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Socio-culturally responsive medical professionalism and ethics education: A curriculum co-creation approach. 顺应社会文化的医学职业精神和伦理教育:课程共创方法。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-01-09 DOI: 10.1080/10872981.2024.2303209

Medical professionalism and ethics (MPE) are critical components influencing how medical practitioners provide patients with the highest standard of care. As a result, a structured attempt has been undertaken to enhance the content and teaching delivery of the medical professionalism and ethics education (MPEE) in the undergraduate medical curriculum. Guided by Vygotsky's sociocultural learning theory, Harre and Van Langenhove's positioning theory and Taba's principles of curriculum development, a curriculum co-creation project was organized with the aim of developing a socio-culturally responsive MPEE. A total of fifteen medical students agreed to participate in the project where they co-created MPE curriculum with a medical educator over the course of three months. Upon completion of the project, a co-created, socio-culturally responsive MPE curriculum was presented. The thematic analysis revealed positive changes in the participants' attitudes, skills, and behaviors towards co-creating the MPE curriculum. They also reported feeling a sense of fulfilment after having a transformative experience as curriculum co-creators and after receiving positive feedback from the faculty, staff, and other students on the co-created MPE curriculum. The project's success demonstrates the importance of curriculum co-creation as a strategy to promote co-creation efforts among students and educators in developing a socio-culturally responsive curriculum. The project's framework and practical recommendations can be adopted by other medical educators and faculties to encourage students' participation and their role on curriculum development using the co-creation approach.

医学职业精神与伦理(MPE)是影响执业医师如何为患者提供最高标准医疗服务的关键要素。因此,我们进行了有组织的尝试,以加强医学本科课程中医学职业精神和伦理教育(MPEE)的内容和教学方式。在维果茨基的社会文化学习理论、Harre 和 Van Langenhove 的定位理论以及 Taba 的课程开发原则的指导下,组织了一个课程共创项目,目的是开发一个适应社会文化的 MPEE。共有 15 名医科学生同意参与该项目,在三个月的时间里,他们与一名医学教育工作者共同创建了 MPEE 课程。项目完成后,他们展示了共同创建的、适应社会文化的 MPE 课程。专题分析表明,参与者在共同创建 MPE 课程的态度、技能和行为方面都发生了积极的变化。他们还表示,在作为课程共同创造者经历了一次变革性的体验,并从教职员工和其他学生那里获得了对共同创造的 MPE 课程的积极反馈之后,他们感到很有成就感。该项目的成功表明,课程共建作为一种策略,对于促进学生和教育工作者在开发适应社会文化的课程方面的共建努力非常重要。本项目的框架和实用建议可供其他医学教育工作者和院系采用,以鼓励学生参与并利用共同创造的方法在课程开发中发挥作用。
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引用次数: 0
Tips for developing a coaching program in medical education. 制定医学教育辅导计划的技巧。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2023-12-05 DOI: 10.1080/10872981.2023.2289262

This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

本文介绍了如何开发、实施和评估一个成功的辅导项目,以有效满足学习者的需求。我们强调了教练式教学在医学教育中的益处,并认识到许多希望建立教练式教学项目的教育者都在寻求资源来指导这一过程。我们将 12 条提示与 Kern 的 "课程开发六步骤 "相统一,并整合了文献中的理论框架,为这一过程提供参考。我们的建议包括:确定需要教练项目的原因;从现有项目和先前文献中学习;对主要利益相关者进行需求评估;确定并获取资源;制定项目目标、目的和方法;确定教练工具;招聘和培训教练;引导学员;评估项目成果以不断改进项目。这些技巧可作为初步计划开发和迭代计划改进的框架。
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引用次数: 0
Biometrically measured sleep in medical students as a predictor of psychological health and academic experiences in the preclinical years. 通过生物测定法测量医学生的睡眠状况,以此预测临床前几年的心理健康和学习经历。
IF 3.1 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-10-09 DOI: 10.1080/10872981.2024.2412400
Lindsay M Oberleitner, Dwayne M Baxa, Scott M Pickett, Kara E Sawarynski

Background: Student wellness is of increasing concern in medical education. Increased rates of burnout, sleep disturbances, and psychological concerns in medical students are well documented. These concerns lead to impacts on current educational goals and may set students on a path for long-term health consequences.

