Advances in Health Sciences Education最新文献

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.

Clinical placements are integral to any health professional education program, allowing students to integrate theoretical knowledge and skills acquired in campus-based learning into authentic, real-world healthcare settings. Limited empirical knowledge exists about the determinants of clinical performance. Contemporary thought is that clinical performance is determined by multiple cognitive, environmental, psychological and social factors. Accordingly, we examined which individual differences and self-regulatory factors are credible determinants of undergraduate physiotherapy student performance within clinical placements. Utilising a measurement burst design, we captured weekly self-reported survey data amongst two cohorts (2019 and 2020) of final year, undergraduate students as they progressed through four 5-week physiotherapy clinical placements. In total, 97 of the 181 consenting students met the data inclusion criteria by completing more than three surveys in a minimum of two clinical placements. For these students, we collated their clinical placement results and utilised multilevel structural equation modelling to examine intra-individual dynamics of diverse psychosocial factors and their association with clinical performance data. Study findings supported stable individual differences, contextual experiences, and self-regulatory factors as meaningful determinants of physiotherapy entry-level performance. Knowledge of salient psychosocial determinants associated with clinical performance can inform curriculum design. Doing so includes practical strategies for early identification of students who may struggle in clinical placement settings, and ways to foster salient student skills and abilities before and during placements to optimise clinical placement performance outcomes.

Mentorship has long been regarded as foundational for academic advancement. However, the potentially transformative role of sponsorship remains underexplored in health professions education (HPE) research. Sponsorship, the proactive leveraging of influence to advocate for others, can offer critical support to early-career researchers. Yet, while sponsorship has clear benefits, it is neither universally necessary, nor free of potential challenges. This article offers a critical examination of sponsorship in HPE research, discussing its advantages, complexities, and potential risks. Drawing from social capital theory and identity frameworks, it explores how sponsorship can both promote and inhibit equity, and it outlines practical considerations for cultivating sponsorship practices that are ethical, inclusive, and sustainable.

This paper details the reason for the decline in medical knowledge after initial certification of physician assistants/associates (PAs) and suggests improvement in competency assessment after initial certification. We hypothesized that the decline was caused by less frequency of use; in other words, knowledge retention was impacted by the active use of knowledge. If so, the likelihood of a decline in knowledge is mediated by the closeness of the test content to the practitioners' daily practice. Data from Physician Assistants (PA) initial certification (PANCE) and re-certification (PANRE-LA, after 6 years) were used for the current study. To quantify the level of active usage, knowledge subdomains were classified into three categories for each medical specialty: dominant, relevant and distant, ranging from the most frequently used to the least used knowledge, which was verified by four independent board-certified PAs with clinical and educational experience. To test the hypothesis, Latent transition analysis (LTA) is used to measure the probability of transitions among behavioral patterns over time, in particular how various levels of transition probabilities (e.g., probability from proficient switching to non-proficient) are related to the frequency of use. We found that the trends of knowledge decline are influenced by practice profile (medical specialty), mainly, knowledge active in daily use (i.e., dominant knowledge) over time- the less frequent the knowledge is used, the more likely the knowledge decline will take place. In particular, compared to dominant knowledge (i.e., most frequently used knowledge), relevant knowledge (i.e., mediumly frequent used knowledge) and distant knowledge (i.e., rarely used knowledge) are more likely to decline (OR = 2.31, CI = [1.82, 2.94], p < 0.001; OR = 2.26, CI = [1.84, 2.78], p < 0.001). Moreover, dominant system knowledge has a better chance to improve over the years as compared to relevant and distant system knowledge (OR = 2.19, CI = [1.71, 2.81], p < 0.001; OR = 2.12, CI = [1.72, 2.65], p < 0.001). Instead of a uniform knowledge decay, medical practitioners suffer from a differential likelihood of knowledge decay over different systems knowledge. Implications for re-certification exams are discussed.

