Advances in Health Sciences Education最新文献

To support a complex health system, students are expected to be competent leaders as well as competent clinicians. Intentional student leadership development is needed in health professional education programs. Student-led experiences such as student-run clinics and interprofessional training wards, are practice-based learning opportunities where learners provide leadership to clinical services and/or address a gap in the system. Given the absence of leadership definitions and concepts, this scoping review explored how student leadership is conceptualized and developed in student-led experiences. The review was conducted in accordance with best practices in scoping review methodology within the scope of relevant practice-based student-led experiences for health professional students. The research team screened 4659 abstracts, identified 315 articles for full-text review and selected 75 articles for data extraction and analysis. A thematic analysis produced themes related to leadership concepts/theories/models, objectives, facilitation/supervision, assessment and evaluation of curriculum. While responding to system gaps within health professional care, student-led experiences need to align explicit leadership theory/concepts/models with curricular objectives, pedagogy, and assessments to support health professional education. To support future student-led experiences, authors mapped five leadership student role profiles that were associated with student-led models and could be constructively aligned with theory and concepts. In addition to leveraging a student workforce to address system needs, student-led experiences must also be a force for learning through a reciprocal model of leadership and service to develop future health professionals and leaders.

Health professional organisations are increasingly promoting the use of self-directed learning. Furthermore, the rapidly evolving field of healthcare has meant that there is greater emphasis within tertiary education for students to become self-directed learners and possess the skills to engage in life-long learning. The aim of this scoping review was to explore the drivers that improve the student learning experience, in undergraduate clinical science programs that utilise self-directed learning. The Joanna Briggs Institute Scoping Review Methodology guided this study. The electronic databases MEDLINE, Embase, Emcare, Scopus and ERIC were comprehensively searched in April 2022 and re-run August 2023, for peer-reviewed research articles published in English. The original search was developed in MEDLINE and then adapted to each database. Following the Joanna Briggs Scoping Review methodology, articles were screened first by title and abstract and then by full text. Included articles were assessment for methodological quality. The search strategy yielded 2209 articles for screening. 19 met the inclusion criteria. Five key factors were identified which improve the student learning experience in self-directed learning: (i) curricular elements; (ii) educator influence; (iii) impact of peers, (iv) environment; and (v) clinical placement experiences. There are many curricular, environmental, and external factors which can improve the student learning experience in programs that utilise self-directed learning. Greater understanding of these factors will allow educators within clinical science programs to implement self-directed learning strategies more effectively within curriculum.

The stigma of underperformance is widely acknowledged but seldom explored. 'Failure to fail' is a perennial problem in health professions education, and learner remediation continues to tax supervisors. In this study, we draw on Goffman's seminal work on stigma to explore supervisors' accounts of judging performance and managing remediation in specialty anesthesia training in Australia and New Zealand. In doing so, we focus on what Goffman calls a "stigma theory" to explain the supervisors' reported practices. We performed a secondary analysis of nineteen interviews originally gathered using purposive sampling to explore how assessment decisions were made. We conducted a theory-informed thematic analysis of the supervisors' accounts to identify signifiers of stigma and underlying structures and beliefs. From both deductive and inductive analysis, we developed themes that demonstrate how the stigma of underperformance influences and is induced by supervisors' reticence to discuss underperformance, their desire to conceal remediation, and their differential treatment of trainees. We also found that accounts of trainees 'lacking insight' resembled stigma-induced stereotyping. We argue from our data that our cultural expectations of perfectionism propagate a stigma that undermines our efforts to remediate underperformance and that our remediation practices inadvertently induce stigma. We suggest that a multifaceted approach using both individual and collective action is necessary to change both culture and practice and encourage the normalisation of remediation.

