Teaching and Learning in Medicine最新文献

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.

There is a growing amount of literature on the benefits of using open-ended questions (OEQs) to assess knowledge in medical education. However, it is unknown how many US medical schools include OEQs in their assessment toolkits and how they are being used. The purpose of this study was to determine if OEQ assessments are an emerging trend in US medical education. We distributed an online survey to assessment leadership at all 156 US accredited allopathic medical schools between September 2022 and April 2024. Questions focused on the use or future interest of OEQs to assess medical knowledge in the pre-clerkship and clerkship curriculum. We calculated descriptive statistics for prevalence and use rates, and completed a conventional content analysis for open-ended comments. Seventy-eight US medical schools completed the survey (50% response rate). Forty schools (51%) reported using OEQs for medical knowledge assessment. OEQs were used during the pre-clerkship (28 schools), clerkship (two schools) or both parts of the curriculum (10 schools). On average, OEQs accounted for 20% of the pre-clerkship and 11% of the clerkship assessments at each school. Schools used OEQs to assess students' understanding, assess certain types of knowledge, and develop students' deeper learning. Representatives at schools not currently using OEQs reported considering using them in the future but expressed concerns about the amount of time needed to implement them. Numerous schools are using OEQs to assess medical knowledge, suggesting that this assessment format is feasible. Institutions can be innovative in their assessments by extending beyond multiple-choice questions and incorporating other question formats, such as OEQs, to fit their educational needs. This study provides a foundation for future research to explore the utility of OEQs and how to overcome the challenges of implementing OEQ assessments.

While US health systems are implementing language proficiency assessments to verify skills needed to ensure meaningful language access for patients, there is no consensus on best practices for multilingual medical students who want to demonstrate language proficiency for direct patient care. Many medical students who report non-English language skills face challenges navigating when and how to appropriately use those skills in clinical interactions. We used a modified Delphi process to seek consensus from an expert panel through the National Association of Medical Spanish (NAMS) for a Qualified Multilingual Assessment (QMA) policy for medical students. The survey included five topics related to QMA logistics and five topics related to QMA implementation guidance for clinical affiliates: QMA purpose, language access standards, responsibilities of supervising physicians, guarding against implicit bias, and monitoring learning opportunities. We set 80% as the threshold for consensus and revised topics that yielded <80% consensus. We circulated the revised topics in a second survey to establish consensus. Following two rounds of surveys among expert stakeholders, we reached consensus across all topics, yielding a first-of-its-kind QMA policy that administrators may adapt for clinical learning environments and institutions with health professional trainees. This policy includes key QMA policy recommendations for medical students: selecting a QMA, QMA logistics, and QMA implementation guidance for clinical affiliates.

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.

Short-term intensive orientation programs have existed at medical schools for decades, yet there is very little published on these programs and the impact they have on medical students, particularly those at the very beginning of their medical training. The annual Rural/Urban Community Orienting Experience (RUCOE) at the Ohio University Heritage College of Osteopathic Medicine is a three-day immersive orientation before the start of the academic year with the goals to build community among students interested in underserved practice, faculty, and staff; foster a curious mind as a practitioner-scholar; and develop a reflective practice. While the deficits and challenges in rural and underserved communities are often obvious to outsiders, the RUCOE intentionally redirects students to see the health of a community, i.e., the assets within rural and urban underserved communities, parallel to the Osteopathic focus on finding health and supporting the body's ability to self-heal. During the RUCOE, students, faculty, and staff learn from community members in both rural and urban underserved communities via structured discussion groups. Program components include didactic presentations, tours of a federally qualified health center and a rural critical access hospital, interactive group activities, a service project, and continuous reflection in action via writing. This article takes an unconventional approach to describing the meaning and significance of an educational program in medical school. Our collaborative reflection on our written reflections paralleled the democratic process employed in the RUCOE; we attempted to dismantle the typical hierarchical scholarship process and include students from the very beginning in envisioning what this article should be. Our singular and simple goal was to share our story of the impact the RUCOE program had on us. Several patterns became clear as we read and discussed our reflections: (1) Shared Values Foster Community, (2) Vulnerability Builds Community, (3) Communities Teach Us, and (4) Envisioning A Professional Future. The common thread tying them together is a developing sense of community and belonging and enduring impact on personal and professional growth. The RUCOE created important connections and bonds between students, between students and faculty, and between students and the underserved communities and organizations we visit. The RUCOE set the stage for students to enter their first year of medical school with humanizing perspectives, a call to listen, to center patient's stories, and with reinforcement of their "Why."