Effective learning depends on metacognitive regulation (MR), especially in interprofessional learning (IPL) contexts, which typically involve collaboration on diverse cases. However, education research and support have devoted insufficient attention to the regulation of group collaborative learning. The present study employed rigorous socio-cognitive content analysis to examine IPL in small mixed groups (N = 7) of undergraduate health professionals (N = 47). A four-week online group discussion period was used to explore the emergence, focus, and function of MR and socially shared metacognitive regulation (SSMR). The results confirm the emergence of MR in every group, ranging from 15 to 25% of sentences produced regarding four themes: task production, case content, interprofessional content, and group collaborative learning. In every group, MR focused more on high-level content processing than on low-level task production. The findings indicate that the primary function of MR is to monitor learning, with little planning or evaluation. While most MR was socially shared, there were clear differences between the groups in this regard. Overall, statistical testing revealed significant differences between the seven groups in terms of the emergence, focus, and function of MR and the extent of SSMR. It can be concluded that consistent high-level collaboration demands explicit educational support to amplify MR emergence, with a greater focus on content integration, planning and evaluation. The study augments the limited existing literature on the role of MR and SSMR in interprofessional collaborative learning; it shows how MR in collaborative learning can enhance instruction in health and social care education contexts.

There is limited evidence and understanding of the factors that promote the successful Peer Observation of Teaching (POT) implementation and long-term sustainability. The purpose of this multi-site study is to examine how Canadian universities implement a POT innovation and what factors influence its implementation and sustainability. This study employed a cross-comparative case study design of two Canadian universities guided by the Diffusion of Innovations (DOI) Theory. Semi-structured interviews were conducted with administrators and faculty who had experience providing or receiving peer observation. Public records relevant to POT innovation implementation and operationalisation were also collected. A qualitative content analysis, using a combination of directed and open coding, was conducted with both sets of data from the two sites. Factors affecting the implementation of POT: the promotion of POT teaching and the availability of resources and supports were insufficient in ensuring adoption in departments where POT was not compatible with demands, routines, and departmental culture. Specifically, the POT innovation was successfully implemented and sustained in two non-medicine departments where it fit with pre-existing professional culture and routines. In contrast, in departments of medicine, where teaching and peer feedback were undervalued, POT was perceived as burdensome and unimportant. Interviews with clinical teachers from medicine and allied health professions suggest the existence of a "hidden curriculum" that may act in contradiction to the principles of a POT innovation. Our findings suggest that while it is important to promote teaching excellence and faculty development, the sustainability and effectiveness of a teaching innovation to this end may require attention to the specific departmental context in which it is employed. Compatibility with routines, time constraints, norms, and culture is important in ensuring an innovation's sustainability.

Virtual and simulated patients are increasingly used in health professional education as learning about patient needs in a safe space greatly benefits student knowledge and skills and increases their empathy towards patients. Yet to date there has been limited focus on using simulated learning techniques in health professional education to promote learning about D/deaf and hard of hearing patients. We used systematic review methodology to search, identify, appraise and abstract relevant articles across CINAHL, MEDLINE, ASSIA and Proquest Central, Scopus, Web of Science and Cochrane databases yielding a total of 1112 papers. After removing duplicates, inclusion criteria were defined and applied, resulting in 132 articles retrieved for full-text review. Six articles met all inclusion criteria, addressing simulated learning methods for health professional students that provide educational opportunities about Deaf patient experiences. Findings suggest that a myriad of possible simulation modalities can be developed that include opportunities to learn about the D/deaf patient experience and to consider learning about communication and application of knowledge to a specific topic environment. This qualitative synthesis provides insight into potential methods and styles of delivery, whilst noting a very small number of studies in this area. Future research should focus on rigorous and longitudinal studies to understand more about student learning and how interventions impact on their communication and encounters with D/deaf patients.