Methods: Undergraduate medical students were recruited to participate in a novel longitudinal wellness tracking project. This project utilized validated wellness surveys to assess emotional health, sleep health, and burnout at multiple timepoints. Biometric information was collected from participant Fitbit devices that tracked longitudinal sleep patterns.

Results: Eighty-one students from three cohorts were assessed during the first semester of their M1 preclinical curriculum. Biometric data showed that nearly 30% of the students had frequent short sleep episodes (<6 hours of sleep for at least 30% of recorded days), and nearly 68% of students had at least one episode of three or more consecutive days of short sleep. Students that had consecutive short sleep episodes had higher rates of stress (8.3%) and depression (5.4%) symptoms and decreased academic efficiency (1.72%).

Conclusions: Biometric data were shown to significantly predict psychological health and academic experiences in medical students. Biometrically assessed sleep is poor in medical students, and consecutive days of short sleep duration are particularly impactful as it relates to other measures of wellness. Longitudinal, biometric data tracking is feasible and can provide students the ability to self-monitor health behaviors and allow for low-intensity health interventions.

背景:在医学教育中,学生的健康问题日益受到关注。医学生的职业倦怠、睡眠障碍和心理问题的发生率越来越高,这些都有据可查。这些问题会影响当前的教育目标,并可能使学生走上长期健康后果的道路:方法:招募本科医学生参与一项新颖的纵向健康追踪项目。该项目利用经过验证的健康调查来评估多个时间点的情绪健康、睡眠健康和职业倦怠。通过追踪纵向睡眠模式的 Fitbit 设备收集参与者的生物特征信息:在 M1 临床前课程的第一学期,对来自三批学生中的 81 名学生进行了评估。生物统计学数据显示,近 30% 的学生经常出现睡眠时间短的情况(结论:生物统计学数据可显著预测学生的睡眠质量:生物统计学数据可显著预测医学生的心理健康和学习经历。通过生物统计学评估发现,医学生的睡眠质量较差,连续几天睡眠时间短对其他健康指标的影响尤为明显。纵向生物计量数据追踪是可行的,可以让学生自我监测健康行为,并进行低强度的健康干预。
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引用次数: 0
Bridging the procedures skill gap from medical school to residency: a simulation-based mastery learning curriculum. 缩小从医学院到实习医生的程序技能差距:基于模拟的掌握学习课程。
IF 3.1 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-10-07 DOI: 10.1080/10872981.2024.2412399
Lauren D Branditz, Andrew P Kendle, Cynthia G Leung, Christopher E San Miguel, David P Way, Ashish R Panchal, Jennifer Yee

Background: The transition from medical student to intern is a recognized educational gap. To help address this, the Association of American Medical Colleges developed the Core Entrustable Professional Activities for entering residency. As these metrics outline expectations for all graduating students regardless of specialty, the described procedural expectations are appropriately basic. However, in procedure-heavy specialties such as emergency medicine, the ability to perform advanced procedures continues to contribute to the disconnect between undergraduate and graduate medical education. To prepare our graduating students for their internship in emergency medicine, we developed a simulation-based mastery learning curriculum housed within a specialty-specific program. Our overall goal was to develop the students' procedural competency for central venous catheter placement and endotracheal intubation before graduation from medical school.

Methods: Twenty-five students participated in a simulation-based mastery learning procedures curriculum for ultrasound-guided internal jugular central venous catheter placement and endotracheal intubation. Students underwent baseline assessment, deliberate practice, and post-test assessments. Both the baseline and post-test assessments used the same internally developed checklists with pre-established minimum passing scores.

Results: Despite completing an emergency medicine rotation and a critical care rotation, none of the students met the competency standard during their baseline assessments. All twenty-five students demonstrated competency on both procedures by the end of the curriculum. A second post-test was required to demonstrate achievement of the central venous catheter and endotracheal intubation minimum passing scores by 16% and 28% of students, respectively.

Conclusions: Students demonstrated procedural competency for central venous catheter placement and endotracheal intubation by engaging in simulation-based mastery learning procedures curriculum as they completed their medical school training. With three instructional hours, students were able to achieve basic procedural competence for two common, high-risk procedures they will need to perform during emergency medicine residency training.

