Teaching and Learning in Medicine最新文献

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

Phenomenon: In China, medical English courses are critical to medical education, equipping Chinese students with the linguistic tools necessary for international medical practice and collaboration. However, a disconnect persists between the pedagogical approaches of medical practitioners and language educators, leading to a curriculum that emphasizes grammatical accuracy over practical communication skills. This misalignment results in student disengagement and falls short of addressing the real-world demands of the medical profession. With the growing importance of English proficiency in the global health sector, the need for significant improvements in medical English education is evident. This study delves into the underlying causes of student demotivation and aims to reconcile educational delivery with the evolving expectations of the medical field. Insights gained from this research will inform targeted interventions, promising to enhance medical English courses and support improved educational experiences for Chinese medical undergraduates. Approach: This cross-sectional quantitative study surveyed 3,046 second-year medical students from four medical universities in Guangdong Province, China, leveraging means-analysis and Expectancy-Disconfirmation Theory (EDT) as its foundation. The research was conducted at the end of the 2022-2023 academic year, utilizing a questionnaire to assess students' perceptions of their medical English courses. Importance-Performance Analysis (IPA) was the primary analytical tool to discern discrepancies between students' expectations and experiences. Findings: The IPA revealed that course content, classroom environment, and instructor effectiveness were pivotal factors influencing the perceived quality of the medical English courses. Students expressed a need for practical and relevant course material, with current content and textbooks falling short of preparing them for future medical communication demands. Additionally, while learning technologies were acknowledged, there was a discernible preference against their excessive application, suggesting a misalignment between student satisfaction and learning outcomes. Insights: This study highlights the need for innovative staffing models, refined qualifications for part-time instructors, development of collaborative and practical teaching materials, and focused training for medical English instructors. It also emphasizes the judicious integration of e-learning to enhance the learning experience. These insights aim to improve instruction quality by informing potential pedagogical adjustments and resource allocations in medical English education.

Phenomenon: Ownership of patient care is a key element of professional growth and professional identity formation, but its development among medical students is incompletely understood. Specifically, how attitudes surrounding ownership of patient care develop, what experiences are most influential in shaping them, and how educators can best support this growth are not well known. Therefore, we studied the longitudinal progression of ownership definitions and experiences in medical students across their core clerkship curriculum. Approach: We conducted a series of four longitudinal focus groups with the same cohort of medical students across their core clerkship curriculum. Using workplace learning theory as a sensitizing concept, we conducted semi-structured interviews to explore how definitions, experiences, and influencers of ownership developed and evolved. Results were analyzed inductively using thematic analysis. Findings: Fifteen students participated in four focus groups spanning their core clerkship curriculum. We constructed four themes from responses: (1) students' definitions of ownership of patient care evolved to include more central roles for themselves and more defined limitations; (2) student conceptions of patient care ownership became more relational and reciprocal over time as they ascribed a more active role to patients; (3) student assessment fostered ownership as an external motivator when it explicitly addressed ownership, but detracted from ownership if it removed students from patient care; and (4) structural and logistical factors impacted students' ability to display patient care ownership. Insights: Student conceptions of ownership evolved over their core clerkship curriculum to include more patient care responsibility and more meaningful relational connections with patients, including recognizing patients' agency in this relationship. This progression was contingent on interactions with real patients and students being afforded opportunities to play a meaningful role in their care. Rotation structures and assessment processes are key influencers of care ownership that merit further study, as well as the voice of patients themselves in these relationships.

Phenomenon: This study explored experiences of simulation-based clinical education in the Speech-Language Pathology and Audiology professions in South Africa, a Global South context where research on this topic is limited. In this context, the COVID-19 pandemic brought simulation to the forefront of clinical education as a training solution when in-person encounters were impossible. As these simulation-based training approaches gain traction, with continued use post-pandemic, it is important to understand how they are currently being used so that appropriate support can be offered to ensure their efficiency and success in the future. Approach: We distributed a survey to South African university departments offering Speech-Language Pathology and Audiology training, inviting participation from students across years of study and clinical educators. Data were collected between October 2022 and February 2023. Twelve responses were received: three from clinical educators and nine from students. We analyzed the responses using descriptive statistics and a domain summary approach. Findings: Simulated activities were implemented as options for clinical education in South African Speech-Language Pathology and Audiology (SLP/A) programs during the pandemic, albeit in a somewhat haphazard way depending on available resources, often with limited preparation or guidance. Some universities have continued using aspects of simulation training post-pandemic. Insights: Our findings, although preliminary, are somewhat consistent with Global North literature, particularly regarding barriers and challenges to implementing these approaches in clinical education. We offer suggestions for enhancing the support of simulation-based clinical education in our context.

