Perspectives on Medical Education最新文献

Background & need for innovation: Objective Structured Clinical Examinations (OSCEs) are commonly employed to assess clinical skills. While several existing tools address components of clinical reasoning, including the Assessment of Reasoning Tool, none are calibrated for competency-based assessment of medical students (UME) in an OSCE setting.

Goal of innovation: We sought to create a clinical reasoning assessment for use in a high-stakes, summative medical student OSCE.

Steps taken for development and implementation of innovation: A minimum-competency OSCE was administered to medical students following their required clinical clerkships. We developed a tool to assess clinical reasoning of medical students at the conclusion of their required clinical clerkships and deployed it during a minimum-competency OSCE exam given at that time. The highest level of the modified tool represented minimum acceptable performance for examinees.

Evaluation of innovation: The scores and analyses provided evidence to support the use of this tool. Examinees' performance on clinical reasoning tasks was comparable with their overall performance on the OSCE. The sub-scores for clinical reasoning accurately distinguished successful examinees from those who did not meet the minimum performance level, providing support for the use of the tool in this high stakes setting.

Critical reflection: This tool was found to be useful and defensible to assess medical students' clinical reasoning. Expanded evidence for generalizability of the tool and its utility in other settings will need to be garnered through multi-center implementation and study.

Introduction: Nursing education equips students with the skills necessary to navigate the clinical environment. Repetitive training in complex skills ensures patient and student safety. Immersive virtual reality (VR) offers a realistic and safe environment for such repetitive learning processes. However, the feasibility of integrating such technology into the training of immediate newborn care skills remains unexplored.

Methods: In this feasibility study, the care procedure for immediate newborn care (INC) was standardized and converted into a VR teaching model. Experts and students were then recruited to assess and evaluate the suitability, usefulness and user-friendliness of the INC-VR model. A total of 35 students were recruited and allocated to a VR learning group and a traditional learning group to evaluate the INC-VR model in terms of knowledge acquisition, skill confidence, performance accuracy, and the time required to complete the INC tasks.

Results: Thirteen INC care tasks were transformed into a 15-minute INC-VR model, and the suitability, usefulness, and user-friendliness of the model were validated by both students and experts. Furthermore, students in the VR group demonstrated comparable INC knowledge, confidence, and performance accuracy to those in the traditional group, with a more time-efficient learning framework (10.3 minutes vs. 35 minutes).

Discussion: The INC-VR model developed herein can supplement traditional teaching to enhance students' learning. This model could provide an accessible platform for additional practice and remediation, addressing the limitations of real-time skill practice opportunities. Therefore, it may also serve as a valuable reference for other institutions developing similar VR educational tools.

Introduction: In this study we aimed to identify behaviours representative of agentic engagement in pre-clinical medical education problem-based learning (PBL) groups. Agentic engagement is defined as the proactive, intentional contributions students make to their flow of instruction. This concept, developed in secondary education, appears relevant for benefitting optimally from PBL in higher medical education.

Methods: We followed a four-step process to identify any behaviours representative of agentic engagement in our PBL setting. Following a literature search on agentic engagement scales, proactive behaviour, PBL practices and adult learning, we listed behaviours that could denote agentic engagement in our context. We fine-tuned this list through exploratory observations and tailored it to our specific context of second-year PBL groups.

Results: We identified ten observable student behaviours representative of agentic engagement within medical PBL groups. Some aligned with previous literature (asking questions, telling the teacher what they (dis)like, telling the teacher what they are interested in, defending opinions, expressing expectations, suggesting co-operation), and others had not been identified before as representative of agentic engagement (making learning as interactive as possible, creating alternative ways of covering the material, correcting content and enriching others' insights); thereby introducing novel behaviours unique to our setting.

Discussion: In medical PBL groups, we identified both known agentic engagement behaviours and distinctive behaviours specific to our context, thereby highlighting that the expression of agentic engagement is context-bound.

In February 2024, medical students in South Korea began submitting leave-of-absence requests in protest of a 65% increase in the number of medical school places in 2025. 14,000 medical students have boycotted classes and 12,000 doctors have resigned en masse. The 2024 Korean medical student collective action highlights the 'power' of medical students, the need for independent medical licensing bodies and the risks to the quality of medical education when places in medical schools are rapidly increased. The South Korean healthcare system is consistently ranked as one of the best in the world but there is now a significant risk that few new doctors will graduate and enter the workforce in March 2025.

A growing evidence base suggests that the integration of museum-based activities into health professions education can contribute to learner resilience and wellbeing, promote capacity for patient-centered care, and encourage equity in learning environments. However, the styles and methods for implementing museum-based programs vary widely across different institutions. This retrospective leverages the lessons learned from 5 years of experience implementing museum-based programs at one large academic institution to examine the various operational and logistical considerations in implementing a museum-based program for health professions learners. These efforts are intended to support the Association of American Medical Colleges and National Academies of Sciences, Engineering, and Medicine's aims to formally integrate the arts and humanities into health professions education. We structure our recommendations under the subheadings of program form, audience, function, and evaluation, with hopes of providing medical educators with starting guidelines that are broadly adoptable across different institutions.

Purpose: As competency-based medical education (CBME) continues to advance in undergraduate medical education, students are expected to simultaneously pursue their competency development while also discriminating themselves for residency selection. During the foundational clerkship year, it is important to understand how these seemingly competing goals are navigated.

Methods: In this phenomenological qualitative study, the authors describe the experience of 15 clerkship students taking part in a pilot pathway seeking to implement CBME principles. These students experienced the same clerkship curriculum and requirements with additional CBME components such as coaching, an entrustment committee to review their data, a dashboard to visualize their assessment data in real-time, and meeting as a community of practice.