背景:从医学生到实习生的过渡是公认的教育差距。为帮助解决这一问题,美国医学院协会为即将进入实习期的学生制定了 "核心委托专业活动"。由于这些指标概括了对所有即将毕业的学生(无论其专业如何)的期望,因此所描述的程序期望是适当的基本期望。然而,在急诊医学等重程序的专业中,执行高级程序的能力仍然是本科生和研究生医学教育脱节的原因之一。为了让即将毕业的学生做好在急诊科实习的准备,我们开发了一套基于模拟的掌握学习课程,并将其融入到特定的专业课程中。我们的总体目标是在医学院毕业前培养学生中心静脉导管置入和气管插管的操作能力:方法:25 名学生参加了超声引导下颈内中心静脉导管置入和气管插管的模拟掌握学习程序课程。学生们接受了基线评估、刻意练习和测试后评估。基线评估和测试后评估均使用相同的内部开发的检查表,并预设了最低及格分数:结果:尽管完成了急诊医学轮转和重症监护轮转,但没有一名学生在基线评估中达到能力标准。在课程结束时,所有 25 名学生都证明了这两项程序的能力。需要进行第二次后测,以证明分别有 16% 和 28% 的学生达到了中心静脉导管和气管插管的最低及格分数:学生在完成医学院培训的过程中,通过参与模拟掌握学习程序课程,展示了中心静脉导管置入和气管插管的程序能力。通过三个学时的教学,学生们能够掌握急诊医学住院医师培训中需要执行的两种常见、高风险手术的基本程序能力。
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引用次数: 0
Student-run free clinics may enhance medical students' self-confidence in their clinical skills and preparedness for clerkships. 学生开办的义诊可以增强医学生对自己临床技能的自信心,为实习做好准备。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-05-02 DOI: 10.1080/10872981.2024.2348276
Venina S Kalistratova, Arina Nisanova, Lucy Z Shi

Introduction: Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students' self-reported confidence in various clinical domains and satisfaction with their medical education.

Methods: We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics.

Results: Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (p < 0.001), performing oral presentations (p < 0.001) and physical exams (p < 0.001). Students also reported significantly greater confidence in working with translators (p < 0.001) or as part of an interprofessional team (p < 0.001) and understanding the needs of the population served (p < 0.001). Students also found SRCs to significantly improve their confidence in preparedness for clerkships (p < 0.001). SRFC involvement can improve medical students' confidence in their clinical and interpersonal skills and enhance preparedness for clerkships and working with diverse patient groups.

Conclusion: SRFCs are a useful tool in the medical school curriculum that help bridge the gap between classroom learning and clinic and may encourage practice in medically underserved communities. SRFCs also integrate classroom material and clinical practice, although standardized evaluation metrics need to be developed. SRFCs should be incorporated as a learning experience by medical schools nationwide.

