Teaching and Learning in Medicine最新文献

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: 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.

The concept of professional resistance describes the principles professionals should follow when they seek to counter social harm and injustice. Applied to medical education, the principles of professional resistance can help learners and teachers balance the responsibilities to respond to harm and injustice with their roles and responsibilities as health professionals. However, there remains the problem of how educators and leaders can constructively respond to learner acts of resistance. It would seem that many leaders have dismissed learner resistance with variations on "Those Darn Kids!", a complaint that has long been levied at those in younger generations who challenge power and authority. How can productive change in medical education be achieved if learners' complaints are not taken seriously? Rather than dismissal, leaders and educators in these situations need the tools to engage learners in conversations that draw out their concerns.

Phenomenon: While professionalism is largely understood to be complex and dynamic, it is oftentimes implemented as if it were static and concrete. As a result, policies and practices reflect dominant historical norms of the medical profession, which can cause tension for trainees from marginalized groups. One such group comprises those who identify as first-generation physicians - those whose parents have not earned an associate's degree or higher. This group is highly diverse in terms of gender, race, ethnicity, and socioeconomic status; however, their experiences with institutional professionalism policies and practices has not yet been fully explored. In this study, our aims were to understand the ways in which these participants experience professionalism, and to inform how professionalism can be more inclusively conceptualized. Approach: In November 2022-March 2023, we conducted semi-structured interviews with 11 first-generation medical students, residents, and physicians and analyzed select national and institutional professionalism policies in relation to key themes identified in the interviews. The interviews were designed to elicit participants' experiences with professionalism and where they experienced tension and challenges because of their first-gen identity. Data were analyzed using thematic analysis through a critical perspective, focused on identifying tensions because of systemic and historical factors. Findings: Participants described the ways in which they experienced tension between what was written, enacted, desirable, and possible around the following elements of professionalism: physical appearance; attendance and leaves of absence; and patient care. They described a deep connection to patient care but that this joy is often overshadowed by other elements of professionalism as well as healthcare system barriers. They also shared the ways in which they wish to contribute to changing how their institutions conceptualize professionalism. Insights: Given their unique paths to and through medicine and their marginalized status in medicine, first-generation interviewees provided a necessary lens for viewing the concept of professionalism that has been largely absent in medicine. These findings contribute to our understanding of professionalism conceptually, but also practically. As professionalism evolves, it is important for institutions to translate professionalism's complexity into educational practice as well as to involve diverse voices in refining professionalism definitions and policies.

Phenomenon: Most medical schools in Indonesia have developed innovations to integrate public health content into the curricula. However, ensuring that all schools meet appropriate standards regarding the quality of subjects, content relevancy, and course delivery takes time and effort. Approach: This study employed a rapid assessment procedure to identify the current knowledge and competencies required to practice medicine effectively in underserved, border, and outer island areas of Indonesia. Ninety-three participants from six remote districts were involved in 12 focus group discussions. Qualitative data were analyzed using content analysis using the social determinants of health as a guiding framework. Findings: Under decentralized health system governance, the local socio-geographical context is critical to understanding the current public health landscape. Medical education with respect to public health must emphasize physicians' ability to advocate and encourage the coordination of healthcare services in responding to disasters, as well as community-based surveillance and other relevant data for synergistic disease control. As part of a healthcare facility management team, prospective doctors should be able to apply systems thinking and provide critical input to improve service delivery at local health facilities. Also, recognizing underlying factors is essential to realizing effective interprofessional collaboration practices and aligning them with leadership skills. Insights: This study outlines recommendations for medical schools and relevant colleges in formulating compulsory block or integrated public health curricula. It also provides a public health learning topic that may aid medical schools in training their students to be competent for practice in underserved, border, and outer island areas. Medical schools should offer initiatives for students to acquire the necessary public health competencies merited by the population's health needs.

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.

