Advances in Health Sciences Education

Consulta los últimos contenidos publicados en Advances in Health Sciences Education:

Latest Results for Advances in Health Sciences Education

The latest content available from Springer

Abstract

There is growing concern about a potential decline in empathy among medical students over time. Despite the importance of empathy toward patients in medicine, it remains unclear the nature of the changes in empathy among medical students. Thus, we systematically investigated affective and cognitive empathy for patients among medical students using neuroscientific approach. Nineteen medical students who completed their fifth-year medical curriculum and 23 age- and sex-matched nonmedical students participated in a functional magnetic resonance imaging study. Inside a brain scanner, all participants read empathy-eliciting scenarios while adopting either the patient or doctor perspective. Brain activation and self-reported ratings during the experience of empathy were obtained. Behavioral results indicated that all participants reported greater emotional negativity and empathic concern in association with the patient perspective condition than with the doctor perspective condition. Functional brain imaging results indicated that neural activity in the posterior superior temporal region implicated in goal-relevant attention reorienting was overall increased under the patient perspective than the doctor perspective condition. Relative to nonmedical students, medical students showed decreased activity in the temporoparietal region implicated in mentalizing under the patient perspective versus doctor perspective condition. Notably, this same region showed increased activity under the doctor versus patient condition in medical students relative to nonmedical students. This study is among the first to investigate the neural mechanisms of empathy among medical students and the current findings point to the cognitive empathy system as the locus of the primary brain differences associated with empathy toward patients.

Posted: October 1, 2021, 12:00 am

Abstract

Medical learners’ achievement emotions during educational activities have remained unexamined in Asian cultural contexts. The Medical Emotion Scale (MES) was previously developed to assess achievement emotions experienced by North American medical learners during learning activities. The goal of this study was to create and validate a Japanese version of the Medical Emotion Scale (J-MES). We translated the MES into Japanese and conducted two initial validation studies of the J-MES. In the first pilot study, we asked five, native-Japanese, second-year medical students to assess their emotions with the J-MES during a computer-based clinical reasoning activity. Each participant was then interviewed to assess the clarity and suitability of the items. In a second, larger study, 41 Japanese medical students were recruited to assess the psychometric properties of the J-MES. We also conducted individual, semi-structured interviews with ten of these participants to explore potential cultural features in the achievement emotions of Japanese students. The first pilot study demonstrated that the J-MES descriptions were clear, and that the scale captured an appropriate range of emotions. The second study revealed that the J-MES scale’s profiles and internal structure were largely consistent with control-value theory. The achievement emotions of pride, compassion, and surprise in the J-MES were found to be susceptible to cultural differences between North American and Japanese contexts. Our findings clearly demonstrated the scoring capacity, generalizability, and extrapolability of the J-MES.

Posted: October 1, 2021, 12:00 am

Abstract

Competency frameworks provide a link between professional practice, education, training, and assessment. They support and inform downstream processes such as curriculum design, assessment, accreditation and professional accountability. However, existing guidelines are limited in accounting for the complexities of professional practice potentially undermining utility of such guidelines and validity of outcomes. This necessitates additional ways of “seeing” situated and context-specific practice. We highlight what a conceptual framework informed by systems thinking can offer when developing competency frameworks. Mirroring shifts towards systems thinking in program evaluation and quality improvement, we suggest that similar approaches that identify and make use of the role and influence of system features and contexts can provide ways of augmenting existing guidelines when developing competency frameworks. We framed a systems thinking approach in two ways. First using an adaptation of Ecological Systems Theory which offers a realist perspective of the person and environment, and the evolving interaction between the two. Second, by employing complexity thinking, which obligates attention to the relationships and influences of features within the system, we can explore the multiple complex, unique, and context-embedded problems that exist within and have stake in real-world practice settings. The ability to represent clinical practice when developing competency frameworks can be improved when features that may be relevant, including their potential interactions, are identified and understood. A conceptual framework informed by systems thinking makes visible features of a practice in context that may otherwise be overlooked when developing competency frameworks using existing guidelines.

