Advances in Health Sciences Education最新文献

Prior studies of the effectiveness of widening participation (WP) tend to focus on 'getting in' to medical school. But what of 'staying in'? Few studies have focused explicitly on the lived experiences of WP students once in medical school, nor have there been direct comparisons of the (potentially) diverse journeys of WP students from different contexts. To address these gaps, we explored how WP medical students in the UK and Australia experience the journey into and at medical school. In this qualitative interview study of 23 participants, we focus on six individual experiences (UK = 3, Australia = 3) via a narrative inquiry approach following inductive and deductive analyses. Narratives were coded in relation to students' experiences with the key actors in their journey through medical education. In both contexts, experiences of social and cultural mobility and challenges to identity featured significantly in participant narratives. Similarly, experiences of misrecognition and microaggression reinforced feelings of being unwelcome in a culturally unsafe environment. Indigenous Australians struggled to feel comfortable in the world of medicine, but person-centred support from key staff members helped establish a sense of security and stability in developing a new identity as a medical student. The data illustrates how WP students carry the long-term impact of historical disadvantage and marginalisation into their time at medical school. Existing supports help, but institutions need to recognise that their actions and structures are unwelcoming and indeed harmful to those from non-traditional backgrounds. To be transformative, medical education must learn to promote different kinds of excellence and embrace diversity and inclusion in more socially accountable ways.

People with intellectual and developmental disabilities experience many barriers to healthcare. To address these barriers and the unique needs of this population, improved training and education for health providers, particularly training that includes persons with lived experience and that teaches interprofessional collaboration, are needed. This study applied a framework to examine the value identified in reflections of program educators for a three-week Extension for Community Health Outcomes for Adults with Intellectual and Developmental Disabilities (ECHO-AIDD for Students) program to teach an interprofessional group of students from health and social care disciplines about caring for persons with intellectual and developmental disabilities. The learning activities associated with the ECHO-AIDD for Students provided immediate value for educators and students. The potential value of participation was highlighted through the development of knowledge capital, particularly the social capital associated with connecting with an interprofessional group of students and educators. Applied and realized value was suggested by embracing a humble epistemology, recognizing the wisdom provided by all participants, and the flattening of social and professional hierarchies experienced by participants. Finally, reframing value was noted by recognizing that ECHO-AIDD for Students was a vibrant collective learning approach for interprofessional education. The three-week ECHO-AIDD for Students is a valuable opportunity for health and social care students to learn about adults with intellectual/developmental disabilities. These results also suggest that the ECHO model can be a platform for teaching health professionals how to engage in transdisciplinary practices recommended for effective healthcare.

The successful teaching of communication skills (CS)-a key competency in medical education-depends on teachers' expertise. Focusing on the experiences of CS teachers in Sweden, this study aims to explore the challenges they identify in teaching CS and how they adapt their practice accordingly. Individual interviews were conducted with 16 CS teachers, guided by a semi-structured interview guide. Data collection and analysis were iterative, aligning with constructivist Grounded Theory methodology. The teachers experienced a conflict between an idealized view of patient-centered communication taught during CS courses and the actual communication practiced in the clinical context, as well as students' attitudes. This conflict permeated participants' perceptions of their teaching goals, the challenges they faced, and the teaching strategies they employed. The teachers' goals were to convey the purpose of CS, aiming for progress rather than expecting students to reach fixed goals and to promote student ownership in classroom practice. Challenges included students' negative attitudes towards CS courses, their focus on succeeding rather than developing, and having to teach and examine simultaneously. Strategies focused on supporting learning by transforming negative attitudes towards CS teaching, providing a safe group climate, and offering constructive feedback to reduce defensiveness. This study highlights the need to bridge the gap between idealized CS teaching and clinical practice through institutional support, including curriculum integration, clear assessment frameworks, and recognition of emotional demands on CS teachers.

High-quality delivery of healthcare requires effective communication between patients and providers. Clinical communication has been a priority in medical education for decades, yet studies continue to show that trainees and providers struggle to communicate effectively in real and simulated clinical scenarios. Many have investigated potential methods to improve the initial acquisition, long-term retention, and holistic evaluation of clinical communication competency in medical trainees. However, there has been a lack of rigorous qualitative research investigating the medical student perspective on this process. This study aimed to identify medical student perceptions of what factors may influence effective clinical communication and how those factors evolve with time. Twenty-two medical students were interviewed between August 2021 and May 2022 at the University of Mississippi Medical Center. Their interviews were transcribed and analyzed using deductive, inductive, and categorical coding methods to construct themes. These themes identified six influencing factors (personal identity; biases and assumptions; norms and expectations; language; episodic contexts; and comfort and trust) and one impact (evolution of personal identity). The relationships between these themes enabled the researchers to establish a preliminary model that demonstrates how medical students believe effective clinical communication occurs. Medical educators may use this model to develop innovative curricular objectives, assessment methods, and teaching strategies that might improve student's acquisition and demonstration of effective clinical communication. These improvements may be most beneficial for students who face minority stress, as well as those combating oppressive systems based on the complex relationships between their multiple minority identities.

