Advances in Health Sciences Education最新文献

Health systems worldwide continue to face health inequities rooted in social, political, and economic structures. In response, health professions education (HPE) programs are increasingly aiming to prepare learners for socially accountable practice. Despite this growing attention, social accountability remains ambiguously defined and inconsistently taught, assessed, and enacted across curricula. The aim of this scoping review was to map the breadth and depth of educational approaches within HPE that promote social accountability. A scoping review was conducted following Arksey and O'Malley's six-stage framework and the Joanna Briggs Institute methodology. MEDLINE, EMBASE, CINAHL, ERIC, APA PsycINFO, and Education Source were searched for articles published from January 2000 to May 2020, with an updated search in 2024. Screening involved a calibration exercise at both title/abstract and full-text stages. Descriptive numerical analysis and reflexive thematic analysis were employed, supported by knowledge user consultation. Most articles originated in North America (n = 179; 82%) and focused on undergraduate medical education (n = 157; 71.7%), especially among future physicians (n = 122; 55.7%). Common strategies included reflection-based learning (n = 90; 41.1%), small group learning (n = 82; 37.4%), and didactic lectures (n = 80; 36.5%). Many studies described using multimodal approaches (n = 85; 38.8%). Educational approaches emphasized experiential, reflective, and community-engaged learning and were grouped into ten overarching categories. These were organized using the Guideline for Reporting Evidence-based practice Educational interventions and Teaching (GREET). By synthesizing how educational approaches to social accountability are reported, this review offers a basis for reflection, dialogue, and further inquiry into their development, delivery, and integration in HPE curricula.

Assessing clinical reasoning is a challenge in all stages of medical education. Beyond the verbal communication of clinical reasoning within the hierarchy of medical education, written communication is a multi-purpose complex adjunct to support the educational process. This study applied and validated a retrospective template analysis of clinical notes using a comprehensive clinical reasoning typology intended to broaden the measurement of clinical reasoning beyond predominantly cognitive activities. Applying the typology to written communication demonstrates that increasing complexity of the analysis is mediated by intra-textual and discourse coherence, as well as the semantic ambiguity of clinical writing. The findings from this study suggest that a significant amount of information during the clinical encounter is pertinent to clinical reasoning but inferred within the contextual medical knowledge held by the writing and reading physician. Ultimately the structure and purpose of the clinical narrative reinforces both a physician-relative and culturally shaped practice of documentation. Beyond specific findings from this study, as the electronic medical record further matures and is shaped by both technology and the computer itself in the exam room, educators must seek to teach the task of clinical reasoning explication through writing, yet pay attention to the technology within the encounter and medical record itself, which shapes the clinical narrative.

Inclusion of patient age and sex in single best answer (SBA) questions is standard practice, whereas ethnicity is typically included only when considered clinically relevant. This selective use may inadvertently cue students or introduce bias. This study examined whether including patient ethnicity in SBA questions influences student performance, response time and item psychometric properties. A prospective randomised controlled study was conducted using two versions of a final-year formative assessment. In each version, approximately half of the questions included the patient's ethnicity, while the corresponding questions in the alternate version omitted this information. Students were randomly assigned to one of the two exam versions. Two hundred and sixty-seven final-year medical students participated in the study. The mean score for questions without ethnicity was 80.3% and for questions with ethnicity was 79.8% (mean difference = -0.5 pp, p = 0.12). On average, students spent 1.6 seconds longer to answer questions with ethnicity compared to questions without ethnicity (p < 0.01). In SBA questions with and without ethnicity, there was no significant difference in mean facility (79.8% vs. 80.3%, p = 0.17) or mean item-total score point-biserial correlation (0.20 vs. 0.21, p = 0.63). These indicate that including patient ethnicity did not significantly impact overall student performance or mean item-level psychometric properties. However, it was associated with longer response times, suggesting a small but significant increase in cognitive load. Educators involved in assessment design should carefully consider this added cognitive burden when deciding whether to include patient ethnicity in future assessments.

Background: In health professions education, cultivating commitment to collaborative practice is essential. However, collective dedication as a desired outcome in interprofessional education (IPE) often remains overlooked. Psychological factors contributing to team members' collective dedication are poorly understood within health professions collaborative learning environments. This study examined relationships among team psychological factors (interdependence, relatedness, efficacy, and potency) and their influence on collective dedication in an IPE context.

Method: Data were from 236 undergraduate students (Chinese medicine, Law, Medicine, Nursing, Pharmacy, Speech Therapy, and Social Work) who attended an IPE simulation at a higher education institution in Hong Kong. Participants completed a set of standardized questionnaires adapted to the IPE context, assessing positive interdependence, sense of relatedness, collective efficacy, group potency, and collective dedication. The data were analyzed using correlational and path analysis.

Results: Findings showed that positive interdependence positively predicted students' sense of relatedness, collective efficacy, and group potency. Further, sense of relatedness positively predicted collective efficacy, group potency, and collective dedication. Further, collective efficacy and group potency positively predicted collective dedication. Lastly, collective efficacy mediated the association between group potency and collective dedication.

Conclusions: This study advances health professions education by examining the pathways to collective dedication in IPE. Positive interdependence indirectly affects collective dedication through students' sense of relatedness, group potency, and collective efficacy. The findings provide practical implications of the findings for health professions educators and IPE program implementers.