Assessment variability in formative assessment occurs when assessors observing a trainee performing the same task evaluate the trainee differently. One major contributor is uncertainty regarding assessment criteria, and efforts to clarify criteria are not always successful. This study explores the cognitive processes that occur in assessors' minds when assessment criteria are clarified. We interviewed clinical teaching faculty from one residency program in a single institution regarding their perceived expectations of select assessment items before and after providing clarifying criteria and how the clarification changed their perception. We analyzed the data thematically. Assessors' cognitive interaction with assessment clarification is a function of four factors: 1) Assessors' fixed ideation, 2) Content of the criteria themselves, 3) Context and setting of criterion interpretation, and 4) Interaction between the assessor and the trainee. The cognitive effects of clarifying assessment items depend not only on the assessor and criteria but additionally on their interactions within a professional and academic context. The complexity and multifactorial nature of assessment variability may explain the difficulty in mitigating criterion uncertainty.

Clinical educators aiming to develop advocacy training have few established guidelines to follow. We conducted a needs assessment to explore perspectives of physician trainees and faculty to inform advocacy curriculum development and potentially facilitate increased advocacy engagement. We conducted 45-minute focus groups with 33 faculty (n = 16) and trainees (n = 17) from the Division of General Internal Medicine at a large US urban teaching hospital between September 2021 and February 2022. Interviews were audiotaped and transcribed on Zoom and de-identified prior to analysis. We used thematic analysis to identify key themes within a constructivist paradigm. Themes relating to participants' definitions of advocacy and their role as advocates included viewing advocacy as (1) supporting health and wellbeing in its broadest sense and viewing physicians as (2) in a position of power to advocate. Themes relating to perceived facilitators and barriers to advocacy engagement included (3) the lack of political education among physicians and (4) the need for interprofessional collaboration. Finally, themes relating to institutional support for advocacy included (5) the need for exposure to role models and (6) the importance of institutional culture. Physician participants reported that structured advocacy training combined with mentorship from professionals actively engaged in advocacy initiatives and a supportive institutional culture can enhance the perceived value of advocacy and empower engagement in it. Future studies are needed to explore interprofessional perspectives, as advocacy initiatives featuring interprofessional teams and supported by an institutional culture of advocacy are more likely to be successful.

Patients have long been involved in health professional education in placement and fieldwork contexts. However, such contexts have been oriented to learning about rather than with patients. Increasing patient involvement in future health professionals' education has been an area of growing scholarly interest in recent decades. Due to the variation in patient involvement across contexts, most literature reviews on this subject have taken a broad conceptual approach. However, with the shift toward more participatory approaches in healthcare generally, we were interested in how patient partnership specifically was represented in health professional education. Our review aims to support educators seeking to enhance health professional education and patient care by critically examining the evolving and varied understandings of patient partnership in health professional education. Using a qualitative synthesis approach, we conducted a comprehensive search of five databases, selecting a final sample of 71 articles. We identified five overarching themes: 1. Rationales for patient partnership reflect a spectrum from transformative commitments to policy drivers; 2. Diverse theoretical and conceptual imaginings of patient partnership; 3. Enacting patient partnership: Effort, time, emotional labor, ethics, and outcomes; 4. Impactful patient partnerships demand that patients and carers are seen by students and educators as people to learn from and with; and 5. Sustainable and inclusive patient partnerships require relational and structural support. We discuss the aspects of health professional education where patient partnership is most meaningful. We recommend investing time, support, and resources to enable the creation of long-term partnerships that emphasize relational processes where shared understandings and diverse perspectives are nurtured. We also advocate for more curriculum flexibility and critical perspectives to push the boundaries of patient partnership in health professional education. An area for further research is evaluating the impact of long-term patient partnerships, including those sustained beyond graduation, as students move into their professional roles.