Advances in Health Sciences Education最新文献

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.

Clinical reasoning skills develop through increased knowledge acquisition, greater clinical experience, and continued practice over time. Yet, across undergraduate and graduate medical education, it is inconsistently taught. As progressive clinical reasoning curricula emerge, research is needed to help inform the content and activities appropriate for different learner levels. While much is understood about the clinical reasoning skills of novices and experts, less has been theorized about students in between those two extremes. Our study explores the clinical reasoning skills of medical students in their final year of medical school, informed by clinical reasoning models and information processing theories. We conducted think-aloud interviews with 18 4th-year medical students tasked with completing a novel web-based assessment. Students reviewed simulated patient charts, answered clinically relevant questions, and justified their thinking and responses. Using a qualitative data collection and analysis framework, we coded interviews for clinical reasoning elements and emergent themes. Our findings present an initial framework for understanding the clinical reasoning skills of 4th-year medical students. The framework includes four high-level skills that we defined as interpreting, framing, generating, and justifying. These skills reflect elements of nonanalytic and analytic thinking in that students used semantic qualifiers, partially activated illness scripts, and engaged in aspects of hypothetical-deductive reasoning. Our framework can help shape how best to structure clinical reasoning instruction in medical education across the novice-to-expert continuum, as well as aid in the development of clinical reasoning theories that incorporate a range of learner levels.

Purpose: This systematic review aims to evaluate the impact of mind maps and Concept Maps on academic performance among undergraduate medical students in the preclinical stage.

Methods: Our protocol was registered on PROSPERO (CRD42024529458). We followed PRISMA guidelines in conducting our systematic review. We searched PubMed, Scopus, Google Scholar, and Cochrane Library from inception to June 2024. We included only randomized controlled trials (RCTs) that involved undergraduate medical students in the preclinical stage, evaluated mind mapping and Concept Maps as the intervention, and compared it to traditional methods or no intervention, with academic performance as the primary outcome. A qualitative synthesis of the results was conducted, and where possible, effect sizes (e.g., Cohen's d) were calculated to quantify the impact of mind maps and concept maps on academic performance. The risk of bias was assessed using the Cochrane Risk of Bias tool. The risk of bias was assessed using the Cochrane Risk of Bias tool.

Results: A total of six RCTs were included. Four studies reported significantly higher assessment scores with the use of mind maps or concept maps. Teli et al. (Indian Journal of Clinical Anatomy and Physiology 7(2):243-246, 2020) observed a significant improvement in knowledge retention in the intervention group (mean score: 82.4% vs. 69.8%, p < 0.0001). Concept maps demonstrated moderate-to-large effect sizes, with Ho et al. (Medical Education 48(7):687-697, 2014) reporting Cohen's d = 0.7-0.8 for improved test scores. Two studies found no significant differences in performance (p > 0.05), but students consistently expressed a preference for these methods due to their utility in understanding and summarizing information. Overall, mind maps and concept maps prove to be effective tools for enhancing academic performance, especially in terms of knowledge retention and comprehension.

Conclusion: This systematic review shows that mind maps and Concept Maps are effective methods in helping undergraduate preclinical medical students achieve better performance, especially in terms of knowledge retention and comprehension. While not all studies showed significant differences, the overall preference for these methods indicates their potential as valuable learning tools. We recommend integrating these tools into preclinical curricula and providing training sessions to enhance their effectiveness.

