Perspectives on Medical Education最新文献

Background: Educators struggle to implement Interprofessional Education (IPE) in workplace settings. We adopted an educational design research (EDR) approach to implement an IPE activity and establish design principles supporting IPE implementation in workplace settings.

Method: We adopted an iterative process of analysis/exploration, design/construction and evaluation/reflection. We performed a scoping review, visited examples of IPE initiatives and involved workplace professionals to define preliminary design principles for implementation. An IPE activity was implemented where students from nursing, midwifery and medicine care for patients together. Continuous reflection during the EDR process supported the refinement of design principles.

Results: We describe 14 design principles for implementation of IPE: (1) Set an objective; (2) Make the project evidence informed and theory driven; (3) Nurture a growth mindset; (4) Stimulate transformative participation; (5) Be aware of culture; (6) Support faculty members; (7) Align learning outcomes (8) Design formative and reflective assessment methods; (9) Position within an authentic context; (10) Facilitate informal interaction; (11) Balance patients' safety with attributing responsibility; (12) Align with the workplace, seize opportunities to improve interprofessional collaboration; (13) Evaluate the implementation; AND (14) Trust the process. The design principles related to three overarching concerns describing IPE implementation as a change process: patient safety, workflow and culture.

Discussion: The 14 design principles support context sensitive IPE implementation in the workplace. The EDR approach nurtured transformative participation, empowering stakeholders to participate and contribute to design and decision making. This resulted in an evidence informed, interprofessional cocreation process in and with the workplace that was aligned with existing workflow and organizational culture.

Purpose: Medical school admissions is a vital area for advancing diversity, equity, and inclusion (DEI). Integrating bias recognition and management (BRM) within the context of admissions is critical in advancing DEI. However, there is a dearth of empirically informed literature on BRM in the admissions context. Therefore, this study sought to explore how individuals involved in admissions decisions process and integrate bias related feedback.

Methods: The authors conducted a qualitative exploratory study using constructivist grounded theory. 21 semi-structured interviews were conducted with various participants in the admissions process at a North American medical school who had participated in bias related training. Participants included medical school faculty, senior medical students, and community volunteers.

Results: Overall, participants expressed diverse perspectives on their personal biases and how these biases impact admissions decisions. Their reflections were shaped by their identities, values, and priorities, which varied based on whether they were faculty members, students, or community members. Participants also highlighted that their biases influenced their perceptions of the ideal admissions candidate, thus influencing their decision-making process. They emphasized the need for more opportunities to engage in dialogue with peers to openly share and discuss how to recognize and manage their biases.

Conclusion: Our study suggests that fostering critical reflection about identity tensions, building and sustaining a community of practice, and facilitating sustained dialogue may provide admissions committees with an evidence-informed, meaningful, and sustained approach to advancing DEI through bias recognition and management.

Introduction: Feedback literacy (FBL) is a critical skill for learners encompassing four behaviors: appreciating feedback, making judgements, managing affect, and taking action. Little guidance has been available for clinical preceptors to promote FBL. The R2C2 feedback and coaching model that guides teachers through building Relationships, exploring Reactions and Reflections, discussing Content and Coaching to co-develop an action plan for follow-up may support FBL. This study sought to identify whether R2C2 conversations operationalized FBL behaviors and the factors that appeared to influence FBL.

Methods: Based on data from a multi-institutional, qualitative study involving 15 dyads of learners (residents and medical students) and their physician preceptors, a secondary analysis of R2C2-guided feedback conversations and debriefing interviews was undertaken. A framework analysis mapped the data to FBL behaviors and explored factors that impacted behaviors in the context of the research and theories underpinning R2C2 and FBL.

Results: Most elements of FBL behaviors were demonstrated in R2C2 conversations. Appreciating feedback and making judgements were most consistently noted. There was less evidence of managing affect as learners indicated acceptance of feedback. There was variability in the co-creation of action plans. Some created action plans, others had incomplete or no plan for immediate action or follow-up. FBL appeared to be impacted by learner-preceptor relationships, active learner engagement in feedback discussions, and personal characteristics.

Discussion: Our analysis demonstrated that effective use of the R2C2 model could enhance FBL behaviors provided attention was paid to optimizing all phases of R2C2, particularly co-creation of action plans for follow-up.

In this introduction, the guest editors of the "Next Era in Assessment" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.

When health professions learners do not meet standards on assessments, educators need to share this information with the learners and determine next steps to improve their performance. Those conversations can be difficult, and educators may lack confidence or skill in holding them. For clinician-educators with experience sharing challenging news with patients, using an analogy from clinical settings may help with these conversations in the education context. One common model in the clinical setting for 'breaking bad news' to patients is SPIKES: Set-up, Perception, Invitation, Knowledge, Emotion, and Summary/Strategy. The authors reviewed evidence in the education setting, particularly from the remediation literature, to consider how the SPIKES model might translate from clinical settings to those in which educators must share 'bad news' with learners about their academic performance. Based on available guidelines and evidence, the authors advocate that the SPIKES model can serve as a useful framework to help educators incorporate, by way of analogy, key components into these conversations, and increase the likelihood of successful outcomes.

