Medical Education Online最新文献

Growing work highlights the importance of diversity, equity, and inclusion (DEI) initiatives in graduate medical education. Few studies have employed participatory research approaches to solicit trainee perspectives related to DEI. Our goal was to utilize group concept mapping (GCM), a mixed-methods participatory research approach, to describe resident perspectives on DEI within a large pediatric residency program. To organize and represent their perspectives on DEI, trainees completed brainstorming, sorting/rating, and interpretation activities in accordance with GCM methodology. Activities occurred via two synchronous discussion sessions (brainstorming and interpretation) and an electronic survey (sorting/rating). Items from the brainstorming session were sorted (i.e. grouped into categories by similarity) and rated (i.e. ranked on perceived importance and likelihood to change) by participants individually. Multidimensional scaling and hierarchical clustering were used to generate point maps, cluster maps, and go-zone illustrations for use in the interpretation session. We present data regarding participant characteristics and engagement, results from GCM activities, and action steps from this process. There were a total of 127 trainees in the residency program in 2021-2022. Participation varied across activities (brainstorming session: 21 participants; sorting/rating: 48 participants; interpretation session: 20 participants). A total of 64 unique items were generated from brainstorming. Five clusters emerged: 1) city factors, 2) institutional factors, 3) program representation, 4) program components, 5) non-DEI program perks. Program representation and program components clusters were rated as the most important and the most likely to be changed. Participants identified several action steps during the interpretation session which were shared with institutional leadership to direct programmatic reform. We demonstrate the utility of GCM, a structured and scalable participatory research method, to characterize trainee perceptions of DEI in graduate medical education.

Resitting, being offered a 'second chance' at an exam following failure to achieve a passing grade, is both common and stressful in medical school. There is a significant gap in the medical education literature around evidence-based support for resitting medical students. The study explores medical student experiences of resits through a peer-assisted learning programme (PAL) delivered to early years resitting medical students at Imperial College School of Medicine (ICSM) in 2021 and 2022. To the authors' knowledge, this is the first qualitative study analysing early years medical students' experiences of resitting exams. The authors performed an inductive thematic analysis of 22 semi-structured interviews with early years medical students who resat exams at ICSM in 2022. The authors identified three key themes and a cross-cutting theme: Theme 1. Self: students' individual and internal characteristics and experiences that influenced their journey of resitting exams. Subthemes included self-sufficiency and students' emotional approach to resitting; Theme 2. Others: resitting students' social networks. Subthemes explored students' relationships as part of the ICSM academic community, with near-peer role models and with their emotional support networks; Theme 3. Structures: organisational and structural factors that influence student experiences of resit exams. Subthemes included academic information, welfare, and socio-economic factors. Cross-cutting theme. Stigma: experienced a lack of open communication around resitting. The data emphasises the holistic nature of resitting, with students' self-image, their relationships with others, and the structural and institutional context all impacting on their experience, cross-cut with their experience of stigma through silence. The authors suggest that resitting is about more than academic ability: the broader context of resit stigma plays a key role in students' experiences of resits. PAL may be a useful tool to address resit stigma alongside institutional commitments to rethink medical school culture around academic failure.

Nonverbal communication is essential in physician-patient interaction, especially in telemedicine where verbal cues may be limited. This study aimed to identify and validate key nonverbal cues for assessing physician empathy in telemedicine consultations through a Delphi method. A three-round Delphi study was conducted from June to November 2022, involving various experts, including academics, healthcare professionals, AI/telemedicine researchers, industry professionals, and patients. Experts evaluated the importance, validity, and reliability of potential nonverbal cues. Consensus was determined based on median responses and expert scoring percentages, with statistical agreement and stability assessed using Kendall's coefficient of concordance (Kendall's W) and Wilcoxon signed-rank test. Analyses were conducted using SPSS, version 23.0 with significance set at p < 0.05. Of the 72 experts invited, 37 (51%) agreed to participate, with 35 completing the first round (95% completion rate). Eight significant nonverbal cues were identified in the first round, though one did not reach consensus. The second round obtained an 89% response rate (31/35), with three new cues introduced; one did not reach consensus. Round 3 achieved a 94% response rate (29/31), finalizing nine key cues: facial expression, eye contact, tone of voice, smiling, head nodding, body posture, hand gesture, distance, and environmental cues. Among these, facial expression, eye contact, and tone of voice were identified as the most crucial. Inter-expert agreement was statistically significant across all items with strong agreement on the importance (W = 0.739, p < 0.001), good agreement on their validity (W = 0.689, p < 0.001), and moderate agreement on their reliability (W = 0.452, p < 0.001). This study highlights the importance of specific nonverbal cues in telemedicine, particularly facial expression, eye contact, and tone of voice. It provides a validated foundation for developing tools to enhance physician-patient interactions and potentially improve health outcomes in telemedicine.