Despite demonstrating the required competencies to graduate, many newly qualified doctors find the transition to internship difficult. There is a concern over whether their preparation is aligned with the expectations of the role. This study aimed to gain a better understanding of the competencies needed for legitimate practice as junior doctors and explores their perceived preparedness for practice. A qualitative, descriptive study using focus groups was undertaken with first year internship doctors. Thirty-two junior doctors in their first year of internship took part in five focus groups. The data were analysed using a reflective thematic analysis approach with a subsequent analysis using the Legitimation Code Theory (LCT) specialisation dimension coding framework to aid interpretation. Personal attributes including adaptability, organisation and proactivity form the basis of achievement in internship. While graduates felt ready in some ways, it was not in the ways that counted. Participants felt well prepared in terms of their clinical knowledge and skills, but legitimacy came from being able to take responsibility, communicate effectively and apply knowledge confidently and efficiently to all aspects of patient care, something that they did not feel ready to do. Using LCT has revealed a shift in the basis of achievement between medical school, where individual academic performance is rewarded, and internship, where personal and social competencies are legitimised. There is a clash between what graduates feel well prepared for and the expectations and demands of the internship role, resulting in a difficult and stressful transition from student to doctor.

Situational Judgement Tests (SJTs) are popular to screen for social skills during undergraduate medical admission as they have been shown to predict relevant study outcomes. Two different types of SJTs can be distinguished: Traditional SJTs, which measure general effective behavior, and construct-driven SJTs which are designed to measure specific constructs. To date, there has been no comparison of the predictive validity of these two types of SJTs in medical admission. With the present research, we examine whether the HAM-SJT, a traditional SJT, and the CD-SJT, a construct-driven SJT with an agentic and a communal scale, administered during undergraduate medical admission can predict OSCE (i.e., objective structured clinical examination) performance in a low-stakes (n_LS = 159) and a high-stakes (n_HS = 160) sample of medical students. Results showed a moderate positive relation between the communal scale of the CD-SJT and performance in OSCE stations with trained patients in the high-stakes sample (r =.20, p =.009). This SJT had also an incremental value in predicting the OSCE performance above and beyond GPA (i.e., grade point average), a science test (i.e., HAM-Nat), and gender (ß = 0.18, 95% CI [0.03; 0.33], p =.020). That is, individuals who chose more communal behavioral responses in the SJT were rated more favorably in interactions with trained patients in the OSCE. A comparable correlation coefficient was observed for the HAM-SJT when controlling for range restriction due to admission (r_raw = 0.14 vs. r_controlled = 0.20). Our research provides a first indication for the predictive validity of construct-driven SJTs in high-stakes undergraduate medical admission.

When considering health professionals' requirements and responsibilities, competence is a complex concept that extends beyond knowledge to encompass understanding, application, technical skills, problem-solving, and clinical judgment. Rural clinical placements provide a rich learning environment for students to improve their competencies, self-esteem, and preparedness for practice (PFP). This scoping review aimed to identify pre-registration health students' perspectives on rural placement regarding competency and skill development, and enablers and barriers to learning. The methodology outlined by the Joanna Briggs Institute was followed. Out of 1186 records (366 duplicates), 821 were screened by title and abstract, 59 underwent full-text screening and 18 studies were included. Over half the studies included medicine students (n = 11). Reported competencies predominantly focused on self-assessed confidence regarding clinical skills. The reported barriers and enablers to learning highlighted the complexity of the placement experience and the importance of interpersonal factors, learner engagement and the supervisor's role. The review identified a gap in the literature pertaining to student perspectives of competencies and skills not assessed or experienced as well as a lack of standardised measures for PFP. The identified enablers and barriers provide suggestions for rural placement design and emphasise the importance of the student learning experience. Future research could include multiple health disciplines and specific methodologies to identify health students' perspectives regarding the development of competency, relatedness and autonomy, that is how to support health students to think, feel and act like health professionals.

