Perspectives on Medical Education最新文献

Background and need for innovation: In healthcare, emotions are traditionally avoided as they might cloud clinical judgement. However, ignoring emotions may lead to emotional exhaustion and burnout, jeopardising quality of care. More attention to emotions is needed to support healthcare professionals' wellbeing and vitality, especially given the high rates of emotional exhaustion and burnout among them and factors like workforce shortages, an ageing population and increasing workload demands.

Goal of innovation: The training aims to support healthcare professionals' wellbeing and vitality and help prevent emotional exhaustion and burnout.

Steps taken for development and implementation of innovation: The training is grounded in the theory of constructed emotion, incorporates an evidence-informed pedagogical approach and uses participatory live music to teach healthy emotion construction. Based on the theory, we refer to this process as 'emotion construction' rather than 'emotion regulation'. The training includes theoretical background, six exercises following a gradual build-up towards (re)constructing emotions, and homework assignments.

Evaluation of innovation: Preliminary findings support music's ability to evoke distinct memories, bodily sensations, feelings and emotions, corroborating its intended function. Eliciting personal memories with specific emotions through music supports the theory of constructed emotion and justifies its use in the training. First training evaluations included descriptions like enlightening, inspiring and empowering.

Critical reflection: The training programme shows a clear build-up and alignment with the theory, while incorporating evidence-informed pedagogical steps seamlessly. Implementation challenges include obtaining funding and, due to time constraints of the target groups, implementing the full training, which we mitigated by developing variations.

Introduction: Learners' experiences of feedback conversations, and their longitudinal impact, are largely invisible to educators. While we know more about what makes for an effective feedback conversation, we are yet to fully understand how learners make sense of these encounters over time. This has implications for understanding the potency of feedback on practice and for how best to support learners, particularly when the experience is challenging. Our research aimed to explore the characteristics of difficult feedback and the temporal aspects of feedback sensemaking.

Methods: We collected written narratives from 32 doctors and 49 medical students via an online questionnaire about a time when they received difficult feedback in a clinical setting. Open- ended prompts facilitated participants to describe their experience, the evaluation of it over time, and the learning that arose from it. We undertook reflexive thematic analysis of the data, informed by constructivist sensemaking perspectives.

Results: Difficult feedback conversations were characterized by unpredictable and complex interactions between emotions, sensemaking and learning. Despite some feedback perceived as personal, inappropriate, or threatening, feedback information was seldom disregarded. Participants engaged in feedback sharing and reflection, which often extended over years, contributing to identity work and to development of their clinical practice.

Discussion: Our findings highlighted the temporal nature of sensemaking of difficult feedback and challenge expectations for learners to respond and commit to progress in the moment. Providing learners with time for reflection on feedback and opportunities to connect with personal and professional networks may facilitate the longitudinal sensemaking processes.

Purpose: In medicine, gender bias and gendered language within assessments of individual performance are well established. Recent shifts toward assessing interdependence (the ability to work supportively and collaboratively within teams) demand we understand how gender bias and gendered language influence assessments. In exploring how faculty assess residents' interdependent performances, this study evaluated how gender-presentation influences faculty raters' assessments of residents' interdependence in Emergency Medicine (EM).

Methods: Using a multiple-methods (an experimental within-subjects study with follow-up interviews), 18 EM faculty from Canada and the United States assessed scripted videos of identical clinical encounters acted by male- and female-presenting residents. Faculty assessed female residents via anonymous online surveys and, six months later, assessed male residents via follow-up interviews using the same clinical scenarios. After every clip, faculty completed entrustable professional activity (EPA) and Milestone ratings and provided narrative justifications. Statistical analyses were conducted using Wilcoxon signed-rank tests to assess gender differences in EPA and Milestone scores. Qualitative data were analyzed using thematic analysis to identify recurring, gendered patterns in narrative justifications.

Results: Quantitative results revealed no gender differences in Milestone and EPA scores, except for the resuscitation entrustment rating, where male residents were rated less favorably (z = -3.09, p = 0.002). Qualitative findings uncovered subtle gender differences. For the same clinical performances, male residents were frequently described as leaders, while female residents as collaborative. Furthermore, male residents' help-seeking was framed as proactive, whereas female residents' help-seeking was indicative of lacking knowledge. Finally, bias was not consistent across genders: male leadership expectations could negatively flavor assessments of male collaborative performances.

Conclusion: EPA and Milestone scores showed marginal gender-based differences, while narrative justifications reflected clear gendered expectations about residents' interdependence. These findings highlight the need for equity-oriented assessment practices that interrogate both the numbers and the narratives. As team-based competencies like interdependence become central to clinical training, ensuring that assessments reflect fair, unbiased interpretations are essential to supporting all learners equitably.

