Advances in Health Sciences Education最新文献

When students learn with-and from-other students, it is called peer-assisted learning (PAL). How undergraduate medical students use their peers for their clinical-reasoning learning process remains unclear, although literature suggests that it is a promising learning strategy at this stage. This research therefore explores the question: 'How is PAL manifested in the clinical learning environment of undergraduate medical students with regard to developing clinical-reasoning skills?'. A constructivist paradigm with a sociocultural theoretical framework was adopted for this research, using PAL and workplace learning as theoretical background. Focused ethnography and a combination of template and open coding was used to gather and analyze qualitative data. Twenty semi-structured interviews were conducted with nine students, four residents, and seven clinical supervisors. A total number of 31.5 h were used for five clinical observations. Following categories were used to describe the data: (1) the role of PAL in the clinical-reasoning learning practice, in which PAL-theory was placed alongside clinical practice, (2) the role of different actors during PAL and (3) the PAL environment, in which contextual factors have been scrutinized. Students deploy various categories of PAL to advance their clinical-reasoning skills, although they were largely unaware of these processes, and facilitation of PAL is not consistently provided. Three topics of discussion are identified that need to be acknowledged: (1) the design of a PAL environment that is conducive to collaborative learning, (2) the shifting roles of peers when they enter clinical practice, and (3) the individualistic tendencies of students that can hamper PAL. Future research could focus on stimulating and facilitating PAL among the next generation of students and integrating PAL into the clinical practice workflow.

Self-management is important for people coping with chronic diseases. The self-determination theory (SDT) emphasizes the role of healthcare professionals' (HCPs) (de)motivating interaction styles in either supporting or thwarting patients' self-management behavior. Since developing (de)motivating interaction styles starts during education, this study aimed to identify profiles among HCPs in training based on their (de)motivating interaction styles and to assess how these profiles differ in sample characteristics, SDT-beliefs, and self-efficacy in self-management support. Cross-sectional data were collected using self-reported questionnaires among nurses (n = 125) and physiotherapists (n = 257) in training (total participants: n = 382). Cluster analyses were performed to identify the profiles followed by chi-square tests and MANCOVA-tests to assess profile differences. Five profiles were identified, labelled as: motivating (16%), active (22%), undifferentiated (29%), demotivating (17%) and inactive (17%). The motivating profile contained fewer men (10%), while the demotivating profile had a higher proportion of men (52%) compared to the whole sample distribution (28%). Fewer nursing students were categorized to the active profile (20%) compared to the overall sample distribution (33%). Higher SDT-beliefs and self-efficacy in self-management support were noted in the motivating and active profiles as opposed to the demotivating and inactive profiles. These results contribute to a better understanding of healthcare students' interaction styles during patient self-management support. In education of HCPs, a focus on improving SDT-beliefs and self-efficacy in self-management support, may help HCPs to improve their interaction profile towards people with chronic diseases.

Erroneous and malpractice claim cases reflect knowledge gaps and complex contextual factors. Incorporating such cases into clinical reasoning education (CRE) may enhance learning and diagnostic skills. However, they may also elicit anxiety among learners, potentially impacting learning. As a result, the optimal utilization of such cases in CRE remains uncertain. This study aims to investigate the effect of erroneous and malpractice claim case vignettes on anxiety and future diagnostic performance in CRE and explores possible underlying factors that may influence learning, including self-reported confidence in the final diagnosis, learners' satisfaction, and retrospective impact of the cases. In this three-phase experiment, GP residents and supervisors were randomly assigned to one of three experimental conditions: neutral (without reference to an error), erroneous (involving a diagnostic error), or malpractice claim (involving a diagnostic error along with a malpractice claim description). During the first session, participants reviewed six cases exclusively in the version of their assigned condition, with anxiety levels measured before and after. In the second session, participants solved six neutral clinical cases featuring the same diagnoses as those in the learning phase but presented in different scenarios, along with four filler cases. Diagnostic performance and self-reported confidence in the diagnosis were assessed. The third session measured learners' satisfaction and longer-term impact on the participants. Case vignettes featuring diagnostic errors or malpractice claims did not lead to increased anxiety and resulted in similar future diagnostic performance compared to neutral vignettes. Additionally, self-reported confidence, learners' satisfaction and long-term impact scores did not differ significantly between conditions. This suggests these cases can be integrated into CRE programs, offering a valuable source of diverse, context-rich examples that broaden case libraries without interfering with diagnostic performance or causing anxiety in learners.