Although feedback is often presented as if it were a well-understood concept in health professions education, in practice it can mean many things. For some, feedback is a conversation about defining and improving performance, while for others it is the information generated by assessments and tools. Indeed, feedback has variously been defined as a process, as data, as a conversation, and as a reflective exercise. As a result, for a concept so central to what educators do, 'feedback' is ambiguous and has multiple meanings. Pattern theory affords opportunities to examine what scholars and practitioners mean when they use the term 'feedback'. Elaborating feedback as a pattern system can connect otherwise disjointed discourses of feedback. In this paper, the authors describe the development of a pattern system of feedback in medical education. Arksey & O'Malley's 5-stages of scoping reviews were adapted to enact a 6-step pattern system development methodology that included (1) Identifying the research question and scope of inquiry; (2) elaborating a strategy for pattern identification; (3) study selection; (4) abductive pattern representation development; (5) pattern system testing; and (6) summarizing and reporting the results. A pattern system of feedback was developed based on review of 218 full text articles and testing against an additional 2833 citations. This pattern system is made up of 36 pattern representations organized under 6 domains: feedback referent, feedback intentions, feedback information, feedback processing, feedback response, and feedback meta. The pattern system was applied to two models of feedback to demonstrate its utility as a lens through which to analyze various instances of feedback and to foreshadow its potential broader applicability as a tool to facilitate knowledge synthesis in the feedback problem space.

Effective teamwork and collaboration among health professionals is a well-recognized strategy toward enhancing patient outcomes. However, there is a lack of understanding on how to best prepare health professionals for collaborative practice. The aim of this research is to gain a better understanding of how graduates of five health professions (dentistry, medicine, nursing, pharmacy, physiotherapy) perceive and experience interprofessional education for collaborative practice (IPECP) throughout their health professions journey, with a focus on transition to practice. This longitudinal study employed an interpretive, narrative methodology to understand interprofessional identity development of 24 individuals who had recently graduated from a health professions program (dentistry, medicine, nursing, pharmacy, physiotherapy) at a Canadian university. Participant experiences were analyzed using narrative analysis. Participants' narratives provided insight into the context, factors and curricular experiences needed for interprofessional identity development and preparedness for collaborative practice. Participants identified the importance of socialization and connection with others, collaborative role models and exposure to collaborative experiences and settings for interprofessional practice. Participants expressed some dissatisfaction with their earliest IPECP experiences and most valued their exposure to 'real-life' practice examples and clinical scenarios. Participants desired more authentic experiences of interprofessional collaboration during their programs. Improving health professionals' interprofessional socialization and collaborative experiences within IPECP is critical to improving patient outcomes. Study findings can inform future curricula and IPECP strategies that create conditions to enhance collaborative practice and ensure the preparedness of a future health workforce with a strong collaborative identity.

Interprofessional collaboration (IPC) in healthcare is regarded as important by professionals, as it increases the quality of care while decreasing costs. Interprofessional education (IPE) is a prerequisite for IPC and influences learners' attitudes, knowledge, and collaboration skills. Since attitudes shape behavior, understanding how they are formed is crucial for influencing IPC in learners' professional practice. We investigated what kind of IPE works, for which students, how, and in what circumstances to develop positive attitudes towards IPC. Using realist synthesis, we extracted causal mechanisms that produce positive attitude outcomes and the conducive contexts that trigger them. Our analysis resulted in six plausible context-mechanism-outcome configurations that explain positive attitude development. Positive IPC attitudes are more likely to arise in contexts where IPE provides time and facilities for formal and informal interactions, as this allows learners to get to know each other both professionally and personally, fostering trust, respect, and mutual liking. Additionally, positive attitudes are more likely in contexts where the IPE curriculum is perceived as career-relevant and boosts confidence. Key mechanisms of positive attitude development include getting to know the other learners professionally and personally, experiencing positive affect during IPE, and learners experiencing mutual dependence. Sustained positive attitudes are more likely to develop when there is organizational support for IPC and professionals attend IPE on an ongoing basis, allowing the attitudes and values expected in IPC to be positively reinforced and eventually integrated into the learners' personal value system.