Advances in Health Sciences Education最新文献

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.

Use of theory to conceptualise interprofessional practice and inform interprofessional education is growing. This paper draws on two emerging theories in education and the sociology of emotions - epistemic cognition and emotional climates - to analyse an important interprofessional setting: weekly case conferences in one radiation oncology department. Drawing on detailed transcription of video data, ethnographic fieldnotes, and reflexive interviews with four participant/co-analysts, we analysed the knowledge aims, ideals, and processes for evaluating knowledge claims across 9 case conferences (3 meetings x 3 groups), as well as their associated emotional climates. Findings indicate that recency, and relational or disciplinary expertise are key values against which knowledge claims are judged. Epistemic styles and emotional climates vary; when meeting leaders encourage others to ask questions and promote a relaxed emotional climate, this may invite more diversified epistemic contributions. More broadly, our study brings together epistemic cognition and emotional climate as situated phenomena, providing empirical, conceptual and potential pedagogical advances.

Learner mistreatment remains a pervasive challenge in medical education, particularly within the surgical learning environment. In medical education scholarship, surgical culture is often cited both as an explanation, and at times, a justification for learner mistreatment in surgery. In this critical qualitative study, informed by constructivist grounded theory, we conducted 20 interviews with surgical faculty, representing 10 different surgical disciplines at a Canadian institution. Surgeons were invited to reflect on their encounters with mistreatment throughout their medical careers. While many surgeons recounted instances of mistreatment during their own training, few recalled witnessing learner mistreatment in their current roles as surgical faculty. This paper utilizes Pierre Bourdieu's concept of habitus as an analytical tool to enhance our understanding of surgeons' perspectives and move beyond reductionist explanations that regard mistreatment as an inherent aspect of surgical culture. Through an exploration of how aspects of surgical culture are embodied and reproduced through the cultivation of a surgical habitus, we provide insights into why learner mistreatment persists in surgery.

Interprofessional identity (IPI) is crucial in shaping the perceptions, knowledge, and collaborative skills of health professions learners. Its development is influenced by external factors (educational and practice contexts) and internal factors (motivational beliefs and confidence). Despite its importance, a comprehensive understanding of IPI formation is limited. This study proposed a theoretical model to clarify how professional self-efficacy and motivational beliefs contribute to IPI development, moderated by learning gains and satisfaction within interprofessional education (IPE). A longitudinal study with 473 health professions students was conducted during a 3-week IPE simulation course. Data were collected at the start and end of an IPE simulation course through questionnaires assessing professional self-efficacy, motivational beliefs, IPI, and program learning gains and satisfaction at two time points in 2023. A bootstrapped moderated mediation analysis using PROCESS Macro was employed to examine the mediating role of motivational beliefs between professional self-efficacy and IPI. Additionally, the study explored whether learning gains and satisfaction moderated the link between motivational beliefs and IPI. Professional self-efficacy significantly predicted IPI, with motivational beliefs mediating this relationship. The mediation effect was strengthened by students' perceived learning gains and satisfaction with the IPE program, indicating a significant index of moderated mediation (B = 0.073, BootSE = 0.026, 95% BootCI [0.020, 0.120]). Effective IPE initiatives should enhance professional self-efficacy and motivational beliefs to develop IPI among health professions students. Creating a supportive interprofessional learning environment is essential, fostering engagement and satisfaction to build a resilient IPI, ultimately enhancing collaborative practices and patient care quality.