Teaching and Learning in Medicine最新文献

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

Issue: Clinical reasoning is essential to physicians' competence, yet assessment of clinical reasoning remains a significant challenge. Clinical reasoning is a complex, evolving, non-linear, context-driven, and content-specific construct which arguably cannot be assessed at one point in time or with a single method. This has posed challenges for educators for many decades, despite significant development of individual assessment methods. Evidence: Programmatic assessment is a systematic assessment approach that is gaining momentum across health professions education. Programmatic assessment, and in particular assessment for learning, is well-suited to address the challenges with clinical reasoning assessment. Several key principles of programmatic assessment are particularly well-aligned with developing a system to assess clinical reasoning: longitudinality, triangulation, use of a mix of assessment methods, proportionality, implementation of intermediate evaluations/reviews with faculty coaches, use of assessment for feedback, and increase in learners' agency. Repeated exposure and measurement are critical to develop a clinical reasoning assessment narrative, thus the assessment approach should optimally be longitudinal, providing multiple opportunities for growth and development. Triangulation provides a lens to assess the multidimensionality and contextuality of clinical reasoning and that of its different, yet related components, using a mix of different assessment methods. Proportionality ensures the richness of information on which to draw conclusions is commensurate with the stakes of the decision. Coaching facilitates the development of a feedback culture and allows to assess growth over time, while enhancing learners' agency. Implications: A programmatic assessment model of clinical reasoning that is developmentally oriented, optimizes learning though feedback and coaching, uses multiple assessment methods, and provides opportunity for meaningful triangulation of data can help address some of the challenges of clinical reasoning assessment.

Problem: Syrian medical research synthesis lags behind that of neighboring countries. The Syrian war has exacerbated the situation, creating obstacles such as destroyed infrastructure, inflated clinical workload, and deteriorated medical training. Poor scientific writing skills have ranked first among perceived obstacles that could be modified to improve Syrian research conduct at every academic level. However, limited access to personal and physical resources in conflict areas consistently hampers the implementation of standard professional-led interventions. Intervention: We designed a peer-run online academic writing and publishing workshop as a feasible, affordable, and sustainable training method to use in low-resource settings. This workshop covered the structure of scientific articles, academic writing basics, plagiarism, and the publication process. It was also supplemented by six practical assignments to exercise the learned skills. Context: The workshop targeted healthcare professionals and medicine, dentistry, and pharmacy trainees (undergraduate and postgraduate) at all Syrian universities. We employed a systematic design to evaluate the workshop's short- and long-term impact when using different instructional delivery methods and assignment formats. Participants were assigned in a stratified manner to four groups; two groups attended the workshop synchronously, and the other two groups attended asynchronously. One arm in each group underwent a supervised peer-review evaluation for the practical writing exercises (active), while the other arm in each group self-reviewed their work on the same exercises using exemplary solutions (passive). We assessed knowledge (30 questions), confidence in the learned skills (11 questions), and the need for further guidance in academic writing (1 question) before the workshop and one month and one year after it. Impact: One-hundred-twenty-one participants completed the workshop, showing improved knowledge, confidence, and need for guidance. At one-year follow-up, participants showed stability in these gains. Outcomes for the synchronous and asynchronous groups were similar. Completing practical assignments was associated with greater knowledge and confidence only in the active arms. Participants in the active arms engaging in the peer-review process showed greater knowledge increase and reported less need for guidance compared to those who did not engage in the peer-review. Lessons learned: Peer-run interventions can provide an effective, affordable alternative to improving scientific writing skills in settings with limited resources and expertise. Online academic writing training can show improvements regardless of method of attendance (i.e., synchronous versus asynchronous). Participation in supplementary practical exercises, especially when associated with peer-review, may improve knowledge and confidence.