Teaching and Learning in Medicine最新文献

Problem: Misleading health information is detrimental to public health. Even physicians can be misled by biased health information; however, medical students and physicians are not taught some of the most effective techniques for identifying bias and misinformation online. Intervention: Using the stages of Kolb's experiential learning cycle as a framework, we aimed to teach 117 third-year students at a United States medical school to apply a fact-checking technique for identifying bias and misinformation called "lateral reading" through a 50-minute learning cycle in a 90-minute class. Each student's concrete experience was to independently read a biased article and rate its credibility, demonstrating their baseline skills at identifying bias. Students were given structured opportunities for reflective observation through individual and large group discussion. Students were guided through abstract conceptualization to determine techniques and frameworks utilized by fact checkers, specifically "lateral reading"-utilizing the internet to research the background of the author, organization, and citations using independent sources before exploring the article itself in depth. Students' active experimentation included re-rating the credibility of the same article and discussing further implications with classmates and instructors. Context: In January 2020, sessions were offered to third-year medical students during their required, longitudinal transition-to-residency course. Impact: Compared to baseline, when using lateral reading, students deemed the article less credible. Students' active experimentation changed whether they identified the organization and sources behind the article as credible. Notably, 86% (53/62) of students who viewed the organization positively pre-intervention did not describe the organization positively post intervention. Similarly, 66% (36/55) of students who cited the sources as positive pre-exercise changed their assessment after the exercise. While three students mentioned the author negatively pre-intervention, none of the 21 students who described the author in a negative fashion post-intervention described the author negatively pre-intervention. Positively describing the organization, author, or sources pre-intervention correlated with differences in credibility rating after the intervention. These findings indicate that teaching students to read laterally may increase their ability to detect bias in online medical information. Lessons Learned: Further research is needed to determine whether students who learned lateral reading via experiential learning will apply this skill in their education and career. Additionally, research should assess whether this skill helps future physicians counter bias and misinformation in ways that improve health.

Guidelines and recommendations to properly elicit and document sexual orientation and gender identity in the clinical setting are rapidly emerging; however, in the epidemiologic research setting, information about collection, analysis, presentation, and dissemination of LGBTQI data is nascent. Federal agencies have worked to optimize epidemiologic research data collection from LGBTQI people. Despite these efforts, research data collection guidelines are inconsistent, and the data remain inadequate. The consequence of neglecting to collect data accurately from LGBTQI people is epidemiologic datasets that distort health professionals' and policymakers' perception of who comprises our communities and what the disease burden truly is. Additional harm is accrued by members of the neglected groups, including medical students and trainees, who may feel invisible, disrespected, and unsafe when presented with discriminatory data. With this article, we use our perspectives as a medical educator and a medical student to describe the challenge of working with inadequate LGBTQI datasets. We recommend five actions that can be taken by individuals, departments, and institutions to mitigate harm from the existing datasets: 1) acknowledge the limitations of the data; 2) develop, disseminate, and encourage use of an inclusive lexicon; 3) include LGBTQI-related criteria on peer teaching reviews; 4) engage students and trainees as partners, and if appropriate, content experts to review curriculum; and 5) self-identify as an agent of social change. In addition, we discuss systems-level considerations for realizing the goal of having comprehensive, accurate, and inclusive national data to drive health care delivery and health policy decisions. These include expanding research guidelines to address reporting and dissemination best practices for LGBTQI data, and widespread adoption of data reporting guidelines by biomedical journals. There is an urgent need for data to support quality care of LGBTQI communities. The health of our family, friends, neighbors, and nation depends on inclusive, accurate data.