Background: Anti-racism curricula are increasingly being recognized as an integral component of medical education. To our knowledge, there has not yet been a publication exploring resident perspectives from multiple institutions and explicitly representing both underrepresented in medicine (UIM) and non-UIM perspectives.

Objective: To explore and compare UIM and non-UIM pediatric residents' perspectives on the content and qualities of meaningful anti-racism curricula.

Methods: We performed an IRB-approved multi-institutional, qualitative study that incorporated Sotto-Santiago et al's conceptual framework for anti-racism education. Between February and May 2021, we conducted focus groups of UIM and non-UIM pediatric residents at three large residency programs in the United States. We developed focus group guides using literature review, expert consensus, feedback from study team racial equity experts, and piloting. Focus groups were conducted virtually, audio-recorded, and transcribed verbatim. We employed thematic analysis to code transcripts, create categories, and develop themes until we reached thematic sufficiency. We completed member checking to ensure trustworthiness of themes.

Results: Forty residents participated (19 UIM and 21 non-UIM) in a total of six focus groups. We identified 7 themes, summarized as: 1) racism in medicine is pervasive, therefore (2) anti-racism education is critical to the development of competent physicians, and 3) education should extend to all healthcare providers. 4) Residents desired education focused on action-oriented strategies to advance anti-racism, 5) taught by those with both learned and lived experiences with racism, 6) in a psychologically safe space for UIM residents, and 7) with adequate time and financial resources for successful implementation and engagement.

Conclusion: Our multi-institutional study affirms the need for pediatric resident anti-racism education, promotes co-creation as a method to affect culture change, and provides practical strategies for curricular design and implementation.

Empathy development is a critical component of medical education, shaping future physicians' ability to provide compassionate, patient-centered care. This study investigates the reflections of male and female medical students on their experiences at a juvenile correctional school, focusing on how gender shapes their interpretations, emotional engagement, and learning outcomes. Using a qualitative analysis of reflective journals collected from 28 participants, the study employed thematic analysis to identify gender-based patterns in emotional engagement, interpretive framing, and learning outcomes. Reflexivity measures and rigorous coding processes were implemented to ensure credibility and minimize bias in data interpretation. Male students frequently adopted a practical form of empathy, characterized by task-oriented interactions and a sense of competitive camaraderie. In contrast, female students exhibited relational empathy, emphasizing emotional connections and nurturing behaviors. These findings underscore the value of integrating gender-sensitive empathy training into medical education, encouraging the development of both relational and practical approaches. By incorporating tailored reflection exercises and interactive strategies, medical education programs can better equip students to engage compassionately with diverse patient populations. This approach enriches the learning experience and fosters a more holistic understanding of patient care, ultimately leading to improved healthcare outcomes.

International medical students (IMS; non-U.S. citizens/permanent residents) greatly enhance the diversity of U.S. medical schools and serve in areas of greatest healthcare needs. Despite 15% of the US population being foreign born, international students represent < 2% of US-MD matriculants. Factors that contribute to this underrepresentation of IMS remain unknown. In this study, we analyzed the accessibility, quality, and inclusivity of publicly available admissions and financial aid policies at all US-MD schools, with the goal of evaluating potential institutional and informational barriers faced by IMS. Institutional webpages and American Association of Medical College (AAMC) databases were searched from May-July 2023 to gather IMS-specific admissions and financial aid information from 153 accredited US-MD schools. Two-tailed t-test or chi-square analysis was used to examine differences. An inductive thematic approach was used to qualitatively categorize institutional webpage friendliness. While 45% (69/153) of U.S.-MD schools reported accepting IMS, only 18% (27/153) admitted students without restrictions (e.g., Canadians only, state/religious preference). Further, 38% (26/69) of the schools that accept IMS did not provide financial aid information, while nearly two-thirds of the remaining schools required proof of personal financial ability with no institutional/federal support. International students also entered schools with a higher average Medical College Admission Test (MCAT) score and Grade Point Average (GPA). In the national AAMC databases, 19 additional programs were listed as accepting IMS although the institutional webpages stated otherwise; the databases also lacked details on specific restrictions posed by the majority of institutions. Of all 153 webpages, only 14% were deemed 'international friendly.' Restrictive admissions and financial aid policies as well as the poor quality and access to information are major barriers that affect IMS. Strategies that aim to overcome these challenges can greatly help advance diversity, equity, and inclusion in medical education.