导言:学生开办的免费诊所(SRFC)为医学生提供了一个独特的机会,在为医疗服务不足的社区提供医疗服务的同时,发展他们的临床、诊断和社交技能。本研究旨在评估参与 SRFC 对学生自我报告的各临床领域自信心以及对医学教育满意度的影响:方法:我们在一家城市学术机构对二年级至四年级医学生进行了一次单中心事后回顾性评估。我们发放了一份包含 25 个项目的调查问卷,以了解学生参与义诊的范围,并评估他们在参与为期一年的学生自办义诊活动后对多个临床领域的自信心:56名学生完成了调查。结果:56 名学生完成了调查。参与义诊活动极大地提高了他们在病史采集方面的自信心(p p p p p p 结论:义诊活动是一种有用的工具,可以帮助学生更好地了解自己的病情:SRFC 是医学院课程中的一个有用工具,有助于弥合课堂学习与临床之间的差距,并可鼓励在医疗服务不足的社区开展实践。尽管需要制定标准化的评估指标,但 SRFC 也能将课堂教学与临床实践相结合。全国的医学院校都应将 SRFC 作为一种学习经验。
{"title":"Student-run free clinics may enhance medical students' self-confidence in their clinical skills and preparedness for clerkships.","authors":"Venina S Kalistratova, Arina Nisanova, Lucy Z Shi","doi":"10.1080/10872981.2024.2348276","DOIUrl":"https://doi.org/10.1080/10872981.2024.2348276","url":null,"abstract":"<p><strong>Introduction: </strong>Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students' self-reported confidence in various clinical domains and satisfaction with their medical education.</p><p><strong>Methods: </strong>We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics.</p><p><strong>Results: </strong>Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (<i>p</i> < 0.001), performing oral presentations (<i>p</i> < 0.001) and physical exams (<i>p</i> < 0.001). Students also reported significantly greater confidence in working with translators (<i>p</i> < 0.001) or as part of an interprofessional team (<i>p</i> < 0.001) and understanding the needs of the population served (<i>p</i> < 0.001). Students also found SRCs to significantly improve their confidence in preparedness for clerkships (<i>p</i> < 0.001). SRFC involvement can improve medical students' confidence in their clinical and interpersonal skills and enhance preparedness for clerkships and working with diverse patient groups.</p><p><strong>Conclusion: </strong>SRFCs are a useful tool in the medical school curriculum that help bridge the gap between classroom learning and clinic and may encourage practice in medically underserved communities. SRFCs also integrate classroom material and clinical practice, although standardized evaluation metrics need to be developed. SRFCs should be incorporated as a learning experience by medical schools nationwide.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2348276"},"PeriodicalIF":4.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11067551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Communication skills of residents: are they as good as they think? 居民的沟通技巧:他们有自己想象的那么好吗?
IF 3.1 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-11-03 DOI: 10.1080/10872981.2024.2396165
Namra Qadeer Shaikh, Ali Aahil Noorali, Asma Altaf Hussain Merchant, Noreen Afzal, Maryam Pyar Ali Lakhdir, Komal Abdul Rahim, Syeda Fatima Shariq, Rida Ahmad, Saqib Kamran Bakhshi, Saad Bin Zafar Mahmood, Shayan Shah, Muhammad Rizwan Khan, Muhammad Tariq, Adil H Haider

Purpose: To evaluate the current communication skills of resident physicians and identify areas for improvement.

Study design: Using a cross-sectional design, data from medical students, residents, fellows, and faculty were assimilated at one of the largest academic medical centers in a low-and-middle-income country via a self-administered, validated survey with a 5-point LIKERT scale. One-way ANOVA was used to compare intra-group means, followed by the Bonferroni test, with a p-value <0.05 considered significant. Heat maps using means were generated and color-coded to signify the level of communication skills expertise.

Results: A total of 320 participants (119 residents, 34 fellows, 78 medical students and 89 attendings) completed the survey. Most residents (58%) reported not having received formal communication skills training. Major barriers impeding effective patient-resident communication were long working hours, inadequate time, and difficulty understanding patients' language (p < 0.001). Residents' self-evaluation of communication skills was significantly higher than observer evaluations from faculty, fellows, and students, reflecting a lack of self-awareness and overestimation of communication expertise. Observer cohorts rated residents moderately on para-verbal communication skills while giving the lowest ratings for breaking bad news (mean 2.8, p-value <0.001) and residents' experience in dealing with workplace conflicts (mean 2.8, p-value = 0.023).

Conclusions: Our study identified a clear and critical need for a structured, longitudinal, competency-based communication skills program for residents. Targeted efforts towards bridging the gaps in communication skills identified in this study can improve trainee communication skills expertise and augment patient satisfaction rates to improve the quality of care in developing countries.