Phenomenon. The language of medicine (i.e., biomedical discourse) represents queerness as pathological, yet it is this same discourse medical education researchers use to resist that narrative. To be truly inclusive, we must examine and disrupt the biomedical discourse we use. The purpose of this study is to disrupt oppressive biomedical discourses by examining the language and structures medical educators use in their publications about queerness in relation to physicians and physician trainees. Approach. We searched PubMed, Web of Science, CINAHL, PsycINFO, and ERIC in October 2021 and again in June 2023 using a combination of controlled vocabulary (select terms designated by a database to enhance and reduce ambiguity in search) and keywords to identify articles related to sexuality, gender, identity, diversity and medical professionals. Searches were limited to articles published from 2013 to the present to align with the passage of The Respect for Marriage Act. Articles were included if they focused on the experiences and paths of physicians and physician trainees identifying with or embodying queerness, were authored by individuals based in the United States, and presented empirical studies. We excluded articles only discussing attitudes of cisgender heterosexual individuals about queerness. Two authors independently screened all articles for inclusion. We then used narrative techniques to "re-story" included articles into summaries, which we analyzed with four guiding questions, using queer theory as a sensitizing concept. Finally, we sought recurrent patterns in these summaries. Findings. We identified 2206 articles of which 23 were included. We found that biomedical discourse often: characterized individuals associated with queerness as a single homogenous group rather than as individuals with a breadth of identities and experiences; implied queer vulnerability without naming-and making responsible-the causes or agents of this vulnerability; and relied minimally on actual intervention, instead speculating on potential changes without attempting to enact them. Reflections. Authors each reflect on these findings from their positionalities, discussing: disrupting essentializing categories like "LGBT"; addressing harm through allyship around queerness; editorial responsibility to disrupt structures supporting oppressive biomedical discourse; the importance of program evaluation and interventions; and shifting the focus of medical education research toward queerness using QuantCrit theory.

Phenomenon: The COVID-19 pandemic necessitated an abrupt shift to online medical education, disrupting learning across knowledge, skills, and social connections. Post-pandemic, medical schools must evaluate how these disruptions shaped student experiences to optimize the return to in-person learning. Approach: This cross-sectional qualitative study explored medical students' perceptions of their learning environment during the post-pandemic reintegration period in Oman. Fifty-four preclinical and clinical students participated in six focus group interviews. Content analysis identified key topics characterizing students' perceptions of change and change processes in the post-pandemic learning environment. The panarchy framework, developed to characterize complex adaptive systems in nature, was used to frame the results. Findings: The return to in-person environments presented a mix of renewed connectivity, involving collaborative benefits alongside transitional adjustment strains. Five major topics characterizing student perceptions of change and change processes in their post-pandemic learning environment were identified: learning skills, developing clinical competence, faculty interactions, physical atmosphere, and social connections. Managing academic schedules and cognitive load as the learning environment opened challenged students' learning skills. Learners valued a renewed opportunity for interactive application of knowledge through collaboration, patient contact, and empathy skill-building to feel prepared for future practice. Returning to in-person instruction renewed a sense of community and peer support networks disrupted by pandemic isolation. Some students continued to struggle with study-life imbalance and felt ill-equipped to handle post-pandemic demands. Improved access to student support and wellness services was emphasized to ease transitional stresses. Students defined an ideal learning climate as supportive, active, personalized, relevant, challenging, accessible, and collaborative. Insights: While pandemic disruptions posed challenges, they provide opportunities to strengthen the educational system's resilience moving forward. Our findings highlight an opportunity for medical educators and learners to capitalize on the innovations that emerged during this period, integrating technology with interactive learning activities and reconnecting students with the core values of the medical profession. Applying the panarchy framework to frame this adaptive process could enable the tracking of multi-level interactions within the medical education environment and the evaluation of interventions targeted at identified areas of concern. Further exploration to achieve complete mapping of specific environmental domains onto the panarchical cycles merits future investigation to build integrated resilience frameworks.

Medical devices are manmade objects existing at the interface between numerous disciplines. They range from as simple as medical gloves to as complex as artificial limbs. This versatility of medical devices and their inherent interdisciplinary nature means that academic courses on them are attended by cohorts of students from varieties of academic backgrounds, who bring with them similarly broad spectra of interests. To satisfy the learning expectations of each and every student in such diverse classes is a daunting task for the instructor. After many years of teaching medical devices at undergraduate and graduate levels at three different universities in the states of Illinois and California, I have come up with an instructional method that solves this challenge by engaging students in the co-creation of the curriculum via selection of their own medical devices of interest and presentation to the class for collective analysis. The threefold presentations are designed so that they reflect an ascent along the hierarchy of a learning taxonomy extending from foundational concepts to critical assessment of knowledge to creative displays of it. In such a way, the students are acquainted with the ability of critical and creative thinking at the expense of rote memorization or inculcation and are prepared to enter the field of medical devices as innovation-centered individuals. The specifics of this new method of instruction are reported here, with the hope that they will be useful to fellow instructors in any interdisciplinary course that benefits from a balance between the rigorous coverage of the instructional material pertaining to engineering and medicine and the flexible selection of topics that comply with students' individual interests.

