Academic Medicine最新文献

Purpose: Written assessment comments are needed to archive feedback and inform decisions. Regrettably, comments are often impoverished, leaving performance-relevant information undocumented. Research has focused on content and supervisor's ability and motivation to write it but has not sufficiently examined how well the undocumented information lends itself to being written as comments. Because missing information threatens the validity of assessment processes, this study examined the performance information that resists being written.

Method: Two sequential data collection methods and multiple elicitation techniques were used to triangulate unwritten assessment comments. Between November 2022 and January 2023, physicians in Canada were recruited by email and social media to describe experiences with wanting to convey assessment information but feeling unable to express it in writing. Fifty supervisors shared examples via survey. From January to May 2023, a subset of 13 participants were then interviewed to further explain what information resisted being written and why it seemed impossible to express in writing and to write comments in response to a video prompt or for their own "unwritable" example. Constructivist grounded theory guided data collection and analysis.

Results: Not all performance-relevant information was equally writable. Information resisted being written as assessment comments when it would require an essay to be expressed in writing, belonged in a conversation and not in writing, or was potentially irrelevant and unverifiable. In particular, disclosing sensitive information discussed in a feedback conversation required extensive recoding to protect the learner and supervisor-learner relationship.

Conclusions: When written comment requests to document performance information are viewed as an act of disclosure, it becomes clear why supervisors may feel compelled to leave some comments unwritten. Although supervisors can be supported in writing better assessment comments, their failure to write invites a reexamination of expectations for documenting feedback and performance information as written comments on assessment forms.

Purpose: Professional identity development (PID) has become an important focus of medical education. To date, contributions of basic science education to physician PID have not been broadly explored. This review explores the literature surrounding the contribution of basic science education to the PID of medical learners and interprets findings critically in terms of the landscapes of practice (LoP) framework.

Method: In this critical scoping review, the authors searched 12 different databases and professional organization websites from January 1988 to October 2022 for references relating to how, if at all, the basic science component of medical education contributes to the PID of medical learners. The LoP learning theory was chosen as a framework for critically interpreting the identified articles.

Results: Of the 6,674 identified references, 257 met the inclusion criteria. After data extraction, content analysis of recorded key findings was used to ensure all findings were incorporated into the synthesis. Findings aligned with and were critically interpreted in relation to the 3 LoP modes of identification: engagement (engaging in the work of a physician), imagination (imagining oneself becoming a "good doctor"), and alignment (aligning with the practices and expectations of a medical community or specialty). Within each mode of identification, it was possible to see how basic science may support, or catalyze, PID and how basic science may serve as a barrier, or an inhibitor, to PID or contribute to the development of negative aspects of identity development.

Conclusions: The LoP learning theory suggests that the effect of basic science on physicians' PID is most effective if educators view themselves as guides through interfaces between their scientific disciplines and medicine. Learners need opportunities to be engaged, to imagine how their current learning activities and developing skills will be useful as future physicians, and to feel alignment with medical specialties.

Purpose: In Canada, many groups (e.g., Black, Indigenous, rural backgrounds) have historically faced and continue to encounter systemic barriers in accessing the medical profession. These barriers often manifest in performance disparities, known as differential attainment, during medical school admissions. This scoping review summarizes the nature and extent of evidence on the association of differential attainment in medical school admissions selection tools and outcomes with applicant social identity in the Canadian context.

Method: The authors used Arksey and O'Malley's scoping review framework to summarize research studies published between 2000-2022 with empirical evidence of differential attainment in admissions selection tools and outcomes with respect to a range of applicant social identity categories. The authors recorded whether studies adopted a structuralist and/or intersectional perspective.

Results: Ultimately, 15 studies were included in the review. While the evidence on differential attainment associated with social identity in Canadian medical education was heterogeneous, numerous studies highlight differential attainment in the admissions process associated with applicant race and/or ethnicity (6 studies), age (5 studies), gender (4 studies), socioeconomic status (3 studies), geographic location (4 studies), and rural or urban background (5 studies). These attainment differences were reported at 3 phases of the admissions process (invitation to interview, offer of admission, and acceptance of offer), and were driven by several admissions selection tools, including grade point average, Medical College Admission Test score, and interview performance.

Conclusions: The review highlights evidence that suggests systemic, structural inequities in admissions systems manifest as differential attainment in Canadian medical school admissions. Based on this evidence, those who identify as Black or Indigenous and those with low socioeconomic status or rural backgrounds were generally more adversely affected. Admission practices must be studied and improved so medical education systems can better avow equality and human dignity and achieve equity goals.