Introduction: Competency committees (CCs) are considered mandatory in competency-based medical education. There remains insufficient research to guide programs in optimizing the work of CCs especially in the undergraduate context. In order to address this gap, the functioning of an undergraduate CC is examined using the construct of a shared mental model (SMM) to explore factors and context that inform a holistic review of performance.

Methods: A qualitative exploratory study was conducted. Using purposive sampling, 10 members of a Student Progress Committee (SPC) participated in 60-minute, semi-structured interviews (April 2022 to June 2023). An abductive thematic analysis approach generated themes which were then mapped onto a mental model construct. This heuristic helped construct and visualize the inner workings of a SMM as a holistic decision-making process that operates on manipulating multiple data inputs (quantitative and qualitative) in order to generate robust outcomes.

Results: SPC members shared similar expectations of the task at hand while having multiple and conflicting perspectives about inputs important for decision making. Members grappled with what they perceived as a subjective process but agreed that having principles specific to holistic decision making can generate robust outcomes. Diversity of group membership was essential for minimizing member bias and group conformity in decision making.

Discussion: This new understanding of how CCs operate at the undergraduate level can inform the SPC and guide its members in their quality improvement efforts and inform broader program-wide improvement, locally; moreover, it may contribute to the ongoing improvement of CCs in other settings.

Introduction: Effective advising is crucial for student success in graduate Health Professions Education (HPE) programs. However, the implementation and impact of advising remain underexplored, particularly from the perspective of program leaders. This study explores how HPE program leaders conceptualize advising practices that support student success.

Methods: We conducted a qualitative narrative inquiry study to explore worldwide leaders' perspectives on advising in graduate HPE programs. Fifteen program leaders across six World Health Organization regions were purposively sampled and interviewed using a semi-structured approach. Thematic analysis, informed by developmental advising theory, was employed to identify key advising strategies and challenges.

Results: Findings revealed that leaders conceptualize advising in terms of learners' academic advancement, personal development, and community building. Leaders largely prioritized clear communication, goal setting, and holistic student support within their programs' advising systems. The advisor-advisee relationship mattered to leaders. They highlighted challenges that might influence this relationship: faculty workload, role conflicts, and the need for structured advising models.

Discussion: This study underscores the critical role of advisors in HPE programs, revealing that effective advising involves both academic guidance and social support. It highlights a gap in the existing literature on how program leaders in graduate HPE programs conceptualize and support advising, and advocates for the expansion of developmental advising that addresses not only administrative tasks but also the broader developmental needs of students, such as career advancement and personal growth. The findings suggest that HPE programs support student success by fostering holistic advising practices and professional development for advisors.

Medical schools are increasingly incorporating the arts and humanities into their curricula, often emphasizing their benefits in enhancing students' clinical skills. However, the potential for these curricula to foster flourishing is equally, if not more, crucial. Although limited in scope, current literature suggests that art museum-based medical education, particularly as Visual Thinking Strategies, may support flourishing among medical learners-although more research is needed to assess the impact of these methods and their mechanisms on learners. In this article, the authors explore how integrating art museum-based programs into medical school curricula can enhance all five domains of the VanderWeele model of human flourishing: physical and mental health, happiness and life satisfaction, meaning and purpose, character and virtue, and close social relationships.

Introduction: Clinician-teachers are engaged in both clinical practice and education. They positively influence student learning by connecting clinical practice and education. Most research into clinician-teacher's dual role was performed in the clinical settings where practice and teaching are intertwined. The benefits of clinician-teachers' dual role in the classroom-setting have been underexplored, whilst a large part of medical education is classroom-based. Using boundary work theory as a lens, this study aimed to illuminate clinician-teachers' observable boundary spanning behavior integrating the clinical practice and medical education in the classroom.

Methods: A qualitative observation study of classroom-teaching within postgraduate general practitioner specialty training at three Dutch medical institutes was conducted. Video recordings and transcripts of classroom teaching were analyzed using a structured observation schedule. Boundary spanning behavior was categorized into: boundary bridging, boundary making and boundary maintenance. Distinctions were made between verbal- and non-verbal behavior.

Results: All three categories of boundary spanning behavior were observed. Clinician-teachers demonstrated boundary bridging by integrating their own clinical experiences, by normalizing students' reported clinical experiences, by encouraging students' sharing of clinical experiences and by encouraging students to apply theory in practice. Clinician-teachers demonstrated boundary making by accentuating discontinuities between clinical practice and educational information, and boundary maintenance by allowing transient differences to exist between the two settings for didactic reasons.

