Teaching and Learning in Medicine最新文献

Patients have long been involved in health professional education in placement and fieldwork contexts. However, such contexts have been oriented to learning about rather than with patients. Increasing patient involvement in future health professionals' education has been an area of growing scholarly interest in recent decades. Due to the variation in patient involvement across contexts, most literature reviews on this subject have taken a broad conceptual approach. However, with the shift toward more participatory approaches in healthcare generally, we were interested in how patient partnership specifically was represented in health professional education. Our review aims to support educators seeking to enhance health professional education and patient care by critically examining the evolving and varied understandings of patient partnership in health professional education. Using a qualitative synthesis approach, we conducted a comprehensive search of five databases, selecting a final sample of 71 articles. We identified five overarching themes: 1. Rationales for patient partnership reflect a spectrum from transformative commitments to policy drivers; 2. Diverse theoretical and conceptual imaginings of patient partnership; 3. Enacting patient partnership: Effort, time, emotional labor, ethics, and outcomes; 4. Impactful patient partnerships demand that patients and carers are seen by students and educators as people to learn from and with; and 5. Sustainable and inclusive patient partnerships require relational and structural support. We discuss the aspects of health professional education where patient partnership is most meaningful. We recommend investing time, support, and resources to enable the creation of long-term partnerships that emphasize relational processes where shared understandings and diverse perspectives are nurtured. We also advocate for more curriculum flexibility and critical perspectives to push the boundaries of patient partnership in health professional education. An area for further research is evaluating the impact of long-term patient partnerships, including those sustained beyond graduation, as students move into their professional roles.

Theory: Impostor phenomenon (IP) is strongly linked to physician burnout, but the nature of this association is not well understood. A better grasp of the mechanism between these constructs could shed new light on ways to mitigate physician IP and burnout. Grounded in self-determination theory (SDT), the present study explores whether and how residents' general causality orientations at work-impersonal, controlled, and autonomous-each moderate the effect of IP on physician burnout. Hypotheses: We theorized that the autonomous orientation would buffer the facilitative effect of IP on burnout, while the controlled and impersonal orientations would each enhance it to varying degrees. Method: Two hundred forty-three residents from the Universities of Saskatchewan, Calgary, and Alberta, across various programs, specialties, and years of training, completed a survey containing demographic questions and three previously validated instruments: the Clance Impostor Phenomenon Scale, Causality Orientations at Work Scale, and Oldenburg Burnout Inventory. We used partial correlation analyses to test our moderation hypotheses. Results: In line with what we expected, the autonomous causality orientation buffered the facilitative effect of IP on burnout, while the controlled and impersonal causality orientations each enhanced it. Conclusions: Results suggest that possessing a stronger autonomous causality orientation (and creating learning/work environments that prime it) will dampen the effect of IP on burnout, while possessing a stronger controlled or impersonal causality orientation (and creating learning/work environments that prime them) will each augment it. Findings and their implications are discussed in terms of instigating theory-informed, system-level wellness interventions in graduate medical education.

Phenomenon: With the proliferation of pass/fail grading practices in the pre-clerkship phase of undergraduate medical education, questions arise about the transparency and variability of grading and grade reporting practices, raising issues of equity in assessment, particularly regarding residency matching. The purpose of this survey was to determine the remediation and academic performance reporting practices of United States (U.S.) allopathic medical schools in the pre-clerkship phase of their curricula. Approach: After an extensive literature search and feedback from curriculum deans and learning experts, we developed a survey that we sent in the Spring of 2022 to pre-clerkship curriculum officials at all 154 accredited U.S. allopathic medical schools. It addressed curriculum content and structure; pre-clerkship remediation (e.g., course retakes) and reporting (e.g., permanency of transcript notation) practices; documentation and reporting of nonacademic competencies; and participant opinions and recommendations regarding reporting, transparency, and equity. We generated descriptive statistics and did manifest coding of open-ended responses. Findings: We had a response rate of 40% (62/155), with over 71% indicating mainly organ systems-based curricula. Depending on the situation, there were a wide range of remediation approaches for single- and multiple-course failures, including tutoring or learning support, re-exams, and referrals to a promotion board. Professionalism concerns were a top priority to report to residency directors, with significant variability in respondent opinions and practices in reporting remedial activities. Respondents were concerned about equity, both in terms of flexible grading practices and transparency of reporting practices. Insights: The variability in reporting practices across schools, while allowing holistic and individualized approaches to academic support, also creates potential inequities. More work is needed to understand how different reporting practices across institutions may disadvantage marginalized and minoritized student groups at different points in their preparation.

