Teaching and Learning in Medicine最新文献

Women medical students experience unique stressors and challenges during medical school related to inherent structural androcentric norms. Through a longitudinal qualitative study of 17 women medical students in their first two years of medical school, we sought to investigate how they navigated their medical school experience. We used a critical lens and narrative inquiry to understand their experiences within the powerful and marginalizing culture of medical school. Our participants identified two essential support groups: those relationships made within, and those sustained outside, medical school. These findings invoked a kinship framework-one where women medical students have a network of chosen kin who provide essential support for them during their first 2 years. The participants' chosen kin within medical school provided support through recognition of one another, belonging by not belonging, being encouraged to reach out, and creating long-term relationships. The chosen kin outside medical school provided support by reminding the student who they are and creating stability. Integrating models of kinship into medical school as practiced by women medical students may have immense value in providing essential supports for medical students, preventing burnout, and changing the culture of care for future physicians that would align recognition and practice of self-care with patient care.

Phenomenon: Increasingly, peer feedback and assessment exercises are being introduced into health professional degree programs with many proposed benefits including the unique feedback received from peers and development of clinical education skills. However, studies investigating the bidirectional significance of peer feedback in workplace-based assessments (WBAs) are limited. The peer assessed mini-clinical evaluation exercise (peer mini-CEX) is a WBA conducted as part of The University of Melbourne Doctor of Medicine course, which involves peers assessing one another in a clinical setting. Approach: This research investigated students' perceptions of the bidirectional effects of peer feedback on medical students undertaking peer mini-CEXs. Between August and October 2023, we conducted semi-structured interviews of penultimate and final year medical students. We undertook an exploratory qualitative study based on social constructivist theory. We transcribed the interviews and analyzed them via inductive thematic analysis, which led to the development of themes and the thematic map. Findings: Fourteen students, including eight third-year and six fourth-year students, participated in the study. Students appeared to engage in two general approaches to the peer mini-CEX: a mastery approach or a compliance approach. These themes encapsulated a tension between the desire to achieve deeper learning versus a strategic approach to assessment. When students took a mastery approach, perceived bidirectional benefits clustered around improvements in feedback provision and reception, more intentional observation and reflection leading to enhanced clinical skills, and development of professional communication skills. If students took a compliance approach, the reported outcomes were limited or undesirable with students viewing the assessment as a tick box exercise and identifying the limitations of peer feedback. A third theme, the social milieu, illustrated the influence of the social context on peer interactions and whether a mastery or compliance approach was undertaken. Insights: This study is the first to explore students' perceptions of the nuanced bidirectional effects of peer feedback in a WBA. Participants report benefits of the peer mini-CEX in domains such as clinical skills, professionalism, communication, and feedback provision and reception. However, even engaged students often described adopting a superficial approach to the peer mini-CEX, resulting in minimal learning. Our findings indicate the influence of the social milieu on peer assessment and feedback processes. With contemporaneous feedback training and priming, peer assessment and feedback can be a valuable exercise for medical students. Further research into peer feedback in WBAs is required.

Problem-Based Learning (PBL) is widely implemented in health professions education (HPE). Small-group knowledge construction plays an essential role in trainees' learning from PBL tutorials. However, there is a dearth of systematic reviews to unpack the black box of the PBL knowledge construction process. The current review tackles this gap by identifying (1) the perspectives and methods adopted to directly assess the PBL knowledge construction process and (2) the factors in group interaction processes that impact PBL knowledge construction. We conducted a systematic search of multiple databases in November 2023 and identified original studies analyzing PBL interaction processes in HPE. Two reviewers conducted a thematic synthesis of the findings. Of 2,691 citations identified, 60 empirical studies (2.2%) from 16 countries and covering eight health professions met the inclusion criteria. Most investigations adopted a social constructivist perspective to analyze recordings, observations, and digital trace data of group interactions, often triangulating with other data for deeper insights. A wide range of qualitative, quantitative, and mixed methods was used to analyze interaction processes. Our synthesis identified a series of intertwined factors that influence knowledge construction: cultural influences and linguistic strategies; interprofessional dynamics, curriculum and assessment practices; learning task design, including technology affordance; tutor facilitation; learner prior knowledge and experience; and team learning behaviors and interaction patterns, such as learner directedness, social-cognitive exchange, group climate, and group interaction patterns. Our review highlighted the complexity of PBL knowledge construction by revealing the interrelated impact of various factors. Future studies should adopt a sociocultural perspective, employ the Design-Based Research approach, and integrate multiple methods and levels of analysis to unravel the dynamic interplay of these factors. Future research directions include exploring new analytics techniques, leveraging AI to develop data-driven interventions, and enhancing the inclusivity of collaborative learning environments.

Health professions education (HPE) in the US is facing a critical disparity between the diversity of students enrolled in health professions programs and the diversity of US society. This disparity has downstream impacts on the healthcare workforce and patient care. The problem is created partly by social determinants of learning (SDOL), which are nonacademic, contextual conditions that impact students' ability to optimally participate in their education. SDOL can be facilitators or barriers and often have disproportionate effects on individuals from underrepresented backgrounds and identities. This article explores these nonacademic factors, the lack of student diversity in HPE, the resulting societal impacts, and offers practical recommendations for individuals and institutions.