Discussion: This observational study contributes to an understanding of how clinician-teachers use their experience as a clinician in classroom-teaching. These insights may contribute to faculty development fostering boundary-spanning teaching practices.

Background: Residents rely on social support from team members to navigate patient care, while also facing challenges integrating into the healthcare team. Although prior research has explored help-seeking behavior, little attention has been given to how residents overcome barriers to mobilizing social resources. This study explores how, in daily clinical practice, do residents perceive and respond to barriers in accessing and making use of social capital during challenging situations?

Methods: We used a mixed-methods social network approach. Twenty-nine junior residents from various specialties participated in qualitative interviews, supplemented by ego (personal) networks to encourage respondents' reflection on social relationship dynamics.

Results: Qualitative ego network analysis revealed that residents encounter significant physical and psychological barriers, such as uncertainty and the perceived costs of seeking support, which limit access to crucial information and expertise. Quantitative ego network analysis showed that residents predominantly turned to supervisors, nurses, and peers in challenging situations. However, interviews highlighted the complexity of supervisory relationships, shaped by concerns about career impact. To navigate these barriers emotional support was sought from friends, parents, and close colleagues, while expertise was sought from supervisors, senior residents, and nurses.

Conclusion: Residents face significant barriers in mobilizing social capital, particularly with supervisors. To cope, they draw on different parts of their network for emotional support and expertise. Our results suggest that existing help-seeking models, such as Borgatti and Cross's, require refinement: power dynamics contribute to the perceived 'costs' of help-seeking, and uncertainty about others' supportive potential reflects the influence of role ambiguity and relational comfort.

Introduction: Despite the well-documented benefits of shared decision-making (SDM), its implementation in practice remains limited. Efforts to promote SDM often fail to produce lasting behavioral change among physicians. Underlying conscious or unconscious beliefs may shape their decision-making processes, influencing the extent to which SDM is applied. This study aimed to explore the perceptions, beliefs and behaviors of Dutch residents and medical specialists regarding SDM and to identify potential barriers to its integration into postgraduate medical education.

Methods: A mixed-method study was conducted, involving a survey (comprising control preference scale (CPS) and iSHARE) and focus group interviews among residents and medical specialists from seven Dutch teaching hospitals.

Results: SDM was supported by 93% (292/315) of survey respondents, with 89% (280/315) agreeing that it should be an integral part of postgraduate medical education. Seven residents (6%) and 33 medical specialists (18%) indicated they had followed an SDM training. Thematic analysis of the focus group interviews identified four disease-centered beliefs that influenced clinical thinking and decision-making among both residents and medical specialists. This disease-centeredness emerged as the primary barrier to the successful implementation of SDM.

Discussion: While SDM is widely endorsed, its practical implementation is constrained by disease-centered thinking. Achieving sustainable integration of SDM in postgraduate medical education requires a fundamental paradigm shift, in which residents and medical specialists become aware of their disease-centered beliefs and instead learn to think and act in a more person-centered manner.

Background & need for innovation: Ethical dilemmas in healthcare often involve navigating emotional and value-laden challenges. Traditional teaching approaches, such as principle-based frameworks, highlight the theory but do not contain tools to integrate emotional reflection and value prioritization, leaving a gap in preparing physicians for real-world ethical decision making.

Goal of innovation: We introduce a novel visual tool named VIEW (Visual Insight for Ethical Wisdom) that enhances ethical decision making by fostering reflection on values, emotions, and professional identity.

Steps taken for development and implementation: The VIEW tool was developed as an interactive framework that allows users to map ethical dilemmas visually. It was implemented in three workshops with 31 participants, including junior and senior physicians and medical educators. Participants used the VIEW to analyze real-life ethical challenges. They created 31 visual maps that captured emotional responses, core values, and interpretations of dilemmas. We qualitatively analyzed these maps, alongside other observations and interviews, to identify key themes.

Outcomes of innovation: Preliminary evaluations indicated that the VIEW tool effectively bridges theory and practice. It externalized thought processes, encouraging emotional awareness, and promoting value-based reasoning. Participants reported improved capacity to navigate complex dilemmas and deeper engagement with their professional identity.

Critical reflection on the process: This visual tool integrates cognitive and emotional dimensions of ethical reasoning, addressing the limitations of traditional approaches. Its implementation highlights the importance of reflection in medical education and clinical practice. Further research is needed to explore the tool's broader applicability.