Purpose: Feedback seeking is an expected learner competency. Motivations to seek feedback are well explored, but we know little about how supervisors perceive such requests for feedback. These perceptions matter because how supervisors judge requests can affect the feedback they give. This study explores how supervisors perceive and attribute motivations behind feedback requests to better understand the benefits and hazards of feedback seeking.

Method: Constructivist grounded theory was used to interview supervisors at the Temerty Faculty of Medicine, University of Toronto, from February 2020 to September 2022. Supervisors were asked to describe instances when they perceived feedback requests as being sincere or insincere, what led to their opinions, and how they responded. Transcripts were analyzed and coded in parallel with data collection; data analysis was guided by constant comparison.

Results: Seventeen faculty were interviewed. Participants perceived 4 motivations when learners sought feedback: affirmation or praise; a desire to improve; an administrative requirement, such as getting forms filled out; and hidden purposes, such as making a good impression. These perceptions were based on assumptions regarding the framing of the initial request, timing, preexisting relationship with the learner, learner characteristics, such as insecurity, and learner reactions to feedback, particularly defensiveness. Although being asked for feedback was generally well received, some participants reported irritation at requests that were repetitive, were poorly timed, or did not appear sincere.

Conclusions: Feedback seeking may prompt supervisors to consider learners' motivations, potentially resulting in a set of entangled attributions, assumptions, and reactions that shape the feedback conversation in invisible and potentially problematic ways. Learners should consider these implications as they frame their feedback requests and be explicit about what they want and why they want it. Supervisors should monitor their responses, ask questions to clarify requests, and err on the side of assuming feedback-seeking requests are sincere.

Purpose: Left-handed medical students contend with unique educational barriers within surgery, such as lack of educational resources, lack of left-handed-specific training, and widespread stigmatization of surgical left-handedness. This study aimed to highlight the surgical experiences of left-handed medical students so educators may be empowered to act with greater care and appreciation of these students' circumstances.

Method: In this qualitative study, the authors conducted semistructured interviews on surgical experiences during medical school between January 31, 2021, and June 20, 2021, on 31 current surgical residents and fellows from 15 U.S. institutions and 6 surgical specialties. Left-handed trainees were included regardless of their surgical hand dominance.

Results: The authors identified 3 themes related to left-handed medical students' surgical experience: (1) disorienting advice from faculty or residents, (2) discouraging right-handed pressures and left-handed stigmatization, and (3) educational wishes of left-handed medical students. Trainees describe dialogues during medical school in which their handedness was directly addressed by residents and faculty with disorienting and nonbeneficial advice. Often trainees were explicitly told which hand to use, neglecting any preferences of the left-handed student. Participants also described possible changes in future surgical clerkships, including normalization of left-handedness, tangible mentorship, or granular and meaningful instruction.

Conclusions: Left-handed medical students encounter unique challenges during their surgical education. These students report being disoriented by the variability of advice provided by mentors, discouraged by how pressured they feel to operate right-handed, and burdened by the need to figure things out by themselves in the absence of adequate left-handed educational resources. Surgical education leadership should detail the unique problems left-handed learners face, impartially elicit the learner's current operative hand preference, take responsibility for their left-handed students, promote acceptance and accommodation strategies of left-handed surgical trainees, and endeavor to improve the breadth of left-handed surgical resources.

Abstract: Left-handedness in a world of right lateral bias can be an invisible barrier both in everyday life as well as in medical career development, and throughout a medical career. Common everyday life actions, including screwing in lightbulbs, inserting a screw, or any action that requires a clockwise rotation, is designed for "righties," making life for "lefties" a challenge. Other examples include writing without a slant or without smudging. In medicine, the physical examination of a patient is taught using the right hand and standing on the right side of the patient, an awkward situation for left handers. Another major concern in medicine specifically, is handwriting-notoriously poor in lefties-impacting legibility in progress notes, prescriptions, and medical records. In surgery and other procedural specialties in particular, using instruments intended for right-handed individuals, including suturing and positioning at the operating room table, presents left-handed individuals with particular challenges. Left-handed medical students and residents are especially vulnerable, as they may feel uncomfortable requesting special accommodations for their "handedness." The significance and impact of handedness often go unrecognized, yet may play a substantial role in career choices: the difficulties of being left-handed may dissuade students from pursuing their desired career. Solutions are available, including using instruments designed for left-handers (or learning to use "righty" instruments), and positioning at the operating room or procedure table as preferred by the left-handed individual. These solutions often require a cooperative attitude by colleagues. The authors describe the significance of handedness, including their own personal experiences, and offer some solutions for left-handed individuals who struggle to adapt to a right-handed world.