研究设计:研究设计:采用横断面设计,在一个中低收入国家最大的学术医疗中心之一,通过自填式、经过验证的 5 点 LIKERT 量表调查,收集医学生、住院医师、研究员和教职员工的数据。采用单因素方差分析比较组内平均值,然后进行Bonferroni检验,得出P值 结果:共有 320 名参与者(119 名住院医师、34 名研究员、78 名医学生和 89 名主治医师)完成了调查。大多数住院医师(58%)表示没有接受过正规的沟通技巧培训。妨碍患者与住院医师有效沟通的主要障碍是工作时间长、时间不足以及难以理解患者的语言(P 结论:我们的研究发现了患者与住院医师沟通的明确而迫切的需求:我们的研究发现,住院医师对结构化、纵向、以能力为基础的沟通技巧课程有着明确而迫切的需求。有针对性地弥补本研究中发现的沟通技巧方面的差距,可以提高受训者的沟通技巧专业水平,提高患者满意度,从而改善发展中国家的医疗质量。
{"title":"Communication skills of residents: are they as good as they think?","authors":"Namra Qadeer Shaikh, Ali Aahil Noorali, Asma Altaf Hussain Merchant, Noreen Afzal, Maryam Pyar Ali Lakhdir, Komal Abdul Rahim, Syeda Fatima Shariq, Rida Ahmad, Saqib Kamran Bakhshi, Saad Bin Zafar Mahmood, Shayan Shah, Muhammad Rizwan Khan, Muhammad Tariq, Adil H Haider","doi":"10.1080/10872981.2024.2396165","DOIUrl":"10.1080/10872981.2024.2396165","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the current communication skills of resident physicians and identify areas for improvement.</p><p><strong>Study design: </strong>Using a cross-sectional design, data from medical students, residents, fellows, and faculty were assimilated at one of the largest academic medical centers in a low-and-middle-income country via a self-administered, validated survey with a 5-point LIKERT scale. One-way ANOVA was used to compare intra-group means, followed by the Bonferroni test, with a p-value <0.05 considered significant. Heat maps using means were generated and color-coded to signify the level of communication skills expertise.</p><p><strong>Results: </strong>A total of 320 participants (119 residents, 34 fellows, 78 medical students and 89 attendings) completed the survey. Most residents (58%) reported not having received formal communication skills training. Major barriers impeding effective patient-resident communication were long working hours, inadequate time, and difficulty understanding patients' language (<i>p</i> < 0.001). Residents' self-evaluation of communication skills was significantly higher than observer evaluations from faculty, fellows, and students, reflecting a lack of self-awareness and overestimation of communication expertise. Observer cohorts rated residents moderately on para-verbal communication skills while giving the lowest ratings for breaking bad news (mean 2.8, p-value <0.001) and residents' experience in dealing with workplace conflicts (mean 2.8, p-value = 0.023).</p><p><strong>Conclusions: </strong>Our study identified a clear and critical need for a structured, longitudinal, competency-based communication skills program for residents. Targeted efforts towards bridging the gaps in communication skills identified in this study can improve trainee communication skills expertise and augment patient satisfaction rates to improve the quality of care in developing countries.</p>","PeriodicalId":47656,"journal":{"name":"Medical Education Online","volume":"29 1","pages":"2396165"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of a workplace-based learning program on clerkship students' behaviors and attitudes toward evidence-based medicine practice. 基于工作场所的学习计划对实习学生循证医学实践行为和态度的影响。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-05-24 DOI: 10.1080/10872981.2024.2357411

In clinical clerkship (CC), medical students can practice evidence-based medicine (EBM) with their assigned patients. Although CC can be a valuable opportunity for EBM education, the impact of EBM training, including long-term behavioral changes, remains unclear. One hundred and nine fourth- and fifth-year medical students undergoing CC at a medical school in Japan attended a workplace-based learning program for EBM during CC (WB-EBM), which included the practice of the five steps of EBM. The program's effect on the students' attitudes toward EBM in CC was assessed through questionnaires. A total of 88 medical students participated in the program. Responses to the questionnaire indicated high satisfaction with the WB-EBM program. The most common theme in students' clinical problems with their assigned patients was the choice of treatment, followed by its effect. Based on the responses in the post-survey for the long-term effects of the program, the frequency of problem formulation and article reading tended to increase in the 'within six months' group comprising 18 students who participated in the WB-EBM program, compared with the control group comprising 34 students who did not. Additionally, the ability to self-assess problem formulation was significantly higher, compared with the control group. However, among 52 students who participated in the WB-EBM program more than six months later, EBM-related behavioral habits in CC and self-assessments of the five steps of EBM were not significantly different from those in the control group. The WB-EBM program was acceptable for medical students in CC. It motivated them to formulate clinical questions and enhanced their critical thinking. Moreover, the WB-EBM program can improve habits and self-evaluations about EBM. However, as its effects may not last more than six months, it may need to be repeated across departments throughout CC to change behavior in EBM practice.