While US health systems are implementing language proficiency assessments to verify skills needed to ensure meaningful language access for patients, there is no consensus on best practices for multilingual medical students who want to demonstrate language proficiency for direct patient care. Many medical students who report non-English language skills face challenges navigating when and how to appropriately use those skills in clinical interactions. We used a modified Delphi process to seek consensus from an expert panel through the National Association of Medical Spanish (NAMS) for a Qualified Multilingual Assessment (QMA) policy for medical students. The survey included five topics related to QMA logistics and five topics related to QMA implementation guidance for clinical affiliates: QMA purpose, language access standards, responsibilities of supervising physicians, guarding against implicit bias, and monitoring learning opportunities. We set 80% as the threshold for consensus and revised topics that yielded <80% consensus. We circulated the revised topics in a second survey to establish consensus. Following two rounds of surveys among expert stakeholders, we reached consensus across all topics, yielding a first-of-its-kind QMA policy that administrators may adapt for clinical learning environments and institutions with health professional trainees. This policy includes key QMA policy recommendations for medical students: selecting a QMA, QMA logistics, and QMA implementation guidance for clinical affiliates.

Assessment variability in formative assessment occurs when assessors observing a trainee performing the same task evaluate the trainee differently. One major contributor is uncertainty regarding assessment criteria, and efforts to clarify criteria are not always successful. This study explores the cognitive processes that occur in assessors' minds when assessment criteria are clarified. We interviewed clinical teaching faculty from one residency program in a single institution regarding their perceived expectations of select assessment items before and after providing clarifying criteria and how the clarification changed their perception. We analyzed the data thematically. Assessors' cognitive interaction with assessment clarification is a function of four factors: 1) Assessors' fixed ideation, 2) Content of the criteria themselves, 3) Context and setting of criterion interpretation, and 4) Interaction between the assessor and the trainee. The cognitive effects of clarifying assessment items depend not only on the assessor and criteria but additionally on their interactions within a professional and academic context. The complexity and multifactorial nature of assessment variability may explain the difficulty in mitigating criterion uncertainty.

Clinical educators aiming to develop advocacy training have few established guidelines to follow. We conducted a needs assessment to explore perspectives of physician trainees and faculty to inform advocacy curriculum development and potentially facilitate increased advocacy engagement. We conducted 45-minute focus groups with 33 faculty (n = 16) and trainees (n = 17) from the Division of General Internal Medicine at a large US urban teaching hospital between September 2021 and February 2022. Interviews were audiotaped and transcribed on Zoom and de-identified prior to analysis. We used thematic analysis to identify key themes within a constructivist paradigm. Themes relating to participants' definitions of advocacy and their role as advocates included viewing advocacy as (1) supporting health and wellbeing in its broadest sense and viewing physicians as (2) in a position of power to advocate. Themes relating to perceived facilitators and barriers to advocacy engagement included (3) the lack of political education among physicians and (4) the need for interprofessional collaboration. Finally, themes relating to institutional support for advocacy included (5) the need for exposure to role models and (6) the importance of institutional culture. Physician participants reported that structured advocacy training combined with mentorship from professionals actively engaged in advocacy initiatives and a supportive institutional culture can enhance the perceived value of advocacy and empower engagement in it. Future studies are needed to explore interprofessional perspectives, as advocacy initiatives featuring interprofessional teams and supported by an institutional culture of advocacy are more likely to be successful.

There is a growing amount of literature on the benefits of using open-ended questions (OEQs) to assess knowledge in medical education. However, it is unknown how many US medical schools include OEQs in their assessment toolkits and how they are being used. The purpose of this study was to determine if OEQ assessments are an emerging trend in US medical education. We distributed an online survey to assessment leadership at all 156 US accredited allopathic medical schools between September 2022 and April 2024. Questions focused on the use or future interest of OEQs to assess medical knowledge in the pre-clerkship and clerkship curriculum. We calculated descriptive statistics for prevalence and use rates, and completed a conventional content analysis for open-ended comments. Seventy-eight US medical schools completed the survey (50% response rate). Forty schools (51%) reported using OEQs for medical knowledge assessment. OEQs were used during the pre-clerkship (28 schools), clerkship (two schools) or both parts of the curriculum (10 schools). On average, OEQs accounted for 20% of the pre-clerkship and 11% of the clerkship assessments at each school. Schools used OEQs to assess students' understanding, assess certain types of knowledge, and develop students' deeper learning. Representatives at schools not currently using OEQs reported considering using them in the future but expressed concerns about the amount of time needed to implement them. Numerous schools are using OEQs to assess medical knowledge, suggesting that this assessment format is feasible. Institutions can be innovative in their assessments by extending beyond multiple-choice questions and incorporating other question formats, such as OEQs, to fit their educational needs. This study provides a foundation for future research to explore the utility of OEQs and how to overcome the challenges of implementing OEQ assessments.