With the future of TikTok's fate remaining uncertain in the United States, two US medical students, one of whom is a content generator with over 68,000 followers, reflect on the impact of this social media app for medical trainees. In particular, they discuss the benefits on student wellbeing and the how the impact has helped those from disadvantaged backgrounds pursue a career in medicine.

Introduction: This study aims to enhance the confidence and operational safety of 5th-year medical students in the operating room (OR), addressing their corona pandemic gap in surgical training.

Methods: We augmented the surgical curriculum focusing on pre-, intra-, and post-operative skills, centered around a phantom operation as a pre-test-retest simulation. We measured confidence to assist in surgery on a 5-level Likert-scale and monitored surgical performance metrics (skin-to-skin time, blood loss, blood and volume transfusion, complications, fatal outcome). Half the cohort was explicitly video trained in hemostasis, while the other half in emergency communication. Factual knowledge gains were assessed with online questionnaires. The groups served as reciprocal controls, as confidence (communication group) and surgical performance (bleeding group) were compared.

Results: Initially, the pre-test performance of the 126 participants on the phantom operation was suboptimal, ranging from poor to mediocre. Notably, the retest outcomes demonstrated significant surgical performance improvements following the targeted lessons (e.g. blood loss pre-test 906 ± 468 mL, retest 292 ± 173 mL, p < 0.01, n = 35 teams), with the most pronounced enhancements observed in confidence and emergency communication skills (confidence pre-test 2.42 ± 0.52, retest 3.55 ± 0.64, p < 0.01, n = 35 teams). There is a strong tendency (p = 0.08) that the communication group (1.28 ± 0.53) had higher gains in confidence than the bleeding group (0.997 ± 0.4) with a moderate effect size (Cohen's D = 0.6). Students reported increased confidence in assisting in surgery compared to their initial self-assessments. These results show that the structured exposure to a pre-test-retest phantom operation substantially elevates students' capability to act safely and assertively in the OR.

Discussion: This approach appears to foster a justified increase in confidence and surgical performance, potentially elevating patient safety among students and residents in training.

Aspiring to become a physician is a natural expectation for applicants to medical school. However, choosing a career in medicine is a critical decision, especially in countries where high school students can apply to medical school without an undergraduate degree. Students may select a medical career for various reasons, including parental pressure and academic performance. The question of whether there are students who enroll in medical school without clear intentions of becoming doctors has not been extensively investigated in the literature. We conducted a retrospective study at a national university in Japan. Given the scarcity of research examining medical students who did not have a clear intention to become doctors at the time of admission, we created a survey. The questionnaire asked students whether they had clear intentions to become doctors upon enrollment, and those who responded affirmatively were defined as students with clear intentions to become doctors at admission and assigned to the first group. The second group was composed of students who entered medical school without clear intentions to become doctors. We then compared the differences in sociodemographic characteristics and career determinants between these groups using statistical methods, including Chi-square tests and logistic regression. The collection rate of the questionnaire was 76.2%. We found that 28.8% of students at a national medical school in Japan entered medical school without clear intentions of becoming doctors. For these students, 'parental expectations' and 'peer influence' were identified as significant career determinants. No sociodemographic characteristics showed significant associations with the ambiguity of students' intentions to pursue a medical career at admission. This study confirmed that some students enroll in medical school without clear intentions of becoming doctors. The background factors related to this type of student were parental expectations and the influence of peers on career choice.

When clinician-educators and medical education researchers use and discuss medical education research, they can advance innovation in medical education as well as improve its quality. To facilitate the use and discussions of medical education research, we created a prefatory visual representation of key medical education research topics and associated experts. We conducted one-on-one virtual interviews with medical education journal editorial board members to identify what they perceived as key medical education research topics as well as who they associated, as experts, with each of the identified topics. We used content analysis to create categories representing key topics and noted occurrences of named experts. Twenty-one editorial board members, representing nine of the top medical education journals, participated. From the data we created a figure entitled, Medical Education Research Library. The library includes 13 research topics, with assessment as the most prevalent. It also notes recognized experts, including van der Vleuten, ten Cate, and Norman. The key medical education research topics identified and included in the library align with what others have identified as trends in the literature. Selected topics, including workplace-based learning, equity, diversity, and inclusion, physician wellbeing and burnout, and social accountability, are emerging. Once transformed into an open educational resource, clinician-educators and medical education researchers can use and contribute to the functional library. Such continuous expansion will generate better awareness and recognition of diverse perspectives. The functional library will help to innovate and improve the quality of medical education through evidence-informed practices and scholarship.