在临床实习(Clinical Clerkship,CC)中,医学生可以对指定的病人进行循证医学(EBM)实践。尽管临床实习是开展循证医学教育的宝贵机会,但循证医学培训的影响(包括长期行为改变)仍不明确。日本一所医学院的 19 名四年级和五年级医学生在 CC 期间参加了基于工作场所的 EBM 学习项目(WB-EBM),其中包括 EBM 五个步骤的实践。我们通过问卷调查评估了该项目对学生在CC中的EBM态度的影响。共有 88 名医学生参加了该项目。问卷调查结果显示,学生对 WB-EBM 项目非常满意。在学生与指定病人的临床问题中,最常见的主题是治疗方法的选择,其次是治疗效果。根据该项目长期效果的后期调查反馈,与由 34 名未参加 WB-EBM 项目的学生组成的对照组相比,由 18 名参加 WB-EBM 项目的学生组成的 "六个月内 "组学生提出问题和阅读文章的频率呈上升趋势。此外,与对照组相比,"六个月内 "组学生自我评估问题表述的能力明显提高。然而,在超过六个月后参加 WB-EBM 项目的 52 名学生中,CC 中与 EBM 相关的行为习惯以及对 EBM 五个步骤的自我评估与对照组学生相比没有明显差异。WB-EBM项目对于CC的医学生来说是可以接受的。它能激励医学生提出临床问题,增强他们的批判性思维。此外,WB-EBM 项目还能改善 EBM 的习惯和自我评价。然而,由于其效果可能不会持续超过六个月,因此可能需要在整个CC的各个科室重复实施,以改变EBM实践行为。
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引用次数: 0
Candid insights and overlooked facets: what medical students write about patient-centeredness in diaries on longitudinal patient contacts. 坦率的见解和被忽视的方面:医学生在纵向患者接触日记中写下的以患者为中心的内容。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-06-11 DOI: 10.1080/10872981.2024.2363611
Christel Grau Canét-Wittkampf, Miranda Trippenzee, Debbie Jaarsma, Agnes Diemers

Despite students' exposure to patient-centered care principles, their dedication to patient-centeredness often experiences a wane throughout their academic journey. The process of learning patient-centeredness is complex and not yet fully understood. Therefore, in our study, we sought to explore what aspects of patient-centeredness students spontaneously document in their diaries during interactions with actual patients. This investigation will help to identify gaps in the current educational practices and better prepare future clinicians to deliver patient-centered healthcare. We analyzed 92 diaries of 28 third-year undergraduate medical students at UMC Utrecht in the Netherlands who participated in an educational intervention, following four patients each as companions over a two-year period early in their clerkships. We conducted thematic analysis, using inductive and deductive coding, within a social-constructionist paradigm. We identified four key themes: communication, the person behind the patient, collaboration and organization in healthcare, and students' professional development. Within these themes, we observed that students spontaneously documented 9 of 15 dimensions of patient-centeredness as outlined in the model of Scholl : 'clinician-patient communication', 'patient as unique person', 'biopsychological perspective', 'essential characteristics of the clinician', 'clinician-patient relationship', 'involvement of family and friends', 'patient-information', 'emotional support' and 'coordination and continuity of care' (mainly principles of patient-centeredness). Conversely, we noted that students underreported six other dimensions (enablers and activities): 'access to care', 'integration of medical and non-medical care', 'teamwork and teambuilding', 'patient involvement in care', 'patient empowerment' and 'physical support'. Throughout their longitudinal journey of following patients as non-medical companions, students spontaneously documented some aspects of patient-centeredness in their diaries. Additionally, students reflected on their own professional development. Our findings suggest that incorporating education on the broadness of the concept of patient-centeredness coupled with enhanced guidance, could potentially enable students to learn about the complete spectrum of patient-centeredness within their medical education.