Posted: October 1, 2021, 12:00 am

Abstract

Health Artificial Intelligence (AI) has the potential to improve health care, but at the same time, raises many ethical challenges. Within the field of health AI ethics, the solutions to the questions posed by ethical issues such as informed consent, bias, safety, transparency, patient privacy, and allocation are complex and difficult to navigate. The increasing amount of data, market forces, and changing landscape of health care suggest that medical students may be faced with a workplace in which understanding how to safely and effectively interact with health AIs will be essential. Here we argue that there is a need to teach health AI ethics in medical schools. Real events in health AI already pose ethical challenges to the medical community. We discuss key ethical issues requiring medical school education and suggest that case studies based on recent real-life examples are useful tools to teach the ethical issues raised by health AIs.

Posted: October 1, 2021, 12:00 am

Abstract

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

Posted: October 1, 2021, 12:00 am

Abstract

Increased importance has been placed on noncognitive skills in professional development and by accrediting bodies of health professions programs in recent years. Therefore, the purpose of this study was to conduct a comprehensive systematic review of evidence examining effects of academic resilience, grit, perceived stress, locus of control, and Big Five Personality Traits on academic performance of health professions students. A literature search of peer-reviewed, English-language articles describing select noncognitive factors was performed using seven databases. Searches were performed from the earliest index date through May 2020. The following data from included studies were extracted and summarized: research design hierarchy, hierarchy of study outcomes (modified from Kirkpatrick), association between noncognitive factors and academic outcomes, and quality assessment criteria. 149 articles met inclusion criteria. Almost 80% of studies were Level III (observational). Medical students were the most frequently studied population (n = 73 articles). The most studied academic outcome was grade point average (n = 61). Perceived stress and Big Five Personality Traits accounted for greater than 50% of studies. Most studies were rated as fair to good quality. Associations between noncognitive factors and academic outcomes were largely inconsistent, although greater perceived stress was generally associated with poorer academic performance outcomes, while higher conscientiousness, academic resilience, and grit were generally associated with better outcomes. This systematic review represents a large body of evidence concerning select noncognitive factors and their association with academic performance of health professions students. Support services addressing noncognitive factors should be deliberated and tailored for specific health professions education programs and student populations.

Posted: October 1, 2021, 12:00 am

Abstract

Direct observation (DO) of residents by supervisors is a highly recommended educational tool in postgraduate medical education, yet its uptake is poor. Residents and supervisors report various reasons for not engaging in DO. Some of these relate to their interaction with patients during DO. We do not know the patient perspectives on these interactions, nor, more broadly, what it is like to be a patient in a DO situation. Understanding the patient perspective may lead to a more complete understanding of the dynamics in DO situations, which may benefit patient wellbeing and improve the use of DO as an educational tool. We conducted a phenomenological interview study to investigate the experience of being a patient in a DO situation. Our analysis included multiple rounds of coding and identifying themes, and a final phase of phenomenological reduction to arrive at the essential elements of the experience. Constant reflexivity was at the heart of this process. Our results provide a new perspective on the role of the supervisor in DO situations. Patients were willing to address the resident, but sought moments of contact with, and some participation by, the supervisor. Consequently, conceptions of DO in which the supervisor thinks she is a fly on the wall rather than a part of the interaction, should be critically reviewed. To that end, we propose the concept of participative direct observation in workplace learning, which also acknowledges the observer’s role as participant. Embracing this concept may benefit both patients’ wellbeing and residents’ learning.

