Advances in Health Sciences Education最新文献

Written examinations are commonly used to assess learning. Different resources made available during testing (closed-note, open-note, and cheat-sheet) may influence student learning. The effect of resource availability on long-term knowledge application is unknown. Understanding the effects of exam resource availability on long-term knowledge application is needed, as application is essential in applied fields such as Occupational Therapy. To explore differences in short-term knowledge retention (course one overall score, midterm exam, and final exam) and long-term knowledge application (course two summative assessment) among occupational therapy students who had different types of exam resource availability during course one (closed-note, open-note, cheat-sheet). Data were extracted from four consecutive cohorts (n = 73) as they completed two sequential occupational therapy courses. Exam resource availability was the independent variable (k = 3), with course one midterm and final exams and overall course grade, and course two summative assessment grade as dependent variables. Kruskal-Wallis tests compared differences across conditions. Concerning short-term retention, no significant differences were observed between groups for course one midterm exam grade or overall course one grade. Course one final exam grades were significantly higher in the cheat sheet condition compared to closed note (3.9%, p = .009). Concerning long-term application as measured by the course two summative assessment grade, the closed note condition scored significantly higher than open note (6.25%, p = .01). No other comparisons were significantly different. In this sample we observed a small difference in short-term knowledge retention in favor of a cheat sheet condition and moderate difference in long-term application in favor of a closed note condition. While results suggest possible differences in performance across exam conditions, findings should be interpreted cautiously due to the small, convenience-based sample. This exploratory analysis offers preliminary insights and identifies directions for future research on the pedagogical impact of exam design.

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.