Advances in Health Sciences Education最新文献

Research on how pedagogical content knowledge (PCK)-informed faculty development initiatives can support PCK development among health professions educators is limited. Given the positive impact of PCK on enhancing professional knowledge for effective teaching, this study investigates the learning process of health professions educators in developing their PCK through a faculty development initiative, supported by the Content Representation (CoRe) tool. Using a qualitative approach, grounded in social constructionism, the study engaged eight educators from diverse health disciplines at an Australian university. Participants collaborated in developing and refining PCK-infused lesson plans using the CoRe tool. Several workshops, writing sessions, feedback sharing, and an online community of practice facilitated PCK-related discussion, resource sharing, and networking. Data collection comprised two rounds of individual interviews, written reflections, and lesson planning artefacts. Data were analysed using team-based thematic framework analysis. Four themes were identified: 1) articulating teaching purposes, (2) understanding students' learning needs, (3) promoting reflection on teaching practice, and (4) challenges in adapting and implementing the CoRe tool. The findings highlight the critical role of faculty development programs and advocate for the use of the CoRe tool for articulating and scaffolding PCK for both experienced and novice educators. The collaborative environment facilitated peer feedback and knowledge sharing, thus fostering a collective understanding of PCK and affirming its relevance within the broader health professions education community.

Doctor-patient communication is a core competency in medical education, which requires learners to adapt their communication flexibly to each clinical encounter. Although conceptual learning models exist, information about how skilled communication develops over time is scant. This study aims to unpack this process of communication learning and to identify its facilitators. We conducted a longitudinal qualitative study employing a constructivist grounded theory approach in a General Practice training setting. Over a 6-month period, we closely monitored 8 first-year and 5 third-year trainees (n = 13) by means of clinical observations, stimulated recall interviews and audio diaries. In an iterative process of data collection and analysis, we triangulated these sources across trainees (horizontal analysis) and over time (vertical analysis) to identify how themes evolved. This analysis led us to the construction of a six-stage cyclic conceptual model during which trainees: (1) have an impactful experience; (2) become aware of own communication; (3) look for alternative communication behaviours; (4) experiment with new behaviours; (5) evaluate the effectiveness; and (6) internalise the new communication behaviours. Additionally, conditions were found to support learning and reflection. Becoming a skilled communicator seems to require a continuous approach, with repeated practice and reflection to adapt and internalise communication in the clinical encounter. Consequently, we recommend that trainees be supported with tailored feedback to strengthen their communication repertoire. Ideally, they should be guided by supervisors who serve as coaches in a safe learning environment with regular, planned learning activities.

At the foundation of research concerned with professional training is the idea of an assumed causal chain between the policies and practices of education and the eventual behaviours of those that graduate these programs. In medicine, given the social accountability to ensure that teaching and learning gives way to a health human resource that is willing and able to provide the healthcare that patients and communities need, it is of critical importance to generate evidence regarding this causal relationship. One question that medical education scholars ask regularly is the degree to which the unique features of training programs and learning environments impact trainee achievement of the intended learning outcomes. To date, this evidence has been difficult to generate because data pertaining to learners is only rarely systematically brought together across institutions or periods of training. We describe new research which leverages an inter-institutional data-driven approach to investigate the influence of school-level factors on the licensing outcomes of medical students. Specifically, we bring together sociodemographic, admissions, and in-training assessment variables pertaining to medical trainee graduates at each of the six medical schools in Ontario, Canada into multilevel stepwise regression models that determine the degree of association between these variables and graduate performances on the Medical Council of Canada Qualifying Examinations (Part 1, n = 1097 observations; Part 2, n = 616 observations), established predictors of downstream physician performance. As part of this analysis, we include an anonymized school-level (School 1, School 2) independent variable in each of these models. Our results demonstrate that the largest variable associated with performance on both the first and second parts of the licensing examinations is prior academic achievement, notably clerkship performance. Ratings of biomedical knowledge were also significantly associated with the first examination, while clerkship OSCE scores and enrollment in a family medicine residency were significantly associated with the Part 2. Small significant school effects were realized in both models accounting for 4% and 2% of the variance realized in the first and second examinations, respectively. These findings highlight that school enrollment plays a minor role relative to individual student performance in influencing examination outcomes.

In previous studies, nursing students have reported experiencing moral distress during practice. However, it is unclear whether student nurses who experience ethical decision-making competence in their clinical internships have a protective effect against moral distress, resilience-protective factors, and resilience. Therefore, this study aimed to examine the effects of ethical decision-making competence on moral distress, resilience, and protective factors among nursing students. The participants were recruited from five nursing schools. The study employed measurement tools, including the Ethical Decision-Making Competence Scale, Scale of Protective Factor-24, Resilience Scale, and Moral Distress Scale-Revised. We applied the partial least squares approach to structural equation modeling and multi-group analysis to analyze the data using SmartPLS software. A group of 134 student nurses participated in this study (72 women and 62 men). Findings revealed that student nurses with higher ethical decision-making competence experienced lower moral distress and greater resilience and protective factors. Students with higher protective factors demonstrated greater resilience. However, resilience was not significantly associated with moral distress. Ethical decision-making competence partially and indirectly affected resilience via protective factors. This study recommends that the cultivation of clinical nursing practice focus on student nurses' ethical decision-making competencies. Narratives (e.g., moving stories that illustrate human suffering) can prompt students to reflect on the role of the ethical subject in a situation and further enhance their ability to identify ethical issues and apply ethical principles appropriately.