Posted: October 1, 2021, 12:00 am

Abstract

Medical education literature suggests clinically-integrated teaching may be the most effective approach to teach evidence-based practice (EBP). Before implementing this educational best practice in rehabilitation curricula, it is imperative to better understand the current context, barriers and facilitators to teach EBP in rehabilitation from the academic to the clinical setting. The aim of this study was to explore faculty and preceptors’ experiences and perceptions of teaching EBP in rehabilitation professions, namely occupational therapy, physical therapy and speech-language pathology. We gathered data from seven focus groups and an individual interview with a sample of 24 faculty and 15 preceptors, i.e., clinical supervisors. Data collected were subjected to inductive thematic content analysis. We identified three overarching themes and corresponding strategies. First, “Recognizing EBP as a multifaceted concept” denoted participants’ lack of consensus regarding the meaning and scope of EBP, and their awareness of such discrepancies. Second, “Complexity of EBP is at the core of teaching practices and experiences” referred to participants’ perception of EBP as a complex process involving high-level cognitive skills, which influenced their teaching practices and challenged students and themselves. Third, “Connections and divides between research and practice” represented the limited and delicate connection between faculty and preceptors, the factors either bridging or maintaining the gap between them, and the impacts of such connections and divides on teaching. Improving collaboration between faculty and preceptors constitutes an essential first step towards more effective EBP training programs in rehabilitation that could be facilitated through online communities of practice or integrated knowledge translation research projects.

Posted: October 1, 2021, 12:00 am

Abstract

Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs’ framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an ‘ethic of caring’ to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.

Posted: October 1, 2021, 12:00 am

Abstract

Programmatic assessment is now well entrenched in medical education, allowing us to reflect on when it first emerged and how it evolved into the form we know today. Drawing upon the intellectual tradition of historical epistemology, we provide a philosophically-oriented historiographical study of programmatic assessment. Our goal is to trace its relatively short historical trajectory by describing shifting configurations in its scene of inquiry—focusing on questions, practices, and philosophical presuppositions. We identify three historical phases: emergence, evolution and entrenchment. For each, we describe the configurations of the scene; examine underlying philosophical presuppositions driving changes; and detail upshots in assessment practice. We find that programmatic assessment emerged in response to positivist ‘turmoil’ prior to 2005, driven by utility considerations and implicit pragmatist undertones. Once introduced, it evolved with notions of diversity and learning being underscored, and a constructivist ontology developing at its core. More recently, programmatic assessment has become entrenched as its own sub-discipline. Rich narratives have been emphasised, but philosophical underpinnings have been blurred. We hope to shed new light on current assessment practices in the medical education community by interrogating the history of programmatic assessment from this philosophical vantage point. Making philosophical presuppositions explicit highlights the perspectival nature of aspects of programmatic assessment, and suggest reasons for perceived benefits as well as potential tensions, contradictions and vulnerabilities in the approach today. We conclude by offering some reflections on important points to emerge from our historical study, and suggest ‘what next’ for programmatic assessment in light of this endeavour.

Posted: October 1, 2021, 12:00 am

Abstract

The use of response formats in assessments of medical knowledge and clinical reasoning continues to be the focus of both research and debate. In this article, we report on an experimental study in which we address the question of how much list-type selected response formats and short-essay type constructed response formats are related to differences in how test takers approach clinical reasoning tasks. The design of this study was informed by a framework developed within cognitive psychology which stresses the importance of the interplay between two components of reasoning—self-monitoring and response inhibition—while solving a task or case. The results presented support the argument that different response formats are related to different processing behavior. Importantly, the pattern of how different factors are related to a correct response in both situations seem to be well in line with contemporary accounts of reasoning. Consequently, we argue that when designing assessments of clinical reasoning, it is crucial to tap into the different facets of this complex and important medical process.

Posted: October 1, 2021, 12:00 am

Abstract

In this editorial the Editor considers the Wittgensteinian language games of scholarly writing in health professional education and their implications for creating and consuming the work that is published in this Journal and across the field in general.

Posted: October 1, 2021, 12:00 am

Abstract

Interactions between faculty and students in higher education has the potential to influence and shape many aspects of teaching, learning, curricula, student experiences and performance, yet has received little attention as an area of study. This study investigates student-faculty interactions within a physiotherapy curriculum from the perspectives of students, faculty and physiotherapy managers at a South African university. The data, produced through multiple methods, derive from students, faculty and physiotherapy managers underpinned by critical-feminist perspectives. Thematic analysis of the data produced four themes. Two dominant threads emerging from the analysis as characterising student-faculty relationships are the deeply hierarchical relations of power characterised by a lack of caring and concern for students, and the exclusion of wider constructs for interaction; deriving from a particular entrenched medical model. Ironically, while caring relationships with patients are overtly advocated and developed, they appear to be largely absent in the same physiotherapy curriculum spaces in the relationships between faculty and students. These findings raise questions about how the most foundational attribute of a health science professional, that of caring, is being produced through the curriculum in the relationship between faculty and students in the health sciences.

