between the two modules. However, students' satisfaction level was higher in the preceptor module than in the peer module (80.1 ± 17.7 vs. 59.2 ± 25.1, p-value <0.001). Among students with poor baseline OSCE performance, a prominent increase in PPI scores was observed in the preceptor-based module.</p><p><strong>Conclusion: </strong>Video-based remediation of patient encounters, either through preceptor review with one-on-one feedback or through private review with peer discussion, was equally effective in improving the OSCE scores and self-efficacy levels of medical students. Underperforming students can benefit from precepted video reviews for building PPI.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2392428"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: In 2020, the American Osteopathic Association merged its residency programs into one system under the Accreditation Council for Graduate Medical Education (ACGME). The effects of this transition on the ophthalmology match is not fully understood. The purpose of this study is to assess the early impact of the transition to ACGME accreditation on MD, DO, and IMG representation in ophthalmology residency programs.
Materials and methods: Information about resident medical degree and resident medical school was gathered from ophthalmology residency program websites from a resident class before and after the Transition. Additionally, the medical degree of residency program directors (PD) was collected to analyze MD vs DO leadership in ophthalmology residency programs and to further stratify resident data to identify any trends in PD preference for different medical graduates.
Results: Data was obtained for 915 ophthalmology residents in 110 residency programs that met the study's inclusion criteria. Of these programs, 102 were allopathic with MD leadership, 1 was allopathic with DO leadership, 3 were osteopathic with MD leadership, and 4 were osteopathic with DO leadership. Overall, MD representation increased while DO and IMG representation decreased although not significantly. For both classes analyzed, DO and IMG representation was disproportionately low.
Discussion: The transition to ACGME accreditation seems to have primarily harmed DO and IMG applicants in the ophthalmology match while benefitting MDs. Various factors such as loss of protected residency positions for DO applicants and the closure of osteopathic ophthalmology residency programs are likely reasons to blame for this decrease in osteopathic representation.
{"title":"Characterizing the initial effects of the single accreditation system merge on the ophthalmology residency match.","authors":"Forrest Bohler, Allison Garden, Christian J Santiago, Lily Bohler, Varna Taranikanti","doi":"10.1080/10872981.2024.2307124","DOIUrl":"10.1080/10872981.2024.2307124","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, the American Osteopathic Association merged its residency programs into one system under the Accreditation Council for Graduate Medical Education (ACGME). The effects of this transition on the ophthalmology match is not fully understood. The purpose of this study is to assess the early impact of the transition to ACGME accreditation on MD, DO, and IMG representation in ophthalmology residency programs.</p><p><strong>Materials and methods: </strong>Information about resident medical degree and resident medical school was gathered from ophthalmology residency program websites from a resident class before and after the Transition. Additionally, the medical degree of residency program directors (PD) was collected to analyze MD vs DO leadership in ophthalmology residency programs and to further stratify resident data to identify any trends in PD preference for different medical graduates.</p><p><strong>Results: </strong>Data was obtained for 915 ophthalmology residents in 110 residency programs that met the study's inclusion criteria. Of these programs, 102 were allopathic with MD leadership, 1 was allopathic with DO leadership, 3 were osteopathic with MD leadership, and 4 were osteopathic with DO leadership. Overall, MD representation increased while DO and IMG representation decreased although not significantly. For both classes analyzed, DO and IMG representation was disproportionately low.</p><p><strong>Discussion: </strong>The transition to ACGME accreditation seems to have primarily harmed DO and IMG applicants in the ophthalmology match while benefitting MDs. Various factors such as loss of protected residency positions for DO applicants and the closure of osteopathic ophthalmology residency programs are likely reasons to blame for this decrease in osteopathic representation.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2307124"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10810612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139543110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31Epub Date: 2024-02-06DOI: 10.1080/10872981.2024.2311481
Julie Blaszczak, Sara Wiener, Melissa Plegue, Dan Shumer, John Shatzer, Anita Hernandez
Background and objectives: It is well established that provider lack of knowledge in the field of transgender and nonbinary health is as ignificant barrier to care and that training in this area is lacking. This study examined how family medicine residents' self-confidence and medical knowledge in providing gender-affirming care changed after completing a novel, online curriculum on transgender and nonbinary care.
Methods: Thirty-nine family medicine residents were invited to complete the curriculum. Change inself-confidence was determined by the difference in scores on a Likert scale on a pre- and post-survey. Change in medical knowledge was assessed by examining the difference between pre- and post-test scores on a novel multiple-choice examination.
Results: Only 7% of current residents agreed that their current training is adequate in order to provide comprehensive primary care to transgender and nonbinary people. After completion of the curriculum, 100% of participants felt at least somewhat confident providing primary care to transgender and nonbinary people, including hormone therapy. Average medical knowledge post-test scores trended higher than the pre-test results (mean (SD) at pre = 11.2 (1.4) vs post = 14.6 (2.8)).
Conclusions: An online, self-directed curriculum on caring for transgender and nonbinary patients in the primary care setting, including management of gender-affirming hormone therapy, has the potential to increase confidence and knowledge in this field, decreasing barriers to care for this population.
{"title":"Evaluating the effectiveness of an online curriculum on caring for transgender and nonbinary patients.","authors":"Julie Blaszczak, Sara Wiener, Melissa Plegue, Dan Shumer, John Shatzer, Anita Hernandez","doi":"10.1080/10872981.2024.2311481","DOIUrl":"10.1080/10872981.2024.2311481","url":null,"abstract":"<p><strong>Background and objectives: </strong> It is well established that provider lack of knowledge in the field of transgender and nonbinary health is as ignificant barrier to care and that training in this area is lacking. This study examined how family medicine residents' self-confidence and medical knowledge in providing gender-affirming care changed after completing a novel, online curriculum on transgender and nonbinary care.</p><p><strong>Methods: </strong>Thirty-nine family medicine residents were invited to complete the curriculum. Change inself-confidence was determined by the difference in scores on a Likert scale on a pre- and post-survey. Change in medical knowledge was assessed by examining the difference between pre- and post-test scores on a novel multiple-choice examination.</p><p><strong>Results: </strong>Only 7% of current residents agreed that their current training is adequate in order to provide comprehensive primary care to transgender and nonbinary people. After completion of the curriculum, 100% of participants felt at least somewhat confident providing primary care to transgender and nonbinary people, including hormone therapy. Average medical knowledge post-test scores trended higher than the pre-test results (mean (SD) at pre = 11.2 (1.4) vs post = 14.6 (2.8)).</p><p><strong>Conclusions: </strong>An online, self-directed curriculum on caring for transgender and nonbinary patients in the primary care setting, including management of gender-affirming hormone therapy, has the potential to increase confidence and knowledge in this field, decreasing barriers to care for this population.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2311481"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10848997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}