Aims: We aimed to identify the unique challenges and opportunities faced by international student nurses in Türkiye when practicing patient care. This understanding is essential for educators, healthcare institutions, and policy makers to create more inclusive and supportive environments that enhance learning and professional development. Addressing these challenges can lead to better integration of foreign student nurses into the healthcare system, ultimately improving patient care quality. This research is important for all stakeholders in healthcare - educators, administrators, policymakers, and patients - because a diverse and well-supported nursing workforce is essential for the delivery of culturally competent and high-quality care. Methods: This study employed interpretative phenomenology. Data were collected from 12 foreign nursing students from Iraq, Egypt, Syria, Saudi Arabia, Iran, and the Netherlands. Data were collected between 01 and 20 May 2023 in the Nursing Department of the Faculty of Health Sciences of a state university in the province of Şanlıurfa, located in the southeastern region of Türkiye. Data were analyzed using Colaizzi's method. Results: We identified four themes: "Metaphors describing patient care practices," "Factors affecting care practices," "Needs for education and support," and "Opportunities during patient care practices." Positively influencing factors included better education and living standards and economic benefits, while negatively influencing factors were traumatic events before studying abroad, racial discrimination, language and cultural differences, negative emotions, peer victimization, and lack of use of standards. Interviewees reported a need for training and support and that patient care practices provided opportunities for greater awareness, responsibility, and professional integration. Discussion: Positive and negative experiences of foreign student nurses were evident in the delivery of patient care practice. Interventions are needed to alleviate negatively influencing factors, provide training and support for students, and improve opportunities for foreign nationals. Identification of these factors can help medical educators to develop culturally sensitive and inclusive approaches, as well as individual/organisational facilitators that enhance existing opportunities and remove barriers.

Clinical medicine's complexities and demands often surpass the scope of formal ethics and leadership training that medical schools and residency programs provide. The discrepancy between medical education and the realities of clinical work may contribute to ethical erosion among learners, namely, medical students and residents. Unlike traditional approaches to teaching professional ethics and leadership in medicine, rights-based (aspirational) pedagogies approach trainees as autonomous moral agents, whose work has moral value to themselves and others, who live with the ethical consequences of their professional choices, and whose work shapes their individual moral character. By incorporating teaching strategies that intentionally build learners' rights-based leadership through the development of moral courage, medical educators may counter important aspects of ethical erosion while promoting learner preparedness, outcomes, and well-being. Military teaching approaches offer a valuable example to medical educators seeking to create structured curricula that foster moral courage to promote rights-based leadership, given the high level of moral and managerial complexity present in both medicine and the military. Through a comparative analysis of professional ethics in the medical and military disciplines, this Observation article explores the validity of applying precedents from military ethics and leadership education to medical training. Through arguments rooted in moral philosophy, military history, and military organizational research, we explore the expansion of rights-based teaching methods within the predominantly traditional and rules-based norms of medical education. In relating these findings to real-life clinical scenarios, we offer six specific, rights-based modifications to medical ethics curricula that have potential to promote morally courageous leadership and counteract the ethical erosion medical students and residents face.

Power dynamics and hierarchy are influential facets of the medical learning environment that are often experienced but seldom studied. One reason for this gap is the lack of sound instruments to measure perceived power distance in medicine. Accordingly, we developed and evaluated the Perceived Power Distance Scale (PPDS). Initial item development involved a literature search that identified a power distance orientation instrument (beliefs about power distance), which we adapted to measure perceived power distance (perceptions of power distance). We gathered item content validity evidence from a panel of seven international scholars of power and hierarchy, resulting in minor item revision. Next, a convenience sample of 312 US medical students completed a survey comprising PPDS (to establish internal validity through confirmatory factor analysis and reliability estimation); a locally adapted power distance measure (to establish convergent validity); and a psychological safety measure (to establish discriminant validity). The best-fitting model was a higher order 1 + 5 factor model for PPDS, and PPDS overall scale reliability was adequate at 0.81. The correlation between the PPDS and an independent measure of power distance was 0.60 (convergent validity) and the correlation of the PPDS with psychological safety was -0.54 (discriminant validity). The PPDS demonstrated adequate evidence of content, internal, convergent, and discriminant validity, along with appropriate reliability evidence to measure perceived power distance in US medical schools. The PPDS can be used as a tracking metric to improve learning environments within medical education in coordination with organizational development efforts.