Posted: September 23, 2021, 12:00 am

Abstract

The work-readiness skills and attributes that facilitate healthcare graduates to succeed in their new workplaces are not well defined. In particular, the perspectives of supervisors of graduates in the diverse hospital and community settings of healthcare practice are not well represented in research about work-readiness. Interview data from a case study of twenty-nine supervisors of speech-language pathology graduates was thematically analysed, using Boundary Critique Theory to interpret how the supervisors’ understanding of graduate work-readiness was bounded within their understanding of their own system, needs and work environment. The four themes captured the skills that the supervisors perceived as critical for graduate work-readiness: Independence; Attitude; Teamwork; and Learning. A tension was identified within these themes, as supervisors’ understanding of work-readiness was bounded by an expectation that graduates are able to moderate how they transfer and apply their graduate skills in their workplace according to the complexity of client needs and the workplace setting. This study increases the visibility of the supervisors’ boundaries around what are and are not considered to be work-ready skills, attributes and expectations of a work ready speech-language pathology graduate. This knowledge can be used to facilitate speech-language pathology graduates to successfully transfer, apply and expand these skills as they transition to work, and may be useful for other health professions to explore.

Posted: September 20, 2021, 12:00 am

Abstract

Dyslexia is a Specific Learning Difficulty that impacts on reading and writing abilities. During the COVID-19 pandemic, medical schools have been forced to undertake distance learning and assessment. The wider literature suggested that e-learning might pose additional challenges for dyslexic students. Here we explore their overall experiences of learning/studying during this time in a phenomenological study. Five medical students were interviewed in depth and the audio-recordings were transcribed verbatim. Transcripts then underwent an interpretive phenomenological analysis. Our results highlighted a largely positive experience, with an improved culture of togetherness, freedom and sense of control. They also revealed issues with a lack of clinical exposure, potential negative impacts on ranking positions for those with dyslexia, and possible cheating in exams. There are some surprising results—in particular the positive responses to how remote learning was delivered. These seemed to put our participants more on a par with their non-dyslexic colleagues—except in some examinations. It is our hope that medical educators may resist a return to ‘the way things have always been done’ when the pandemic has resolved, and by doing so, continue to foster this new, positive culture and paradigm shift.

Posted: September 17, 2021, 12:00 am

Abstract

Feedback uptake relies on interactions between learners and educators Winstone (Educ Psychol 52: 17–37, 2017). Feedback that coaches using a feedforward approach, is considered to be more personal and emotionally literate Bussey (Bull R Coll Surg Engl 99: 180–182, 2017), Hattie (Rev Educ Res 77: 81–112, 2007). Many modes of feedback are employed in clinical teaching environments, however, written feedback is particularly important, as a component of feedback discourse, as significant time may elapse before a similar clinical situation is encountered. In practice, time constraints often result in brief or descriptive written feedback rather than longer coaching feedback. This study aimed to explore whether a change in ethos and staff development would encourage clinical dental tutors to utilise a coaching approach in their written feedback. Across two time-points, written feedback was categorised into either descriptive, evaluative or coaching approaches. Cross-sections of data from 2017 to 2019 were examined to determine whether changes in practice were noted and whether there were any alterations in the affective nature of the language used. Feedback moved significantly towards coaching and away from a descriptive approach. A shift towards the use of more positive language was seen overall, although this was solely driven by a change in the evaluative feedback category. Descriptive feedback generally used neutral language with coaching feedback using marginally more positive language. Both categories employed significantly lower levels of affective language than evaluative feedback. These data indicate a move towards feedback approaches and language that may support increased uptake and utilisation of feedback.

