Teaching and Learning in Medicine最新文献

Purpose: Enabling undergraduate medical trainees to develop professional identities consistent with their consciousness of inequities in healthcare and their obligation to provide just healthcare is a pressing challenge. Except as a duty not to discriminate, the positive obligations of a physician's commitment to social justice in the clinic can be unclear, including for educators seeking to empower learners to incorporate such commitments into their developing identities. This study explored the pedagogical value of allyship-to be in supportive association with a marginalized or mistreated group-seeking to understand the allyship issues students in clinical training reflect on as noteworthy and how they assess allyship-related encounters with respect to their professional identity. Method: We conducted a qualitative content analysis of 110 vignettes and reflections that students doing their clerkships as acting interns submitted as part of a required ethics course at a US allopathic medical school in 2020-21. Independent coders followed an inductive, iterative process to code the submissions. Results: Students reflected on demonstrated acts of allyship in 65.5% of cases, and in 34.5% of cases, students described situations in which allyship was warranted but lacking. Students most frequently reflected on the allyship needs of those who were racially minoritized, identified as LGBTQ+, were perceived as "difficult," and had complex care needs, and they specified issues like disparaging remarks, implicit bias, ignored patient needs, and treatment refusals as calling for allyship. The highlighted issues reflected their salience in contemporary social justice discourses in medicine. All analyzed submissions also featured meaningful reflections on at least one demonstrated act of allyship or failure thereof. Students discussed these acts' significance by connecting them to a constellation of professional values, such as the obligation to treat the whole person, be inclusive, be fair, and advocate. Conclusions: This study's results show allyship can be a pedagogically useful concept with which students can reflect on and raise their consciousness of vulnerable patients and populations, what acts of allyship can look like at the bedside, and how their commitment to allyship connects with and is reinforced by other professional values.

Background: This study investigated the views and experiences of students, teachers, and administrators regarding educational ethics to gain a deeper understanding of the role educational ethics can play in medical education. This research contributes to a deeper understanding of ethical issues related to increasingly complex medical education and may encourage all stakeholders in the field of medical education to reflect on these issues. Method: In this qualitative study, we conducted 29 individual interviews with medical teachers and medical school administrators and seven focus group interviews with 45 medical students. Interviews took place in 2020 at seven medical schools with different qualifications in Türkiye. We examined the interview data using thematic content analysis. Findings: We developed six themes: 1) fundamental ethical values in medical education, 2) responsibilities of medical students, 3) responsibilities of medical teachers, 4) responsibilities of medical school administrators, 5) ethical problems experienced in learning-teaching processes, and 6) suggestions for solutions to ethical problems in teaching processes. Conclusion: Our findings provide a basic rationale for considering educational ethics in medical education. Educational ethics appear to be important in creating an academic climate in which human values are protected, thus promoting professional identity formation and internalization of the medical profession's ethical values. Medical schools should be encouraged to prepare position statements as a sign of ethical sensitivity to maintain and enhance the value of trust in medicine among both the public and members of the medical community.

Background: Effective pain management is essential to high-quality dental care, and its inclusion in dental curricula is vital to ensure future professionals are adequately trained. In Brazil, however, little is known about how pain-related content is integrated into undergraduate dental education. This study aimed to¹ identify whether pain curricula are present in Brazilian undergraduate dentistry programs and² analyze the content covered in these curricula, using international recommendations as a benchmark. Methods: We examined all accredited dental education programs (DEPs) in Brazil and analyzed their curricular content based on guidelines from the International Association for the Study of Pain (IASP) and the American Dental Association (ADA). Results: Among 274 DEPs analyzed, only 50 (18.2%) included a dedicated pain curriculum. Regional distribution varied, with 91 programs (25.1%) in the Northeast, 141 (38.8%) in the Southeast, 43 (11.8%) in the Midwest, 26 (7.2%) in the North, and 62 (17.1%) in the South. Among the 17 programs with curricula fully available, the most frequently covered topics were related to pharmacological management, such as local anesthetics (70.6%), airway anatomy and physiology (64.7%), and drug administration routes, analgesics, and antagonists (52.9%). In contrast, topics such as pain definitions and orofacial pain conditions (23.5%), orofacial malignancies (41.2%), and pain and anxiety control (11.8%) were less frequent. Notably, non-pharmacological approaches and drug abuse prevention were almost entirely absent. Conclusion: Brazilian dental education programs fall short of meeting the IASP and ADA recommendations for pain education, particularly regarding non-pharmacological content and substance misuse. These findings highlight significant curricular gaps that may affect dental students' training and preparedness. Our results can support curriculum planners and academic leaders in identifying regional disparities and thematic omissions, ultimately guiding improvements in pain education within undergraduate dental programs.