Results: Students shared their experiences with growth during the clerkship year. They conveyed the importance of learning from mistakes, but pushing past their discomfort with imperfect performance was a challenge when they feel pressure to perform well for grades. This tension led to significant effort spent on impression management while also trying to identify their role, clarify expectations, and learn to navigate feedback.

Conclusions: Tension exists in the clinical environment for clerkship students between an orientation that focuses on maximizing grades versus maximizing growth. The former defined an era of medical education that is fading, while the latter offers a new vision for the future. The threats posed by continuing to grade and rank students seems incompatible with goals of implementing CBME.

Introduction: International medical students (IMSs) experience various problems preventing them from making career decisions. Assessing the difficulties involved in the career decision-making process is instrumental for identifying the sources of their career indecision, which may assist them in making more informed career decisions. This study aims to develop and validate an instrument to measure career decision-making challenges of IMSs in China, who are mainly from low- and middle-income countries.

Methods: A new scale, INternational meDical studEnt Carrer decISION-making Scale (INDECISION Scale) was developed utilising data from IMSs in China. Initial item generation stemmed from a literature review and qualitative interviews (n = 20), with items adapted or formulated referencing phrasing used in prior instruments. Subsequent expert validation and cognitive interviews (n = 6) informed adjustments, followed by a pilot study (n = 52) and focus group discussions (n = 6). Exploratory factor analysis (EFA) was performed on data from four Chinese universities (n = 334), followed by confirmatory factor analysis (CFA) on data from eight other Chinese universities (n = 514). Convergent validity (n = 102) and test-retest reliability (n = 86) were evaluated using subsets of respondents.

Results: The EFA retained 21 items, identifying six factors: unreadiness; lack of self-knowledge; lack of options knowledge; external complexity; lack of decision-making competence; and negative mentality. The CFA confirmed the six-factor model, demonstrating satisfactory model fit indices. Convergent validity and test-retest reliability were supported.

Conclusions: The INDECISION Scale exhibits adequate psychometric properties, helping IMSs systematically navigate their decision-making process, allowing for individual challenges to be effectively identified for discussion in counselling. This study serves as a starting point for further research on career indecision and career guidance for IMSs.

Introduction: Differential attainment (DA) - systematic differences in training and assessment outcomes when grouping individuals by demographic characteristics - is a pervasive problem in health professions education. Despite evidence of its prevalence, there have been few qualitative studies relating to disabled learners' experiences of differential attainment. This represents a significant gap, as understanding disabled learners' experiences is key to developing effective interventions that mitigate the impact of differential attainment.

Methods: We used critical poetic inquiry to explore the lived experiences - including emotional, cultural, and contextual dimensions - of differential attainment for disabled health professions students. We constructed poems following a secondary analysis of a large interview dataset (n = 123 participants) from one institution. We focused on students who disclosed disability (n = 18), narrowing to health professions education (n = 10).

Results: Poems reflect individuals' experiences of DA. Four themes were constructed, within which we use poems to illustrate key connections: The perseverance stereotype, Managing the hidden curriculum, Privilege and access, and Surviving, not thriving. These themes illustrate the complex interplay of systemic barriers, ableist stereotypes, and privilege in the educational journey of disabled students.

Discussion: The poems reveal the often-unseen struggles of disabled learners, challenging ableist perceptions and highlighting the necessity of inclusive practices. Our findings underscore the need for a shift in educational approaches, advocating for universal design and comprehensive support systems that consider the unique experiences of disabled learners. This study lays the groundwork for future research to develop interventions that address DA in a more inclusive and equitable manner, ensuring educational environments support all learners effectively.

The increasing use of technology in health care and health professions education is an invitation to examine how digital sources of evidence are used in making assessment claims. In this paper, we describe how four sets of terms-primary and secondary data; structured and unstructured data; development and use; and deterministic and generative-can aid in examining how data from digital sources are used in evaluating what learners know and can do. Drawing on multiple examples, this paper shows how the four sets of terms can help both developers and users of technology-based assessment systems.

Introduction: Medical training traditionally holds a deterministic view of professional socialization wherein many medical learners struggle to construct a professional identity. Previous research has demonstrated the dysfunctional norms and conflicting ideologies that create identity struggle, disproportionally affecting women and individuals underrepresented in medicine. Symbolic interactionism can help explain identity struggles, emphasizing the influence of socio-contextual factors on identity construction. The purpose of this study was to explore how residents navigate identity struggles during residency training.

Method: We conducted a qualitative exploration of 12 residents in three specialties at three academic institutions in the United States. Participants engaged in rich picture drawings followed by one-on-one interviews. We coded transcript data and met regularly to identify themes related to residents' experiences with navigating professional identity struggles.

Results: We identified three main themes on navigating identity struggles: the weight of identity work, the isolating nature of identity work, and the navigation that occurs with and against socio-contextual currents. Residents described identity work as navigation like a boat at sea. This work felt weighty and at times overwhelming and residents often felt unable to discuss their identity struggles with others. Residents utilized what agency they had to either navigate with the current, navigating towards acceptable-albeit imperfect-paths forward, or attempting to go against the current to forge new paths through resistance.

Discussion: This study highlights how context enables and constrains identity construction, how contextual constraints can create dissonance between identities, and the considerable effort required to reconcile dissonance and construct professional identities. Training program adjustments, enhanced resident support, and cultural shifts are required to sustain residents' identity work. Medical professionals should engage in collective identity work to reimagine the profession's identity by addressing dysfunctional cultural norms.