Background: The Truth and Reconciliation Commission of Canada called upon health professional programs to teach about historical and on-going colonalism. Since these calls to action, there has been an increase in educational opportunities on the topic. Although it is generally assumed that learning about colonialism will reduce racism and improve allyship towards Indigenous Peoples, an evaluation of this assumption is needed.

Purpose: An integrated review of the literature was conducted to assess how participation in educational experiences is associated with learner outcomes and how they may vary according to course design considerations including the guiding framework, content foci, mode of delivery, activities, and duration.

Methods: Studies assessing outcomes of educational activities related to the legacy of colonialism identified in a previous scoping review, as well as any such studies published since then were included in the present study. Data synthesis was performed using content analysis of the results and discussions presented in the included papers.

Results: A review of 15 papers identified a backfire effect that was only evident among the studies that included a delayed post-evaluation timeframe. In two educational experiences, it was found that learners were more likely to express unfavourable attitudes towards Indigenous Peoples post-training. These educational opportunities were designed using a cultural safety framework and followed a similar course delivery (e.g., viewing of vodcasts, use of case studies) and provided similar content (historical policies, Indigenous cultural beliefs and practices).

Conclusions: The findings should be interpreted with caution but point to plausible implications related to the backfire effect of educational opportunities on learners' attitudes towards Indigenous Peoples post-training.

Social skills (e.g., assertiveness, empathy, ability to accept criticism) are essential for the medical profession and therefore also for the selection and development of medical students. However, the term "social skills" is understood differently in different contexts. There is no agreed upon taxonomy for classifying physicians' social skills, and skills with the same meaning often have different names. This conceptual ambiguity presents a hurdle to cross-context communication and to the development of methods to assess social skills. Drawing from behavioral psychology, we aim to contribute to a better understanding of social skills in the medical context. To this end, we introduce a theoretically and empirically informed taxonomy that can be used to integrate the large number of different social skills. We consider how skills manifest at the behavioral level to ensure that we focus only on skills that are actually observable, distinguishable, and measurable. Here, behavioral research has shown that three overarching skill dimensions can be seen in interpersonal situations and are clearly distinguishable from each other: agency skill (i.e., getting ahead in social situations), communion skill (i.e., getting along in social situations), and interpersonal resilience (i.e., staying calm in social situations). We show that almost all social skills relevant for physicians fit into this structure. The approach presented allows redundant descriptions to be combined under three clearly distinguishable and behavior-based dimensions of social skills. This approach has implications for the assessment of social skills in both the selection and development of students.

Introduction: Undergraduate healthcare students on placement abroad can experience challenges that affect their wellbeing, personal and professional development. These challenges may result in students taking a more peripheral role in workplace activities, which negatively impacts learning. We studied how personal and professional challenges affect students' learning and wellbeing during a clinical placement abroad.

Methods: We used the rich pictures drawing method to elicit semi-structured student interviews and capture personal and professional challenges within different contexts. Language, culture, education, and belonging were used as sensitizing concepts, underlying thematic analysis. We conducted a parallel and iterative analysis of the transcripts and rich pictures. Team discussions focused on developing patterns and further conceptualization of results.

Results: Based on thirteen student accounts, we identified four main themes: 'Learning to work in the international context'; 'Cultural differences shape professional identity'; 'Deliberate social connections'; and 'Personal growth through international experiences'. Active participation in local practices was crucial to overcome barriers in language, culture or education, and increase belonging. Local healthcare teams and peers supported students' wellbeing, personal and professional development by helping them establish their role as a learner, whilst exploring the scope and boundaries of their future profession.

Conclusions: Language, cultural and educational challenges can be considered an inevitable part of student placement abroad. Local peers and staff may support this transition and help recognize learning opportunities and challenges in the workplace. Clinical educators can facilitate learning and wellbeing by providing social support and guidance on professional behavior, including communication.

Introduction: Medical students learn to reflect to gain new insights into self and practice; however, allowing for reflection within a busy curriculum is challenging. In this study we embedded reflective writing prompts (RWP) into an existing assessment item, Online Submission of Case Reports (OSCAR), to investigate whether this minimalistic scaffolding intervention could develop students' reflective capacity and increase their exposure to rural social determinants of health.

Methods: This study is framed by ontological realism and informed by an interpretivist stance. Focus group transcripts (medical students and educators) were inductively analysed using thematic analysis. Written OSCAR reflections were analysed in a deductive top-down method to provide a contrasting perspective and triangulation.

Results: Focus groups included 27 students, 10 educators, and 52 OSCAR reflections. Inductive analysis generated three themes: Scaffolded Learning, Affording Diverse Responses, and Maximising Learning Opportunities. Deductive analysis indicated that most students (87%) demonstrated lower-order thinking.

Discussion: Most participants valued the impact of RWP on students' learning. Though the RWP did not assist students to demonstrate higher-order thinking, they did increase the breadth of rural social determinants of health topics reflected upon by students, thereby increasing student knowledge of the impact of rural context on patient care.

The integration of technology into health professions assessment has created multiple possibilities. In this paper, we focus on the challenges and opportunities of integrating technologies that are used during clinical activities or that are completed by raters after a clinical encounter. In focusing on technologies that are more proximal to practice, we identify tradeoffs with different data collection approaches. To maximize the benefits of integrating technology in workplace-based assessment, we describe the importance of using preexisting frameworks from the fields of assessment design, implementation research, and clinical artificial intelligence governance.