Limited diversity among physical therapists throughout the United States warrants exploration of avenues to enhance representation across the profession and, ultimately, improve population health. Pathway programs are arguably a means of supporting and recruiting underrepresented minority (URM) students into the physical therapist profession. The purpose of this investigation was to explore whether meaningful relationships exist between URM status, pathway program participation, and student pursuit of careers as licensed physical therapists. A total of 139 first-year post-Baccalaureate, entry-level Doctor of Physical Therapy (DPT) students participated in the research investigation. Among study participants, 45.3% were URM students and 54.7% were non-URM students. Participants completed an online survey involving self-report of grade point average (GPA), graduate record examination (GRE) percentile rankings, and reflections on pathway program experiences. Student GPA leading into entry-level DPT program application was not influenced by URM status or pathway program participation. The relationships between pathway program participation and the three sections of the GRE were inconsistent, yet promising signs of pathway program benefit to GRE performance among some URM students were evident. All students with pathway program experience demonstrated greater career interest development, self-efficacy beliefs, outcome expectations, and goal representations. Pathway programs appear to be a viable avenue through which a diverse composition of individuals may be ushered into the licensed physical therapist profession.

Point-of-care ultrasound (POCUS) is a vital tool for diagnosis of life-threatening conditions, with broad consensus supporting its integration into medical curricula. Despite evidence of effectiveness of POCUS training, many clinicians do not utilise skills in practice, resulting in missed patient benefits. Research on the barriers to POCUS utilisation remains limited. To address this, we conducted a theory-informed exploratory qualitative case study to investigate the utilisation of Focused Intensive Care Echo (FICE) in a specialist heart and lung hospital. The investigation was framed using situated learning and activity theory. We undertook 28 interviews, three focus groups (N = 27) and two expert discussions. Thematic analysis identified barriers while difference-within-similarity-analysis (Hofmann, 2020) uncovered how these interact to hinder POCUS-utilisation. We demonstrate how barriers preventing trainees from using POCUS interacted with the wider activity system, forming vicious cycles to further hinder use. These vicious cycles related to enthusiasm, opportunity, support, participation, communication and norms that hindered POCUS-use, and manifest as an underlying tension between competing priorities of POCUS training and patient care. We discuss how theoretically re-framing the findings suggests low/medium-resource mechanisms which helped mitigate this tension and overcome the vicious cycles. These facilitative mechanisms could generate scalable and sustainable solutions to support POCUS-training and utilisation.

In health professions education, there is a call to rethink pedagogical practices and institutions that often perpetuate racism, colonialism, and other systems of oppression. Researchers have stressed the importance of integrating critical pedagogies, such as antiracist pedagogy, to help learners understand societal and structural factors behind health inequities and recognize power dynamics in health science and healthcare. Various antiracist pedagogical interventions have been designed, but their outcomes remain unclear. Based on Levac et al.'s framework, a scoping review was conducted to map the literature evaluating the outcomes of antiracist pedagogy in health professions education. A systematic database search was conducted between April and June 2022 for articles describing evaluation methods and outcomes of antiracist pedagogical interventions in health professions education. We included 41 articles in the final selection. The data was organized within the following themes: aim of intervention, type of intervention, evaluation tools, outcomes and indicators for each of Kirkpatrick's levels of training evaluation, theoretical frameworks, and authors' positionalities. The thematic analysis revealed that, in most cases, evaluations targeted participants' attitudes on systemic racism, their racial identity and critical awareness, as well as their satisfaction with the activities. The antiracist pedagogical interventions were rarely evaluated beyond learners' perceptions. Discrepancies were also raised between the principles of antiracist education and the use of antiracist pedagogy to design, implement and evaluate the outcomes of antiracist pedagogical interventions in health professions education. Although only a few interventions had transformative outcomes beyond individuals, we identified promising pedagogical strategies to foster engagement and motivation to transform professional practices.

Histology is a foundational course in many life science programs. Microscopes have long been the primary instruments used in this discipline, playing a crucial role in histology education for decades. However, with the current significant technological advancements, digital tools are progressively replacing microscopes in university classrooms worldwide. Due to their expense and maintenance requirements, educators are questioning whether the use of traditional microscopes remains a practical approach to teaching this subject. This work aims to present an alternative perspective on the importance and the epistemic peculiarities of microscopes in understanding the microstructure of tissues, moving from internalist approaches to enactive perspectives. Rather than adjudicating a technological contest that many programs have already resolved pragmatically, we offer a philosophical and pedagogical reflection that clarifies what kinds of understanding are cultivated by optical and virtual practices and how those understandings align with contemporary research.