尽管学生们已经接触过以病人为中心的护理原则,但在整个学习过程中,他们对以病人为中心的奉献精神往往会有所减退。学习 "以病人为中心 "的过程是复杂的,而且尚未被完全理解。因此,在我们的研究中,我们试图探索学生在与实际患者互动的过程中,会自发地在日记中记录以患者为中心的哪些方面。这项调查将有助于找出当前教育实践中的不足之处,更好地培养未来的临床医生提供以患者为中心的医疗服务。我们分析了荷兰乌得勒支大学医学系 28 名三年级本科生的 92 篇日记,他们参加了一项教育干预活动,在实习初期的两年时间里,每人作为陪护跟踪 4 名患者。我们采用社会建构主义范式,通过归纳和演绎编码进行了主题分析。我们确定了四个关键主题:沟通、病人背后的人、医疗保健中的合作与组织以及学生的专业发展。在这些主题中,我们注意到学生们自发地记录了烁尔模型中概述的 15 个 "以病人为中心 "维度中的 9 个:"临床医生与病人的沟通"、"病人作为独特的个体"、"生物心理学视角"、"临床医生的基本特征"、"临床医生与病人的关系"、"家人和朋友的参与"、"病人信息"、"情感支持 "和 "护理的协调性和连续性"(主要是 "以病人为中心 "的原则)。相反,我们注意到学生对其他六个方面(促进因素和活动)的报告不足:获得护理"、"医疗和非医疗护理的整合"、"团队合作和团队建设"、"患者参与护理"、"患者赋权 "和 "物质支持"。在以非医护人员身份陪伴病人的纵向旅程中,学生们自发地在日记中记录了以病人为中心的一些方面。此外,学生们还对自己的专业发展进行了反思。我们的研究结果表明,将有关 "以病人为中心 "这一广泛概念的教育与加强指导相结合,有可能使学生在医学教育中学习到 "以病人为中心 "的全部内容。
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引用次数: 0
The experiences of students with mental health difficulties at medical school: a qualitative interview study. 医学院中有心理健康问题的学生的经历:定性访谈研究。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-06-13 DOI: 10.1080/10872981.2024.2366557
Antonia Rich, Rowena Viney, Milou Silkens, Ann Griffin, Asta Medisauskaite

Background: High rates of burnout, anxiety, and depression in medical students are widespread, yet we have limited knowledge of the medical school experiences of students with mental health issues. The aim of the study is to understand the impact of mental health issues on students' experience and training at medical school by adopting a qualitative approach.

Methods: Qualitative study using in-depth semi-structured interviews with 20 students with mental health issues from eight UK medical schools of varying size and location. Students were purposefully sampled to gain variety in the type of mental health issue experienced and demographic characteristics. Reflexive thematic analysis was employed using NVivo software.

Results: Three themes were identified. 1) Culture of medicine: medical culture contributed to causing mental ill-health through study demands, competitiveness with peers, a 'suck it up' mentality where the expectation is that medical school is tough and medical students must push through, and stigma towards mental ill-health. 2) Help-seeking: students feared others discovering their difficulties and thus initially tried to cope alone, hiding symptoms until they were severe. There were multiple barriers to help-seeking including stigma and fear of damage to their career. 3) Impact on academic life: mental health issues had a detrimental impact on academic commitments, with students' unable to keep up with their studies and some needing to take time out from medical school.

Conclusion: This study provides insight into how medical culture contributes both to the cause of mental health difficulties and the reluctance of medical students to seek help. Mental health issues had a considerable negative impact on medical students' ability to learn and progress through their degree. Addressing the medical culture factors that contribute to the cause of mental health issues and the barriers to help-seeking must be a priority to ensure a healthier medical workforce.