Background: Clinical education and healthcare work occur within their own complex sociocultural contexts, where interactions can be emotionally intense. Scholars have begun to conceptualize emotional experiences using a socio-cultural lens, examining emotions within their own complexity and contextuality. To better understand and help providers process the intense emotional experiences inherent to clinical education and work, it is important to analyze them from a socio-cultural perspective. Objective: This study aimed to identify the emotional experiences of clinical providers engaged in healthcare work and to determine the value of adopting a reflective approach to processing intense emotions. Our research questions were (1) What clinical activities prompt emotional response among providers, and how does context (system, socio-cultural, political, etc.) shape these experiences? (2) How does providers' reflectivity about their emotional experiences in context affect their understanding and outcomes? Method: The study was conducted between 12 July 2021 and 07 January 2022 at a university hospital's general surgery clinic in the Eastern Anatolia Region of Türkiye. This narrative, ethnographic study analyzed the emotional narratives embedded in clinical work. The participant group consisted of 31 volunteers from a single clinical team: five faculty members, five residents, six nurses, 15 sixth-year medical students (interns). We analyzed narratives generated from participant observation and narrative interviewing using the "Three Stage Contextual Theme Analysis Framework" model. Findings: We created a tripartite conceptual framework to convey (a) the multi-level context in which emotional experiences occur, (b) providers' reflection on emotional experiences in context, and (c) the consequences of contextual, reflective emotional experiences. Our analysis revealed two main contexts in which emotional experiences take place: "institutional and clinical context" and "national and local context." The institutional and clinical context consists of "social, emotional," "physical," and "institutional and clinical system" subcontexts, while the national and local context consists of "health system" and "socio-cultural life" subcontexts. Conclusion: Given the consequences of intense emotional experiences in clinical education and healthcare work, it is important to understand them in context, using a reflective narrative approach. This approach allows educators to reframe both clinical education and healthcare work in a more humane and socioculturally sensitive manner.

Phenomenon: Clinicians employed by hospitals affiliated with medical schools play vital roles in undergraduate medical education. Clinical affiliate faculty (CAF) have opportunities for academic advancement to reward activities aligned with the school's mission, yet many do not pursue promotion. While the challenges underlying these outcomes are well-described, the motivations, expectations, and experiences of those who do pursue and attain promotion remain underexplored. Inquiry into these experiences may reveal actionable facilitators and institutional practices that make promotion more effective in recognizing and sustaining CAF engagement. Approach: In our roles as faculty affairs deans, we conducted a qualitative study to explore what motivates CAF to pursue promotion and their expectations and experiences of successful promotion. We conducted semi-structured interviews between 2023 and 2024 with 24 CAF from one US medical school who were promoted in rank between 2018 and 2023. We used reflexive thematic analysis to analyze the interview transcripts, and our interpretation was informed by social cognitive career theory and the social cognitive model of career self-management. Findings: Three overarching themes captured CAF experiences of promotion: (1) intrinsic and extrinsic motivation, (2) symbolic capital, and (3) professional affirmation. CAF motivation to pursue promotion was rooted in their belief that it was an attainable goal,-a belief supported by reflection, empowering social influences, and intrinsic traits. The expectation that successful promotion would position them to advance their own careers and support the careers of others further fueled their motivation. In addition to these anticipated outcomes, successful promotion provided CAF personal fulfillment, validated their contributions to undergraduate medical education, legitimized their identities as clinical educators, fostered a sense of belonging to the medical school, and inspired greater engagement with the school. Importantly, some CAF achieved promotion despite challenges related to their socioeconomic background and their identities as individuals underrepresented in medicine. Insights: This study expands our understanding of what motivates CAF to pursue promotion and their expectations and experiences of successful advancement. The findings offer insights into how promotion reinforces CAF legitimacy as clinical educators and strengthens their sense of belonging to the medical school, thereby empowering them to contribute meaningfully to the institution. The findings also illuminate practical strategies to improve promotion processes and mitigate the contextual influences of socioeconomic status, gender, and race/ethnicity to ensure all CAF can achieve these outcomes.