The presence of digital technologies in clinical learning environments is increasing. However, there is little research into how technologies influence the interplay between touch and the acquisition of physical examination skills by health professional students. In this study, we aimed to explore how digital technologies feature in clinical educators' accounts of current physical examination teaching in practice. A qualitative interpretive design was used. Data was collected via in-depth interviews with 18 clinical educators from the disciplines of medicine, physiotherapy, midwifery, and nursing to investigate the current perspectives and practices used in teaching physical examination. We interpreted three themes within the data: Polarised perspectives of digital technology use in physical examination teaching, the integration of digital technologies into the teaching of physical examination, and the invisibility of digital technologies in physical examination teaching. Digital technologies have been extensively integrated into the teaching of physical examination. However, the perceptions of the participating clinical educators have not evolved at the same pace. We suggest that clinical educators re-examine their assumptions and attune themselves to the dynamic relationship between hands-on skills and digital tools.

Self-regulated learning (SRL) has been the focus of medical education, with the belief that mastering effective SRL strategies can significantly contribute to the academic achievements of medical students, thereby establishing a robust foundation for their future clinical practice. Despite the importance of SRL, empirical evidence linking SRL to academic performance has been mixed. This study aims to quantify the association between SRL and the academic performance of medical students. A one-year longitudinal study was conducted consisting of two waves separated by one year, wherein students from China Medical University who were enrolled in the clinical medicine program in 2018 were randomly selected and followed. Participants provided socioeconomic information in the first wave and completed the Self-regulated Learning Perception Scale (SRLPS) in both waves. Participants' academic performance was assessed using Grade-point Average (GPA) scores for the following year. Fixed-effects models were utilized to address potential endogeneity issues when investigating the association between SRL and academic performance based on the longitudinal data collected. The final sampled data consisted of 395 medical students who completed two rounds of questionnaires. The overall score of SRL was positively correlated with academic performance insignificantly (β = 0.007, SE = 0.004). However, the domain, Learning motivation and action, was significantly positively correlated with academic performance (β = 0.052, SE = 0.020), while the other domain, Lack of self-directedness, was significantly negatively correlated with academic performance (β=-0.037, SE = 0.009). Enhancements in certain self-regulated learning behaviors, like cultivating intrinsic motivation for learning, positively correlated with the academic performance of Chinese medical students. However, the negative correlation with self-directedness in learning highlights the multifaceted nature of SRL and the complexity of its relationship with students' educational outcomes.

Developing and maintaining connections with others, or what we refer to as the formation of social ties, may strengthen medical students' sense of belonging in medical school. Social ties play a particularly important role for women medical students as the medical field remains largely dominated by masculine norms. However, forming social ties remains challenging for women in medicine. This study used the COVID-19 pandemic to examine how women medical students navigated the spatial contexts of medical school to form social ties. Using longitudinal qualitative research and narrative inquiry, it describes how 17 women medical students formed social ties during the early stages of COVID-19. Beginning in fall 2020, during the initial two-years of medical school, the participants (1) described how personal ties were deterred from forming in early experiences of medical school; (2) shared experiences that promoted a sense of community bonding during middle and later periods; and (3) expressed limitations of access to the formation of professional ties throughout their initial 2-years. This study has important implications for understanding ways spatial contexts, access to physical connections, and the mental and emotional barriers or pathways play roles in social tie formation for women medical students and how longitudinal qualitative research can narrate these changes through time.

There is increasing interest in health professions education (HPE) in applying argument-based validity approaches, such as Kane's, to assessment design. The critical first step in employing Kane's approach is to specify the interpretation-use argument (IUA). However, in the HPE literature, this step is often poorly articulated. This article provides guidance on developing the IUA using a worked example involving a workplace performance assessment tool. In developing the IUA, we have drawn inspiration from approaches used in the discipline of language assessment to situate the inferences, warrants and assumptions in the context of the assessment tool. The worked example makes use of Toulmin's model of informal logic/argumentation as a framework to structure the IUA and presents Toulmin diagrams for each inference such that the reader can connect the argument chain together. We also present several lessons learned so the reader can understand the issues we grappled with in developing the IUA. A well laid out IUA allows the argument to be critiqued by others and provides a framework to guide collection of validity evidence, and therefore is an essential ingredient in the work of assessment design and validation.

In this commentary, the authors comment on a recent paper that argued for clear definitions of metacognition, reflection, and metacognitive reflection. Challenging the notion that exclusive definitions are essential to the sciences of health professions education, the authors argue for approaches that define conceptual spaces in which different definitional positions can coexist and scholarship based on similarity rather than identity can be pursued.