Short-term intensive orientation programs have existed at medical schools for decades, yet there is very little published on these programs and the impact they have on medical students, particularly those at the very beginning of their medical training. The annual Rural/Urban Community Orienting Experience (RUCOE) at the Ohio University Heritage College of Osteopathic Medicine is a three-day immersive orientation before the start of the academic year with the goals to build community among students interested in underserved practice, faculty, and staff; foster a curious mind as a practitioner-scholar; and develop a reflective practice. While the deficits and challenges in rural and underserved communities are often obvious to outsiders, the RUCOE intentionally redirects students to see the health of a community, i.e., the assets within rural and urban underserved communities, parallel to the Osteopathic focus on finding health and supporting the body's ability to self-heal. During the RUCOE, students, faculty, and staff learn from community members in both rural and urban underserved communities via structured discussion groups. Program components include didactic presentations, tours of a federally qualified health center and a rural critical access hospital, interactive group activities, a service project, and continuous reflection in action via writing. This article takes an unconventional approach to describing the meaning and significance of an educational program in medical school. Our collaborative reflection on our written reflections paralleled the democratic process employed in the RUCOE; we attempted to dismantle the typical hierarchical scholarship process and include students from the very beginning in envisioning what this article should be. Our singular and simple goal was to share our story of the impact the RUCOE program had on us. Several patterns became clear as we read and discussed our reflections: (1) Shared Values Foster Community, (2) Vulnerability Builds Community, (3) Communities Teach Us, and (4) Envisioning A Professional Future. The common thread tying them together is a developing sense of community and belonging and enduring impact on personal and professional growth. The RUCOE created important connections and bonds between students, between students and faculty, and between students and the underserved communities and organizations we visit. The RUCOE set the stage for students to enter their first year of medical school with humanizing perspectives, a call to listen, to center patient's stories, and with reinforcement of their "Why."

Despite increased attention and advocacy around disability in academia, both health professions trainees and Disabled people seeking healthcare in the US continue to report shortcomings in the providers' preparedness to care effectively for Disabled patients. Some of these shortcomings have historical roots in flawed theories of disability and ableism, but even with advancements in Disability Studies and the adoption of the biopsychosocial model of disability, trainees continue to receive insufficient exposure to disability theory and Disabled people. When graduates become independent providers and clinical directors, their educational shortcomings persist, and Disabled patients pay the price in the form of universally worse healthcare outcomes. We focus this article on the need for improved training; in part, we offer a student response to the health equity policy recommendation from the National Council on Disability to require "…comprehensive disability clinical-care curricula in all US medical, nursing and other healthcare professional schools," a platform also reflected in the American Medical Association's Organizational Strategic Plan to Advance Health Equity. A group of medical students and educators at a large health institution in Philadelphia, PA, formed a working group inspired by an institutional review process around disability in their medical curriculum. Alongside a Disabled advocate and licensed clinical social worker (LCSW) in the same community, students imagined steps they would take to pursue a Disability Affirming Model of Medicine. We begin this article by reflecting on the progress made in academic and clinical medicine on the national level and at our institution, examining persistent failures in disability curricula in undergraduate medical education and discussing elements of wisdom gleaned from allied fields like social work. Our LCSW coauthor reflects on his experiences as a Disabled provider and as an educator within a medical field that remains largely inaccessible. Student coauthors consider their meaningful experiences with disability in educational and personal spheres, focusing on how learning from Disabled people like their coauthor has shaped their approach to disability in healthcare. Reflecting on these lessons and drawing on wisdom from their experience with curricular reform around Disability Studies, students conclude with recommendations for pedagogical redesign to facilitate comfort and proficiency in trainees' delivery of care to Disabled patients. We hope to galvanize efforts toward building a Disability Affirming Model of Medicine by calling upon peer advocates at every level of medical education, at home in the US and internationally.