Aligning examiners judgements to a shared standard is desirable within Objective Structured Clinical Exams (OSCEs) because it accords with OSCEs' epistemic assumptions and purpose. Video-based benchmarking (VBB) involves examiners scoring station specific videos and comparing their judgements against an agreed score. Despite promising potential to enhance examiner alignment, VBB has been little researched. As the intervention's efficacy is likely influenced by context, we used Realist Evaluation to study how, why and under what circumstances VBB may aid examiner alignment. Within stimulated interviews, examiners viewed videos of year-3 student OSCE performances and received expert-panel derived benchmark information. Different participants experienced adaptations of VBB, including varying benchmark performance standards, and different timings of receiving the benchmark information. Our resulting middle range theory suggests that despite conscientious preparation with written material, examiners' expectations remain uncertain until encountering concrete performance examples. Judging a video serves this role, whilst comparison to a standard allows examiners to locate their judgement. Examiners experience dissonance when their scores are discrepant, and several contextual factors mediate whether they dismiss the suggested standard or adjust their perspectives. Examiners' degree of engagement with video observation and score reflection is critical to VBB's efficacy, and is influenced by examiner factors and other procedural contexts. These procedural contexts underpin tentative recommendations for practice which may enhance the likelihood of VBB's effectiveness. When conscientious examiners engage effectively with well-constructed benchmarks, they perceive themselves as more prepared and aligned in their judgements because comparative reflection produces adjustment to their frame of reference.

Black women physicians often face bias, discrimination, and mistreatment within the academic environment because of their racial and gender identities. This shows up as microaggressions, exclusion, and minimal opportunities to advance their careers despite their expertise, contributions, and leadership to support institutions with creating environments that prioritize broad representation, welcoming and respectful spaces, and addressing barriers that prohibit individuals from thriving. Their first-hand experiences with intersecting oppressions told in their own voices as clinicians, educators, and leaders are largely absent from the literature, yet are critical in moving forward. We conducted semi-structured interviews with fifteen women identifying as Black or African American physicians who were faculty members, administrators, or instructors at U.S. academic medical institutions to examine their experiences with racial trauma and how these affect their careers. We used Black feminist constructs as a conceptual framework and Collins' concepts of disciplinary and hegemonic power as a theoretical lens to center intersecting social identities and identify oppression in academic medicine. We also explored how acts of resistance are utilized to counter oppressive experiences. We identified six themes of oppression paired with acts of resistance within the disciplinary and hegemonic domains of power that were particularly salient in participants' stories. While some Black women physicians are choosing to resist oppression by centering themselves, their values, and what they bring to the profession, we must continue elevating their stories to advance institutional change.

Prior research shows that writing interventions can foster perspective-taking, the ability to imagine how other people would experience things. An aspect that is not well understood concerns the experienced effects of such writing for healthcare practitioners. How do clinicians experience the relevance and effects of personal reflective/creative writing from different points of view for their clinical practice? To investigate clinicians' experienced effects of personal writing on perspective-taking and ethical patient-centered practice, we administered weekly writing interventions to healthcare and social work professionals over a 7-week course that followed the narrative medicine model. We guided participants to explore three narrator choices in their personal writing: The autobiographical first person; the autobiographical third person; and the fictional first person (i.e., a patient's/client's POV). Interviews with course participants (n = 14), analyzed using inductive reflexive thematic analysis, generated three themes reflecting experienced effects of personal writing from different points of view: (1) The familiar seen in a new light, the experience that the writing helped participants to see their clinical work and their own role with new acuity; (2) Transformations of emotions and relationships through the reframing and reinterpretation of experienced events, experienced changes in perspective and reoriented interpretations of clinical encounters and relationships; and (3) Questioning the objectivity of one's observations and assumptions, questions related to epistemic humility inspired by the writing. The results illustrate the experienced relevance of personal reflective/creative writing for healthcare practitioners and show that narrator choice is relevant for the experienced effects.