Background Currently no guidelines exist for the development of surgical handover educational curricula. This critical review synthesises the relevant literature to identify best approaches to handover education and develop an evidence-based framework for teaching and assessing surgical handover skills. Methods The following resources were critically reviewed by two independent researchers to identify key educational components; (1) all published studies primarily utilising an educational intervention to improve surgical handover up to May 2023, (2) key international guidelines and (3) reviews of all handover interventions published within the last 10 years. Results A total of eight comparative studies, two systematic reviews, and four handover guidelines were included. Findings were reported across eight domains; including educational setting, approach, format, content, resources used, assessment, student feedback, and follow-up training. A framework for developing surgical handover curricula was also reported. Conclusion The reported educational framework or 'blueprint' aims to assist educators across multiple settings to develop evidence-based surgical handover curricula for undergraduate and postgraduate learners. Future studies need to achieve higher Kirkpatrick levels to demonstrate both effectiveness and sustainability of educational interventions, ensuring safer patient care.

Professional work in healthcare is increasingly disruptive, requiring professionals to be flexible and adaptable. Research on adaptive expertise and adaptive performance in healthcare has grown, and operationalisation and measurement of these concepts are crucial to meet professionals' evolving needs. This study provides an overview of measurement instruments for adaptive expertise and adaptive performance in (becoming) healthcare professionals, including an evaluation of their operationalisations and the amount of evidence supporting their quality. A scoping review was conducted, including an analysis of operationalisations and the amount of evidence supporting the quality of instruments, based on the criteria outlined in the Standards for Educational and Psychological Testing (2014). Seventeen articles were included, comprising nineteen measurement instruments, three of which were specifically developed for the healthcare domain. The instruments, categorized into six types, varied in the nature and volume of evidence supporting their quality. Analysis of the operationalisations led to a clearer understanding of the concepts, with themes emerging around adaptive expertise and adaptive performance. The study reveals a dominance of self-evaluation and job requirement instruments, while other methods, such as design scenarios, mixed-methods instruments, and collegial verbalization, are underrepresented. Instruments developed specifically for healthcare need further validation and reliability testing. The categorization of subscales into 13 themes provides further clarification of the concepts and suggestions for future research. Instruments to measure adaptive expertise and adaptive performance are limited and vary in conceptualisation, operationalisation and quality. Further research is needed to improve the validity and reliability of healthcare-specific instruments.

The rise of robotic surgery has been accompanied by numerous educational challenges as surgeons and trainees learn skills unique to the robotic platform. Remote instruction is a solution to provide surgeons ongoing education when in-person teaching is not feasible. However, surgical instruction faces challenges from unclear communication. We aimed to describe, examine, and compare ambiguities in remote and in-person robotic instruction. We designed a simulation scenario in which a standardized learner performed tasks in robotic surgery while making pre-scripted errors. Instructors provided remote or in-person instruction to the standardized learner. We applied tools from discourse analysis to transcribe sessions, identify instructional instances, classify ambiguities, and select passages for further review. We used tests of proportions to compare ambiguities between the settings. We conducted four simulation sessions, including two remote and two in-person sessions, and identified 206 instructional instances. Within these, we found 964 occurrences of three common semantic ambiguities, or ambiguities arising from words alone. Instructors used visual tools - thus employing multimodality - to clarify semantic ambiguities in 32% of instructional instances. We identified a similar degree of referential ambiguity, or ambiguity for which context from multimodality did not provide clarifying information, during remote (60%) and in-person (48%) instructional instances (p = 0.08). We described, examined, and compared ambiguities in remote and in-person instruction for simulated robotic surgery. Based on the high prevalence of ambiguity in both settings, we recommend that robotic instructors decrease referential ambiguity. To do so, instructors can reduce semantic ambiguity, harness multimodality, or both.

