Advances in Health Sciences Education最新文献

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.

Though transferability is a multidimensional concept, our representations of transferability within Health Professions Education have largely focused on whether innovations or outcomes can be applied in different contexts. However, transferability has been variously described and used as a quality criterion through the history of qualitative research. To capture the complexity of this concept we propose a tri-dimensional conceptualisation of transferability, drawing on foundational qualitative research literature and our own experiences as qualitative researchers. We consider the origins of transferability within qualitative and Health Professions Education research, including its association with the concept of generalisability. We draw attention to shifts in debate, and the need for a clear conceptualisation of transferability as a concept. The three dimensions we propose, as part of our 3D transferability model, are: applicability; theoretical engagement; and resonance. By exploring these three dimensions, we highlight the importance of a critical, multifaceted approach to understanding and operationalising transferability. To promote practical application, we make suggestions regarding the use and discussion of each dimension of transferability. In doing so, we hope this exploration will be useful for scholars seeking to achieve broader impact of their evaluative work and empirical research.

Inequality of healthcare provision between metropolitan and rural communities is an enduring international concern. Geographical narcissism (GN) in medicine is a belief that the best healthcare provision only occurs in the big cities. In healthcare education and workforce development, there is a growing sentiment that GN exists, and is likely contributing to access inequalities and rural workforce shortages. This qualitative study aimed to explore if and understand how, where, when and why GN was experienced by medical students and prevocational doctors during their medical education and training. A constructivism research paradigm was applied, and reflexive thematic analysis was utilised for inductive coding of the different experiences and perceptions of GN. Semi-structured interviews with 29 Australian medical students and prevocational doctors were undertaken. Four key themes, with ten subthemes, were identified. First, GN is part of the hidden curriculum of medical education and training. Second, GN occurs across the continuum of medical education and training. Third, GN occurs with medical career advice. Fourth, GN is demonstrated by models of healthcare and health systems. This exploratory study confirmed previous anecdotal evidence that GN exists in healthcare and has outlined how, where, when and why it is experienced during medical education and training. Ignoring the potential damage and consequences of GN perpetuates the established metrocentric models of medical education, training, workplace culture, healthcare service provision and investment. The cycle of inequality will persist for rural populations, including poorer health outcomes and the rural medical workforce shortfall will continue - in part due to GN.

Psychologists, like many health professionals, must effectively self-assess their competencies across the career trajectory in order to practice ethically and within the bounds of their knowledge and skills. Given this, research is needed to explore the cognitive process of self-assessment, and the utility of a structured measure for psychologists. This study aimed to explore: 1) how psychologists self-assess their competencies, 2) what value a structured measure has for self-assessment, and 3) the barriers or limitations to using a structured measure for self-assessment. Twelve registered psychologists were interviewed, and reflexive thematic analysis was applied. Themes were identified in the following two broad areas: 1) metacognitive processes and helpful cognitive strategies that aid self-assessment and the use of a structured self-assessment measure, and 2) barriers to self-assessment including unhelpful metacognitions about both the process of self-assessment itself, and the self. One theme and three sub-themes were identified to explain the metacognitive processes and helpful cognitive strategies described by participants, and three themes were identified pertaining to barriers to self-assessment. The current research extends the existing literature through incorporating the voice of psychologists in understanding the metacognitive processes and barriers of self-assessment, including structured self-assessment. This research has implications for health science practitioners, supervisors, educators and research.

This study investigates sources of distress experienced by some medical students performing cadaveric dissection in the anatomy lab. Using a novel theoretical framework adapted from the humanities, faculty at the University of Rochester sought to understand the connection between distress, dissection, and the ontological assumptions students hold about cadavers. Between 2019 and 2021, the authors engaged in an iterative inductive thematic analysis to better understand student experiences. We conducted 14 semi-structured individual interviews with medical students about their experiences. We found that students' experiences of distress were closely related to confusion surrounding the cadaver's ontological status. Our study contributes to understanding this connection in three significant ways: (1) our findings bolster the existing literature linking distress to the ontological ambiguity surrounding the cadaver-an ambiguity related to the ontological status of persons in Western societies; (2) we share a conceptual framework, derived from Roberto Esposito's work on persons and things in Western history, to better understand distress in the anatomy laboratory and to facilitate development of healthy coping strategies for morally complicated situations in patient care; and (3) applying our framework, we demonstrate how dissection challenges norms fundamental to our moral understanding, and consider how it may create experiences of moral distress for some students.

Simulation is an established pedagogical approach in health professions education, typically led by educators and informed by their clinical expertise. Partnerships between educators and people with lived experience ensures simulation authentically represents the needs of people accessing healthcare. To map available literature on how lived experiences are incorporated into health professions simulation-based education a scoping review was conducted. In April 2024 CINAHL Complete, Scopus, ERIC, Medline, PsycINFO, and ProQuest Dissertations and Theses Global Database were searched. Studies were screened against the inclusion criteria, and data was extracted from 45 studies using a purposively developed and piloted extraction tool, and organised according to four research questions. Medicine and nursing most commonly include lived experiences in simulation-based education and cultural and linguistic diversity is the lived experience most often harnessed. Lived experience involvement across the entire six phases of simulation design and delivery was not common, however active and meaningful involvement was represented at each stage. Lived experience involvement enhances simulation-based education and provides an additional opportunity for people with lived experience to be involved in health professions education. There is an urgent need for guidelines describing how educators can harness lived experiences in simulation-based education. Further research, in partnership with people with lived experience, is required to determine how to more authentically represent lived experience in simulation-based education.