Traditional clinical teaching involves physician teachers asking questions to gauge students' knowledge-controversially referred to as "pimping." Previous studies have explored students' perceptions of pimping; however, research from a motivational science perspective is limited. This study used Self-Determination Theory (SDT) as a lens to explore medical students' perspectives of pimping. In this qualitative study, we purposively sampled and interviewed undergraduate medical students from the class cohorts of 2019-2022 from the University of Saskatchewan, Canada, who shared their experiences and perspectives of pimping and how it affected motivation and well-being. We used thematic analysis guided by SDT to code the data and develop themes. We conducted interviews until no new themes were identified. Thirteen medical students participated-nine from Year 1 (five female, four male), one from Year 2 (female), one from Year 3 (male), and two from Year 4 (both male). Learners expressed mixed perspectives about pimping, some noting increased motivation for studying and engagement, while others experienced the opposite. We identified themes related to thwarting of autonomy, competence, and relatedness; more controlled forms of motivational behaviors (feeling forced, guilt, embarrassment, desire to prove); and negative well-being consequences. Learners described autonomy-supportive approaches to questioning. This study supports SDT's continuum of motivation emphasizing quality of motivation beyond just presence or absence of motivation, which helps understand how pimping can motivate students but through less optimal controlled forms of motivation, accompanied by negative well-being. Effects of pimping may also differ between junior and senior learners. We present practical implications for questioning approaches that support learner autonomy and shift away from exerting control and pressure.

The complex skill of prescribing often fails to translate effectively from basic medical training into clinical practice, leading to poor patient management and medication errors. Previous research has demonstrated that learners face substantial challenges in achieving the threshold of integrated understanding and decision-making required for rational prescribing in different contexts. These challenges stem from the fact that learning to prescribe remains an implicit experience. Students tend to imitate physicians' prescribing patterns without understanding how the expert's cognitive schema operates, making it difficult to transfer this skill to new or diverse situations. While several interventions have been introduced, the challenge in transferring this skill may lie in the educational strategies for prescribing, further compounded by the complex web of underlying concepts inherent to the task. To address this, we explore the Four Component Instructional Design (4 C/ID) model, integrated with cognitive load theory. The 4 C/ID model posits that complex skills training requires a combination of learning tasks, supportive information, procedural information, and part-task practice. This integration aims to develop the knowledge, skills, and attitudes necessary for complex tasks and enhance knowledge transfer without overloading cognitive abilities. To illustrate this integration, we present a blueprint for an antimicrobial module spanning pre-clinical to clinical years, focusing on identified threshold concepts of pharmacology and fostering the practice of both routine and non-routine prescribing skills. Students engage in whole-task activities, supported by mental models, procedural knowledge, and repetitive practice. We recommend a blended learning approach for this module, using successful strategies from other domains. In traditional curricula, our module can be introduced during clinical rotations and culminate as a capstone course. This module offers a promising solution to current challenges in teaching and practicing prescribing.

Medical education's ongoing expansion in Brazil presents new challenges, including the growing demand for qualified educators to support effective interprofessional training. In this essay, we examine the role and contributions of non-physician educators in medical programs, highlighting the need to recognize their value. Beyond their andragogical and scientific contributions, non-physician educators often play a central role in educational innovation and scientific advancement. We also underscore the need for greater financial and institutional recognition to ensure a more comprehensive and robust medical education, better preparing future physicians to work in multidisciplinary teams. In this context, we encourage institutions to review their curricula and implement policies that integrate and adequately acknowledge the significance of these professionals in medical training.

Prosocial behavior, a cornerstone of effective healthcare, is crucial for positive doctor-patient relationships and ethical medical practice. However, cultivating prosociality in medical students, particularly within diverse cultural contexts, presents a significant challenge. While mindfulness interventions show promise, the underlying mechanisms, especially the role of self-construal, remain underexplored. This study addresses this gap by investigating the effects of a seven-day online mindfulness program on prosocial behavior among Chinese medical students and the mediating role of self-construal, a culturally contingent framework. Divergent from Western research suggesting mindfulness promotes prosociality via interdependent self-construal, we explored a potentially distinct dynamic in a collectivist setting. In 2023, we randomly assigned 64 medical students without prior mindfulness experience to a mindfulness practice group (n = 33) or a control group (n = 31). Pre- and post-intervention assessments included trait mindfulness, self-construal, and prosocial behavior, using validated Chinese instruments. The mindfulness intervention significantly increased prosocial behavior and both independent and interdependent self-construal. However, mediation analysis revealed that only independent self-construal significantly mediated the mindfulness-prosociality link; interdependent self-construal showed no significant mediating effect. This unexpected finding highlights the cultural plasticity of self-construal theory, suggesting mindfulness in collectivist contexts may facilitate prosociality by activating individual agency and autonomy-a pathway diverging from Western observations. These findings have substantial implications for adapting mindfulness interventions in global medical education, advocating for culturally informed designs that leverage the dynamic interplay between mindfulness, self-construal, and prosocial development. This research refines the theoretical understanding of self-construal and offers a novel perspective on cultivating essential prosocial attributes in future healthcare professionals. Furthermore, this work suggests practical strategies for integrating mindfulness training into medical curricula, potentially enhancing student well-being, ethical decision-making, and patient-centered care.