Government, organizational, and professional society policies are part of the complex system that underpins and influences the education of health professionals. Despite their significant influence, these policies rarely receive attention in scholarship examining the processes and outcomes of current health profession education systems. Policy analysis is a field of research that examines how and why policies are developed, the assumptions underpinning policies, and policies' effects. Given the potential value policy analysis can offer health professions education research, our manuscript aims to 1) describe policy analysis as a field of research that draws on multiple disciplines and methodologies, and 2) demonstrate and discuss what policy analysis research can contribute to health professions education by sharing examples of two studies and discussing their value. To explain how policy analysis can be applied in health professions education research, we describe four key steps and considerations for using policy analysis- (i) assemble your research team; (ii) develop the research questions; (iii) select the methodology for the policy analysis; and (iv) select methods for data collection and analysis.

Ensuring equitable access to professional education programs for learners who need accommodations is distinctly challenging when education moves beyond the classroom into clinical or fieldwork sites. Fieldwork educators and university academic coordinators who arrange fieldwork placements work with university accessibility services and students to arrange required accommodations, while preserving confidentiality, maintaining high learning standards, and ensuring attainment of professional competencies. This work is complicated by time pressures and heavy caseloads in fieldwork settings. Here we report on a subset of data from a cross-Canada online survey of fieldwork educators (n = 233) and academic coordinators (n = 54) in 10 health and social service professions. Using descriptive statistics, we analyze responses to two question series concerning perceptions of the capacity of disabled students to attain professional competencies, and overall perceptions of students who need accommodations. Respondents showed most concern about competency attainment for learners with cognitive or learning disabilities, followed by neurological and mental health issues. Thematic analysis of open-ended comments suggests doubt regarding the ability of institutional fieldwork sites to adequately implement accommodations. In their perception of learners who need accommodations, academic coordinators were somewhat more negative than fieldwork educators, in particular seeing students who need accommodations as a potential burden that could harm placement relationships with fieldwork sites. They tended to indicate that fieldwork success depended on student insight and self-advocacy. Struggles faced by disabled students in health and social service professions appear to be occasioned not only by disabling systems and institutions, but also by perceptions that they may have diminished competence.

In this essay, a pediatric fellow reflects on her educational journey and the people, questions, and surprising pieces of advice that have shaped her approach to learning, thinking, and learning how to think.

Phenomenon:  Marginalized individuals in medicine face many structural inequities which can have enduring consequences on their progress. Therefore, inequity must be addressed by dismantling underlying unjust policies, environments, and curricula. However, once these injustices have been taken apart, how do we build more just systems from the rubble? Many current strategies to address this question have foundational values of urgency, solutionism, and top-down leadership. Approach: This paper explores a counternarrative: Design Justice. As a set of guiding principles, Design Justice centers the experiences and perspectives of marginalized individuals and communities. These principles include mutual accountability and transparency, co-ownership, and community-led outcomes, and honoring local, traditional, Indigenous knowledge. Findings: Rooted in critical scholarship and critical design, Design Justice recognizes the interconnectedness of various forms of marginalization and works to critically examine power dynamics that exist in every design process. These co-created principles act as practical guardrails, directing progress toward justice. Insights: This paper begins with an overview of Design Justice's history in critical scholarship and critical design, providing foundational background knowledge for medical educators, scholars, and leaders in key concepts of justice and design. We explore how the Design Justice principles were developed and have been applied across sectors, highlighting its applications, including education applications. Finally, we raise critical questions about medical education prompted by Design Justice.

Autism manifests in various progressive, fluctuating, or static differences that may be disabling. This requires healthcare staff to provide individualized, culturally competent care for autistic people (AP). However, staff are underprepared since disability curricula are not universally implemented, which may exacerbate health disparities for AP. The Alliance for Disability in Health Care Education (ADHCE) delineated staff competencies to address disparities. The purpose of this review was to describe what is known about disability education initiatives and health-related outcomes for AP. The review included published literature on disability education for any health personnel providing services to AP in any setting where healthcare services are delivered. In June 2023, six databases were queried. Of 3,396 screened reports, 42 were extracted. Most articles originated in the United States and reported various instructional strategies on child-focused educational content for small interprofessional groups in various settings. The biomedical and biopsychosocial disability models were prominent. The training covered few, if any, ADHCE competencies and rarely involved collaboration with AP. Positive outcomes included improved functional health, behavior, and communication. Patient-reported outcomes and physical and psychosocial health were underreported. Future initiatives should involve scaled-up global efforts, address core competencies for care across the lifespan, and establish community partnerships to ensure meaningful outcomes.