背景:医学生的职业倦怠、焦虑和抑郁率很高,但我们对有心理健康问题的学生在医学院的经历了解有限。本研究旨在通过定性方法了解心理健康问题对学生在医学院的经历和培训的影响:定性研究采用深入的半结构式访谈,对来自英国八所不同规模和地点的医学院的 20 名有心理健康问题的学生进行访谈。对学生进行有目的的抽样调查,以了解他们所经历的心理健康问题的类型和人口特征。使用 NVivo 软件进行了反思性主题分析:结果:确定了三个主题。1) 医学文化:医学文化通过学习要求、与同龄人的竞争、"忍耐 "心态(即期望医学院是艰难的,医学生必须挺过去)以及对心理疾病的污名化,导致了心理疾病。2) 寻求帮助:学生们害怕别人发现自己的困难,因此一开始都试图独自应对,将 症状隐藏起来,直到严重时才寻求帮助。寻求帮助有多重障碍,包括耻辱感和担心职业生涯受损。3) 对学术生活的影响:心理健康问题对学术承诺产生了不利影响,学生无法坚持学业,有些学生需要从医学院休学:本研究深入探讨了医学文化是如何造成心理健康问题以及医学生不愿寻求帮助的。心理健康问题对医学生的学习能力和学位进展产生了相当大的负面影响。要确保医学人才队伍更加健康,必须优先解决导致心理健康问题的医学文化因素和寻求帮助的障碍。
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引用次数: 0
High- and low-achieving international medical students' perceptions of the factors influencing their academic performance at Chinese universities. 成绩优秀和成绩较差的医科留学生对影响其在中国大学学习成绩的因素的看法。
IF 4.6 2区 医学 Q1 EDUCATION & EDUCATIONAL RESEARCH Pub Date : 2024-12-31 Epub Date: 2024-01-03 DOI: 10.1080/10872981.2023.2300194
Qinxu Jiang, Hugo Horta, Mantak Yuen

China has become an attractive destination for international medical students, particularly those from developing countries in Asia and Africa. These students are known to face difficulties in adapting to Chinese medical universities and they tend to score poorly on subsequent examinations to enter the medical profession in their home or in a third country. To date, limited research concerning the factors that affect the academic performance of this group of students in China has been conducted. In particular, there have been very few comparisons between high and low achievers to identify the factors that high- and low-achieving international medical students in all years of study perceive as affecting their academic performance. A qualitative research approach was implemented at two medical universities. Semi-structured interviews were conducted with 18 high achievers and 22 low achievers in their second, third, fourth, fifth, sixth, and post-graduation years. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach.A few key overlapping factors were identified: social support, learning motivation and interest, exam preparation and strategies, time management, and coping. The high achievers manipulated these strategies successfully while the low achievers did not. The high achievers demonstrated efficient learning methods (efficient use of class time, good note-taking habits, preview and review strategies, expanded learning, self-study and group learning, deep learning, choosing an appropriate study location, and focusing on basics and concepts). They also achieved a good balance between studying and leisure. The low achievers mentioned learning challenges, health issues, English language barriers, and problems with online classes. This study allowed us to identify important factors that international medical students at Chinese institutions perceive to influence their performance. The findings contribute to the literature on the topic and provide a solid basis for practice and policy development.

中国已成为吸引国际医科学生的目的地,尤其是那些来自亚洲和非洲发展中国家的学生。众所周知,这些学生在适应中国的医科大学时会遇到困难,而且他们往往在随后的考试中成绩不佳,无法进入本国或第三国的医学专业。迄今为止,有关影响这部分学生在中国学习成绩的因素的研究十分有限。特别是,很少有研究对成绩优秀和成绩较差的学生进行比较,以确定各年级成绩优秀和成绩较差的医学留学生认为哪些因素影响了他们的学业成绩。我们在两所医科大学采用了定性研究方法。对第二、第三、第四、第五、第六和毕业后各年级的 18 名成绩优秀学生和 22 名成绩较差学生进行了半结构式访谈。对访谈进行了录音、转录,并采用主题分析法进行了编码。确定了几个关键的重叠因素:社会支持、学习动机和兴趣、备考和策略、时间管理和应对。成绩优秀的学生成功地运用了这些策略,而成绩较差的学生则没有。成绩优秀的学生表现出了高效的学习方法(有效利用课堂时间、良好的记笔记习惯、预习和复习策略、拓展学习、自学和小组学习、深度学习、选择合适的学习地点、专注于基础知识和概念)。他们还在学习和休闲之间取得了良好的平衡。学习成绩较差的学生提到了学习挑战、健康问题、英语语言障碍以及网络课程的问题。通过这项研究,我们发现了中国院校的国际医学生认为影响其学习成绩的重要因素。研究结果为相关文献做出了贡献,并为实践和政策制定提供了坚实的基础。
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引用次数: 0
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Medical Education Online
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