Phenomenon: Choosing a medical specialty is a critical decision that significantly impacts medical students' future career. Understanding the factors influencing this decision-making process is important for medical educators, policymakers, and healthcare providers to develop effective strategies that support and guide students in making informed decisions. Approach: We distributed an online self-administered questionnaire to clinical-year medical students (Years 4 to 6) and interns from all medical faculties in Jordan. The questionnaire gathered demographic information, specialty preferences, and factors influencing specialty decision-making. We analyzed the data using descriptive statistics and logistic regression. Findings: 1805 participants completed the questionnaire (51.7% women). General surgery was the most preferred specialty among both genders, followed by internal medicine. Women significantly preferred family medicine, pediatrics, obstetrics and gynecology, and dermatology, whereas men significantly preferred urology, orthopedic surgery, neurosurgery, general surgery, and internal medicine. The factors that most strongly influenced respondents' specialty preferences were the specialty's perceived stress levels and working hours, whereas the least influential factors were the specialty's perceived prestige and role models in the specialty. Women's specialty preferences were significantly more influenced by their family than men's. Men were substantially more influenced by specialties' perceived action-orientation and stress levels than women. Insights: Gender significantly influences medical trainees' specialty preferences in Jordan. Women tended to prefer specialties that provided greater work-life balance, such as family medicine, pediatrics, obstetrics and gynecology, and dermatology, while men were more drawn toward competitive and profitable surgical specialties like orthopedic surgery, neurosurgery, urology, and general surgery. Additionally, family had a stronger influence on women's decisions, likely due to cultural and social expectations prioritizing marriage and family for women. Career counseling and mentorship programs are needed to provide guidance, support, and networking opportunities that can help women overcome barriers and biases that may hinder their career advancement.

Starting with reflexivity: As a Black woman medical student at a predominately white institution, a white woman full professor and deputy editor-in-chief of a journal, and a white woman associate professor with a deep interest in language, we understand that medicine and medical education interpellate each of us as a particular kind of subject. As such, we begin with a narrative grounding in our personal stances. Phenomenon: While there are a growing number of empirical studies of Black physicians' and trainees' experiences of racism, there are still few accounts from a first-person perspective. Black authors of these personal commentaries or editorials, who already experience microaggressions and racial trauma in their work spaces, must put on their academic armor to further experience them in publishing spaces. This study seeks to understand the stances Black physicians and trainees take as they share their personal experiences of racism. Approach: We searched four databases, identifying 29 articles authored by Black physicians and trainees describing their experiences. During initial analysis, we identified and coded for three sets of discursive strategies: identification, intertextuality, and space-time. Throughout the study, we reflected on our own stances in relation to the experience of conducting the study and its findings. Findings: Authors engaged in stance-taking, which aligned with the concept of donning academic armor, by evaluating and positioning themselves with respect to racism and the norms of academic discourse in response to ongoing conversations both within medicine and in the broader U.S. culture. They did this by (a) positioning themselves as being Black and, therefore, qualified to notice and name personal racist experiences while also aligning themselves with the reader through shared professional experiences and goals; (b) intertextual connections to other related events, people, and institutions that they-and their readers-value; and (c) aligning themselves with a hoped-for future rather than a racist present. Personal insights: Because the discourses of medicine and medical publishing interpellate Black authors as Others they must carefully consider the stances they take, particularly when naming racism. The academic armor they put on must be able to not only defend them from attack but also help them slip unseen through institutional bodies replete with mechanisms to eject them. In addition to analyzing our own personal stance, we leave readers with thought-provoking questions regarding this armor as we return to narrative grounding.

Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.

Problem: Traditionally, clinical reasoning is developed with purposeful exposure to clinical problems through case-based learning and clinical reasoning conferences that harvest a collaborative exchange of information in real-life settings. While virtual platforms have greatly expanded access to remote clinical learning, case-based clinical reasoning opportunities are scarce in low and middle income countries. Intervention: The Clinical Problem Solvers (CPSolvers), a nonprofit organization focused on clinical reasoning education, launched Virtual Morning Report (VMR) during the COVID-19 pandemic. VMR is an open-access, case-based clinical reasoning virtual conference on the Zoom platform modeled after an academic morning report format available to participants worldwide. The authors conducted 17 semi-structured interviews with CPSolvers' VMR participants from 10 different countries to explore the experiences of the international participants of VMR. Context: The CPSolvers was founded by US physicians and has now expanded to include international members throughout all levels of the organization. VMR is open-access to all learners. Preliminary survey data collected from VMR sessions revealed 35% of the attendees were from non-English speaking countries and 53% from non US countries. Impact: Analysis generated four themes that captured the experiences of international participants of VMR: 1) Improving clinical reasoning skills where participants had little to no access to this education or content; 2) Creating a global community from a diverse, safe, and welcoming environment made possible by the virtual platform; 3) Allowing learners to become agents of change by providing tools and skills that are directly applicable in the setting in which they practice medicine; 4) Establishing a global platform, with low barriers to entry and open-access to expertise and quality teaching and content. Study participants agreed with the themes, supporting trustworthiness. Lessons Learned: Findings suggest VMR functions as and has grown into a global community of practice for clinical reasoning. The authors propose strategies and guiding principles based on the identified themes for educators to consider when building effective global learning communities. In an interdependent world where the virtual space eliminates the physical boundaries that silo educational opportunities, emphasis on thoughtful implementation of learning communities in a global context has the potential to reduce medical education disparities in the clinical reasoning space and beyond.