Advances in Health Sciences Education最新文献

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.

Previous studies suggest that time factors heavily into trainees' decision-making around issues of pregnancy within graduate medical education (GME). Trainees are often dissatisfied with parental leave policies and tension exists as they navigate training interruptions. However, our understanding is limited because prior studies have conceptualized only two main actors involved in this negotiation, program directors (PDs) and trainees. This study aimed to understand the role of a third ever present character that has been overlooked - Time. We recruited 13 pairs of residents/fellows who had been pregnant during GME training and their PDs. We conducted semi-structured interviews on trainee and PD experiences, which were then analyzed utilizing narrative analysis to interrogate how individuals assigned meaning to time. Time loomed in the background of all trainees' and PDs' experiences as they negotiated pregnancy. Depending on context, time was positioned either as an ally, assisting trainees with achieving their personal and professional goals, or as a foil, sabotaging their experience. As an ally, time was positioned as a malleable commodity that was flexed to meet the individual trainee's needs. As a foil, time was an immovable barrier exerting rigid constraints. How time was experienced by the trainee was strongly influenced by the attitudes and actions of the PD. This study positions time as a main actor in trainees' narratives of pregnancy. The role time plays largely reflects the value assigned to conformity with traditional timelines and whether a program has revised their perspectives to position time as a side character.

Despite the integral role that clinical teachers' coaching behaviors play in shaping residents' learning experiences, these behaviors are not always enacted. To better understand the behavioral determinants of coaching, the objectives of this study were to (a) identify barriers and facilitators of engaging in coaching behaviors using behavior change theories (Behavior Change Wheel, BCW; Theoretical Domains Framework, TDF), and (b) propose relevant interventions and policy changes to facilitate the engagement in coaching behaviors. Using a social constructionist approach, we interviewed 13 clinical teachers with relevant lived coaching experiences. We first used reflexive thematic analysis to analyze the data inductively. Second, we deductively mapped the themes onto the BCW and TDF to identify the behavioral determinants of coaching, relevant interventions, and applicable policy changes. Participants' perceptions of coaching behaviors were captured in six themes pertaining to clinical teachers' capability (a self-directed journey; a balancing act), opportunity (the show must go on; setting the stage), and motivation (call me coach; an audience for coaching). Although clinical teachers had the necessary coaching knowledge and skills, social and environmental constraints limited the practical implementation of these behaviors. This work supports applying behavior change theories in medical education research. Recommendations include shifting interventions beyond targeting individual-level knowledge to fostering coaching-supportive environments, including focusing on training, modelling, and enablement and developing policy-level supports such as guidelines, planning, services, and regulation.

Aim: This study was aimed to examine the relationship among witnessing workplace bullying, resilience, and professional identity in student nurses, and to investigate the mediating and moderating effects of resilience on the relationship between witnessing workplace bullying and professional identity.

Background: Workplace bullying is an increasingly serious problem in nursing practice and can affect the professional identity of student nurses. Resilience, a potential protective role, must be examined in relation to witnessing workplace bullying and professional identity.

Method: Cross-sectional design and secondary data analysis were conducted. 127 junior and senior nursing students in eight colleges and universities were recruited.

Results: A significant positive correlation was found between resilience and professional identity (r = 0.51, p < 0.001). However, the mediating and moderating effects of resilience were not significant.

Conclusion: Resilience is a crucial factor in promoting professional identity among nursing students. However, further research investigating witnessing workplace bullying, resilience, and professional identity is required.