Learner Handover (LH) involves sharing information about learners between faculty supervisors, aligning with a growth mindset. Previous studies, however, demonstrate LH can bias subsequent ratings. Most of these studies collect ratings after a single encounter but faculty often have multiple interactions with learners potentially mitigating LH-related bias. This study explored if LH influences faculty ratings, entrustment decisions and feedback after observing several encounters of the same learner. Internal medicine faculty (n = 57) from five medical schools were randomly assigned to one of three study groups. Each group received either positive, negative or no LH prior to watching five simulated resident-patient encounter videos of the same white male resident. Participants rated each video using an entrustment scale, the Mini-CEX and provided written feedback. Feedback was assigned a valence score (-3 to + 3). There were no statistically significant differences between the mean ratings across the LH conditions (positive, control, negative) for entrustment [3.42, 3.26, 3.62], Mini-CEX [6.00, 5.90, 6.28] or feedback valence ratings [-0.34, -0.99, -0.74]. In the post-study questionnaire, most raters reported the LH had minimal effect on their decisions. Only 29% of raters guessed the true purpose of the study. Unlike previous studies, LH had no effect on ratings, entrustment decisions, or feedback after one encounter, nor over subsequent encounters with the same resident. These findings suggest LH's influence may vary and highlight the need for replication under different conditions, including diverse genders and equity-deserving groups, to identify factors that contribute to or mitigate bias.

Intensification of resource scarcity in health professions education (HPE) requires careful consideration of educational costs. Educators play a significant role in this process, as they make resource allocation decisions when designing, developing, organizing and overseeing education, yet little is known about how educators view the idea of incorporating information on educational costs into decision-making. Therefore, this study maps educator views on cost-conscious decision-making in HPE. Using Q-Methodology, we explored how HPE educators perceive costs and cost-conscious decision-making. Participants ranked 34 statements and engaged in semi-structured interviews. By-person inverted factor analysis with varimax rotation was used to extract factors representing distinct patterns of thinking held by three or more educators. These patterns were interpreted using factor arrays, distinguishing and consensus statements, and interview transcripts, yielding narrative descriptions of unique educator perspectives. Twenty-five educators holding diverse educational responsibilities and 1-29 years of experience were classified into four distinct perspectives. Unaware Doubters (n = 3) are unexposed to educational cost considerations and lack motivation for involvement. Cautious Realists (n = 8) are personally impacted by resource constraints, yet hesitant about cost-conscious decision-making. Pragmatic Supporters (n = 8) hold implicit awareness of resource scarcity but remain open to participation in cost-conscious decision-making. Empowered Agents (n = 6) are aware, active and engaged in cost-conscious decision-making, yet seek a unifying vision and transparent communication from leadership. These four distinct educator perspectives on costs and cost-conscious decision-making in education illustrate varying levels of awareness, motivation and engagement, which indicates the need for tailored strategies to improve cost-conscious decision-making in HPE. This information can be used by educational institutes to develop a vision, policy and strategy to involve educators in considerations concerning educational costs in view of the increasing resource scarcity in HPE. Future research should evaluate the effectiveness of different strategies targeted to these perspectives and explore how perspectives vary across settings and contexts.

Many medical schools primarily use multiple-choice questions (MCQs) in pre-clinical assessments due to their efficiency and consistency. However, while MCQs are easy to grade, they often fall short in evaluating higher-order reasoning and understanding student thought processes. Despite these limitations, MCQs remain popular because alternative assessments require more time and resources to grade. This study explored whether OpenAI's GPT-4o Large Language Model (LLM) could be used to effectively grade narrative short answer questions (SAQs) in case-based learning (CBL) exams when compared to faculty graders. The primary outcome was equivalence of LLM grading, assessed using a bootstrapping procedure to calculate 95% confidence intervals (CIs) for mean score differences. Equivalence was defined as the entire 95% CI falling within a ± 5% margin. Secondary outcomes included grading precision, subgroup analysis by Bloom's taxonomy, and correlation between question complexity and LLM performance. Analysis of 1,450 responses showed LLM scores were equivalent to faculty scores overall (mean difference: -0.55%, 95% CI: -1.53%, + 0.45%). Equivalence was also demonstrated for Remembering, Applying, and Analyzing questions, however, discrepancies were observed for Understanding and Evaluating questions. AI grading demonstrated high precision (ICC = 0.993, 95% CI: 0.992-0.994). Greater differences between LLM and faculty scores were found for more difficult questions (R2 = 0.6199, p < 0.0001). LLM grading could serve as a tool for preliminary scoring of student assessments, enhancing SAQ grading efficiency and improving undergraduate medical education examination quality. Secondary outcome findings emphasize the need to use these tools in combination with, not as a replacement for, faculty involvement in the grading process.