Introducing students to real-world contexts through clinical placements can provide rich learning experiences. In health professional education, these placements primarily focus on the supervised development of clinical skills within discipline-specific contexts. However, numerous implicit contexts influence the learning event, which may not be explicitly addressed in the placement's curriculum or teaching structure but are nonetheless pedagogically significant. This study examines the distinctive contexts of a student-led, interdisciplinary Aboriginal allied health service placement in rural South Australia, highlighting the contexts' unique experiential characteristics. We used a bricolage of phenomenological engagement and abductive thinking to investigate students' experiences within and across these learning contexts. Students' accounts revealed that their experiences at the intersections of these contexts held pedagogical significance. This finding prompts critical questions about the design and delivery of educational placements to maximise the inherent learning potential of contexts. We discuss the role of context in clinical placements and explore how context and context complexity can be effectively configured to support student learning across various clinical placement settings and models. We propose that developing context awareness and perspective, and attending to context convergence, can enhance meaningful learning in complex environments.

We have previously argued that empathy is a multidimensional, context-modulated attribute, and that the Western unidimensional 'one size fits all' approach to empathy is inadequate particularly in intercultural settings. We called for relational empathy characterized by qualities such as curiosity; cultural and epistemic humility; bidirectional engagement; relational consciousness/ubuntu. In a paradigm shift from dominant models of ego-based empathy as projected content, here we describe a model of empathies or multiple 'local stories' that are process-based, fluid and context-dependent. Such empathies are not 'given' but 'generated' as an emergent property of social engagement based on a dialectic of democracy. Establishing such Intercultural Relational Empathies demands a shift from singular 'content' empathy to multiple 'process' empathies produced through sensitive, democratic encounter. We thus distinguish between 'settled' empathy as an individual trait and 'nomadic' empathies as negotiation in social settings. While the former describes empathy as ego-based content, the latter describes empathy as process and eco-centric - specifically, an emergent property of a nonlinear, open, dynamic, complex system that is an active social collective. We focus on the collective of an intercultural healthcare setting common to contemporary global healthcare - multicultural healthcare teams treating a range of patients. We describe 'nomadic' empathies as produced through dialectic and negotiation, both collaborative and competitive. We suggest that the globally dominant modernist model of content-based, ego-driven empathy is grounded in the values systems of individualism common to high-income countries. This affords a 'grand narrative' or dominant value, but one size does not fit all.

Programmatic assessment is gaining traction in health professions education. Despite this popularity, educators continue to grapple with complex contextual factors that impact implementation and outcome attainment. We used contribution analysis, a theory-informed evaluation method, to understand the mechanisms underpinning successful implementation. Applying the six steps of contribution analysis, we developed a postulated theory of change (ToC) and then conducted a qualitative study with programmatic assessment stakeholders (graduates n = 15, supervisors n = 32, faculty n = 19) from four Australian dietetic programs. These data were analysed using the Framework Analysis method and integrated with data derived from a literature review across health disciplines, to assemble contribution claims and the story, and verify the ToC. Impact pathways for programmatic assessment from inception to implementation, and contribution to outcomes were articulated in the ToC. Leaders drove implementation using compromise and worked with a design team to apply the versatile principles. All people required training, and purposefully designed tools were implemented within an ideologically aligned system. Re-orientation of responsibilities situated learners as leaders, contributing to a psychologically safe environment which promoted growth mindsets. Credible high-stakes progression decisions were enabled, people experienced less stress, and derived gratification from assessment. External factors (institutional and accreditation requirements) and threats (resource mismatches, ideological misalignments, and capabilities of the people) were identified. Contribution analysis revealed mechanisms that educators can apply to implement a contextually responsive programmatic assessment across diverse settings.