Posted: September 14, 2021, 12:00 am

Abstract

This study describes a theory-informed application of data science methods to analyze the quality of reflections made in a health professions education program over time. One thousand five hundred reflections written by a cohort of 369 dental students over 4 years of academic study were evaluated for an overall measure of reflection depth (No, Shallow, Deep) and the presence of six theoretically-indicated elements of reflection quality (Description, Analysis, Feeling, Perspective, Evaluation, Outcome). Machine learning models were then built to automatically detect these qualities based on linguistic features in the reflections. Results showed a dramatic increase from No to Shallow reflections from the start to end of year one (20%  →  66%), but only a limited gradual rise in Deep reflections across all four years (2%  →  26%). The presence of all six reflection elements increased over time, but inclusion of Feelings and Analysis remained relatively low even at the end of year four (found in 44% and 60% of reflections respectively). Models were able to reliably detect the presence of Description (κTEST = 0.70) and Evaluation (κTEST = 0.65) in reflections; models to detect the presence of Analysis (κTEST = 0.50), Feelings (κTEST = 0.54), and Perspectives (κTEST = 0.53) showed moderate performance; the model to detect Outcomes suffered from overfitting (κTRAIN = 0.90, κTEST = 0.53). A classifier for overall depth built on the reflection elements showed moderate performance across all time periods (κTEST > 0.60) but relied almost exclusively on the presence of Description. Implications for the conceptualization of reflection quality and providing personalized learning support to help students develop reflective skills are discussed.

Posted: September 2, 2021, 12:00 am

Abstract

This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded–in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.

Posted: August 30, 2021, 12:00 am

Abstract

The main purpose of the study was to examine whether health professions students in Taiwan who study in different programmes experience similar patient autonomy-related professionalism dilemmas caused by disconnections between school and clinical culture. To investigate this issue, we draw specifically on situated learning theory and its cultural concept to examine their professionalism dilemma narratives that were collected through interviews. Of the 79 interviewed students, nearly half of them experienced patient autonomy dilemmas caused by conflicts between school and clinical culture, which have significant negative impacts on their learning and emotional wellbeing. Four major types of patient autonomy-related dilemmas emerge from the data. It was also found that when school culture and clinical culture clash, the latter has a greater influence on students. Thus, the study argues that Taiwanese students’ frequent encounters with patient-autonomy dilemmas highlight the challenges faced by health professions students in transferring knowledge between school and clinical cultures, and clinical culture has a more powerful influence on their behaviour and clinical decision making. This phenomenon should be taken into account when organizing health professions education.

Posted: August 26, 2021, 12:00 am

Abstract

Although the principles behind assessment for and as learning are well-established, there can be a struggle when reforming traditional assessment of learning to a program which encompasses assessment for and as learning. When introducing and reporting reforms, tensions in faculty may arise because of differing beliefs about the relationship between assessment and learning and the rules for the validity of assessments. Traditional systems of assessment of learning privilege objective, structured quantification of learners’ performances, and are done to the students. Newer systems of assessment promote assessment for learning, emphasise subjectivity, collate data from multiple sources, emphasise narrative-rich feedback to promote learner agency, and are done with the students. This contrast has implications for implementation and evaluative research. Research of assessment which is done to students typically asks, “what works”, whereas assessment that is done with the students focuses on more complex questions such as “what works, for whom, in which context, and why?” We applied such a critical realist perspective drawing on the interplay between structure and agency, and a systems approach to explore what theory says about introducing programmatic assessment in the context of pre-existing traditional approaches. Using a reflective technique, the internal conversation, we developed four factors that can assist educators considering major change to assessment practice in their own contexts. These include enabling positive learner agency and engagement; establishing argument-based validity frameworks; designing purposeful and eclectic evidence-based assessment tasks; and developing a shared narrative that promotes reflexivity in appreciating the complex relationships between assessment and learning.

Posted: August 24, 2021, 12:00 am