Background. Despite their impact on children's health and well-being in the U.S., race and racism are not routinely discussed during pediatric outpatient visits. It is unclear whether families want to discuss race and racism with their pediatrician and - if so - how pediatric residents should be trained to facilitate these conversations effectively. Objective. We explored the perspectives of physician parents, community members, and pediatric residents on discussing race and racism during outpatient pediatric visits as part of a needs assessment to inform the development of a curriculum to teach pediatric residents how to discuss race and racism with families in the primary care setting. Methods. We recruited pediatric residents (n = 6), physician parents (n = 6), and community members (n = 2) to participate in focus groups. Participants were divided into focus groups based on their stakeholder role and self-identified race. We recorded and transcribed focus group dialogue and used thematic analysis to examine the data. Results: Participants expressed hesitancy regarding discussions about racism between families and their pediatrician, given possible unintended consequences. Participants felt that shared experiences amongst patients and providers could help improve provider and patient comfort during these conversations. Black physician parents and community members highlighted the importance of celebrating children's racial identities and avoiding preemptively broaching conversations about racism. White physician parents and residents, in contrast, expressed desire for standardized guidance and suggested phrasing to improve their comfort. To effectively train pediatricians to have conversations about racism, all participants expressed the importance of pediatricians learning about racism's effects on children's health, both broadly and locally. To learn this information, community members felt community involvement would be most beneficial, whereas pediatric trainees and white physician parents felt standardized training with role play would be most helpful. Conclusions. Facilitating conversations about race and racism in the outpatient setting requires a patient-and family-centered, nuanced approach. Educators developing curricula to teach trainees how to have these conversations should consider including information on how racism impacts children's health, both broadly and locally. Recognizing the divergent perspectives between stakeholder groups, educators may consider developing structured, longitudinal curricula focused on the current and historical health impacts of race, racism, bias, and discrimination, incorporating experiential learning in the community setting instead of focusing on developing curricula specifically focused on teaching trainees how to discuss racism in the primary care setting.

Introduction. Medical trainees often confront a healthcare system entrenched in longstanding social harm, including racism, sexism, and homophobia. Yet, advocacy remains vaguely addressed in U.S. medical training, leaving trainees without structural support as they engage in acts of professional resistance to social injustice. This study explores medical trainees' development of a "resistor identity" and how this identity shapes their professional identity as physicians committed to challenging systemic injustices. Methods. Using a qualitative approach, we applied constructivist grounded theory to semi-structured interviews with 18 medical trainees known for engaging in professional resistance. Data collection spanned two interview rounds, 10 months apart. Drawing from Selinger's professional development identity framework of "being" and "becoming," and Syed and McLean's identity integration theory, our analysis examined the origins of resistor identity and its dynamic interrelations with professional identity. We employed constant comparative analysis to identify patterns. Results. Findings reveal that trainees' resistor identities emerge in response to conflicts between their professional roles and their desire to address systemic injustice within medical education and practice. Three relationships between their resistor and professional identities were identified: (1) Conflict: Trainees perceived tension between their resistor and professional identities, and avoided the former being assimilated into the latter to maintain awareness of systemic injustice. (2) Intertwining: Some saw these identities as deeply connected but maintained some level of distinctness. They observed role models who demonstrated ways to help both identities coexist harmoniously. (3) Integration: Some trainees experienced an initial conflict or intertwinement between identities, but later achieved integration, transforming their professionalism to include humane concerns and mature expressions of resistance. Discussion. These interrelations are fluid rather than fixed or mutually exclusive. Trainees critically reflect on what it means to be a physician, actively expanding their professional identities to incorporate values of advocacy and justice. The resistor identity allows trainees to resist privileged norms of the profession while still fulfilling their roles as competent and effective physicians. Findings highlight both challenges and possible pathways to professional identity integration, while call for acknowledging advocacy and professional resistance as key roles for future physicians.

Medical education is witnessing a growing need for disability support, particularly for cognitive and psychiatric disabilities, yet many medical learners do not receive the necessary accommodations. These barriers may arise from uncertainty in how to approach multifaceted challenges, lack of disability recognition by both learners and educators, fear of stigma, and unclear or inadequate institutional policies and support systems. This case study about a urology resident in a U.S. training program, presented from the viewpoint of his competency development coach and residency program leadership with case description and insights from the resident, explores how adopting a Master Adaptive Learner (MAL) approach to identifying multiple intertwined challenges enables targeted remediation and disability support efforts. While situated in a U.S. surgical graduate medical education program, this case offers insights that can be helpful to medical educators in a variety of settings about how to effectively support struggling learners, while emphasizing the importance of early identification, tailored accommodations, and the value of creating an inclusive learning environment for all medical learners. By modeling how the ability to be vulnerable is a strength in the learning environment, this case aims to reduce the stigma associated with having learning requirements that fall outside a program's standard curriculum. Ultimately, this paper advocates for shifting the remediation process from a stigma-laden experience to one that fosters growth, helping both learners and programs evolve.