The COVID-19 pandemic triggered a global pivot to virtual care (VC) technologies. While there has been considerable academic work exploring the "how" of VC, few studies have explored the impact of this pivot, its unintended consequences, and its governing rationales. This study addresses this gap in relation to care, professional identity and the evolving requirements for health professions education. Collected over three years, data for this study included evaluation surveys (134), interviews (59), publicly-available documents (240), and academic articles (217). Interviews and surveys were conducted in the Toronto Academic Health Science Network (TAHSN) and in a European academic medical centre (Maastricht UMC). Criteria for academic literature were that they addressed the shift to VC and were published between 2019 and 2023. Foucault's work, The Birth of the Clinic, his methodologies of Critical Discourse Analysis and his concept of spatiality, guided the analysis. Patients, clinicians and institutional leaders were appreciative of VC and the perceived improvements brought to care logistics, patient experience and efficiencies. Two discourses governed these sentiments-VC as a tool for both "service" and "managerialism." Assessing changes in clinical practice, experience and professional identity, our analysis suggested that a new virtual clinical space was being produced, one in which rules and experiences were different from that of a classical clinic. We named this new space the "Mediverse"-a space of undiscovered complexity with material and unintended consequences on user experience. This study identifies a new framework in which to study and assess this new clinical space.

Big datasets and data analytics enable granular analyses examining group differences in performance. Our focus is on differential attainment (DA) in postgraduate College (Board) examinations. We asked: Are candidates' sociodemographic characteristics associated with performance on the UK's Membership of the Royal College of Physicians (MRCP) Part 1 after adjusting for medical school performance (MSP) and type of medical programme? This was a retrospective longitudinal cohort study of 6040 medical graduates with linked sociodemographic data in the UK Medical Education Database qualifying from a UK medical school (2012-2014) and sitting MRCP Part 1 before October 2019. Chi-squared tests established univariable associations with MRCP performance (pass/fail first sitting MRCP Part 1). Multivariable mixed-effects logistic regression identified independent explanatory factors of success, adjusted for medical school. The odds (95% CI) of passing MRCP Part 1 exams on first sitting were greater for men (OR = 1.61, CI 1.42-1.81, p < 0.001) and those on a graduate entry programme (OR = 1.44, 1.05-1.99, p < 0.001). The odds of passing were lower as age increases (OR = 0.87, 0.85-0.90, p < 0.001), for minority ethnic (OR = 0.61, CI 0.53-0.7, p < 0.001), and gateway to medicine (OR = 0.49, CI 0.27-0.90, p = 0.02) candidates. After adjusting for MSP, odds were greater for passing in men (OR = 1.62, CI 1.24-2.11, p < 0.001) and candidates with higher MSP (OR = 4.12, CI 3.40-4.96, p < 0.001). Our findings illustrate how performance on MRCP part 1 is associated with group-level social and educational factors. This DA may be due to aspects of the assessment itself, and/or the persistent nature of social and educational disadvantage.

Implementing competency based medical education (CBME) has generated enormous amounts of assessment data. To help residents synthesize and use these data, some programs have appointed academic advisors (AA) to 'coach over time'. This study explored how resident and faculty AA dyads perceived their relationship developing and evolving, and the extent to which it aligned with 'coaching over time'. Over a two-year period at four separate time-points, we conducted longitudinal qualitative interviews with nine dyads of Internal Medicine residents (32 interviews) and their paired AA (27). We used constructivist grounded theory to develop a conceptual understanding of how AA-resident relationships evolved. Three major themes were identified. 'Building the Relationship' included elements perceived to facilitate or impede growth of the relationship. Most relationships flourished, facilitated by passage of time, 'fit' between the two, and often by working together clinically. Still, many residents perceived the need to 'save face' with their AAs. 'Enacting the AA Role' had features that appeared to align more with mentorship than coaching. 'Finding Meaning in the Relationship' underscored the perceived value fostered by the longitudinal pairing. The relationships often, but not always, achieved far-reaching benefits, though not necessarily limited to those intended by the program. Our study helps us understand what 'coaching over time' might look like for large residency programs wherein residents rotate through many sites and services. The dyads created an opportunity for a coaching relationship to form and develop in beneficial ways, though it was different to and went beyond the narrower focus on meeting CBME requirements.