Uncertainty and disability are simultaneously well-studied and enigmatic conditions in medicine. Yet while uncertainty and disability have individually received significant attention, little mind has been paid to how they interact. Common assumptions and biases underscore the frequently negative view of both conditions. However, overemphasis on reducing and eliminating uncertainty has negatively impacted physicians beholden to a culture that venerates certainty. At the same time, medicine's focus on fixing and curing disability, which is founded on ableist practices and policies, has led to deleterious patient health outcomes. If what is required for equitable, person-centered care is a greater tolerance of uncertainty, then we might derive wider benefits from approaches with demonstrated efficacy in dismantling ableist logic. For this reason, we employ the social model of disability to formulate three interrelated strategies for reframing uncertainty as a source of possibility in clinical encounters and life more broadly. The first strategy entails reappraising mental models that have contributed to structural barriers. Applying Paul Han's framework for tolerance to pervasive sources of bias, we argue that reappraisal inhibits certainty preference from erasing the subjectivities that invigorate our collective wisdom and grant significance to our lived experiences. The second strategy involves reexamining ways of knowing that have controlled ways of being. By applying a critical lens to the labels and categories indispensable to contemporary knowledge systems, we illustrate how an ethics of uncertainty can help us realize the principles of epistemic justice. The third strategy involves replacing the "un-choosing of disability" as described by the disabled poet and activist Eli Clare with the reclaiming of uncertainty. This approach reveals how creating a medical culture that fosters meaning and purpose can positively influence the relational aspects of care. Collectively, these strategies form the foundation of a praxis necessary to foster tolerance of uncertainty and bodily variability throughout medicine. We conclude by demonstrating how leaning into the discomfort inherent to paradoxes can transform uncertainty from a limiting factor to a liberating force for epistemic justice.

In the dynamically evolving field of medicine, mentorship is crucial for educating students, and Artificial Intelligence (AI) potentially revolutionizes this process through automated and data-enhanced guidance. This study aims to investigate AI's potential in mentoring medical students by collecting expert opinions, assessing its potential benefits and limitations, and developing a consensus-driven framework for the effective integration of AI-based mentorship into medical education. Specifically, it addresses ethical concerns such as data security, algorithmic bias, and the potential for reduced human interaction. Using a structured online Delphi technique, this interdisciplinary research involved 27 experts in medical education and AI to investigate the intersection of AI with medical mentorship. The study employed both qualitative (e.g., expert interviews) and quantitative (e.g., survey data) research methods, with consensus measured via descriptive and inferential statistics, including Fleiss' kappa and the Intraclass Correlation Coefficient (ICC). Detailed methodological steps, including the selection criteria for experts and the iterative feedback process across the four Delphi rounds, were meticulously followed to ensure robust consensus building. Conducted over four rounds, the Delphi technique achieved substantial consensus among panelists regarding the AI mentors' capabilities and the critical aspects requiring attention, with a kappa value of .79 ([.73-.85]) and high reliability (ICC=.873). The study also compared traditional mentorship roles with those enhanced by AI, highlighting areas where AI can complement and extend human mentorship rather than replace it. Panelists recognized AI mentors' potential to enhance learning processes, while also identifying limitations in areas requiring deep human judgment, emphasizing the need for careful application. AI mentors can significantly guide students across various aspects of medical training, from career planning to achieving academic goals, through personalized learning experiences. They hold promise for improving clinical skills and decision-making abilities through real-time feedback and adaptive learning modules. However, their limitations and the potential risks of overreliance necessitate balanced and cautious application. Ethical considerations, such as ensuring data integrity and preventing bias, are paramount in the deployment of AI mentors. These insights advocate the strategic implementation of AI mentors in medical education, suggesting phased integration and interdisciplinary oversight to harness their full educational potential while mitigating possible drawbacks. Furthermore, the study proposes a hybrid mentorship model that combines AI-driven insights with human empathy and ethical oversight to create a more comprehensive and effective mentorship framework. This study lays the groundwork for future research into the optimal integration of AI in medical mentor