Medical Students' Self-Perceptions of Harassment During Clinical Placement.

Objectives: Exploring workplace dynamics during clinical placement is crucial to determine whether medical students are encountering safe and meaningful learning experiences. The aim of this original article is to describe medical students' reported harassment experiences whilst on clinical placement. Design: Medical students in years 4 to 6 were invited to participate in the survey. In this mixed-methods study, data collection included demographic information, responses to the Generalized Workplace Harassment Questionnaire, and qualitative commentaries. Results: Two hundred and five students completed the questionnaire. Medical students experienced harassment in areas of verbal aggression, disrespect, isolation/exclusion, threats/bribes, and physical aggression. Concerning levels of occurrence were noted for disrespect, isolation/exclusion, and verbal aggression. Conclusions: Many medical students in this study reported experiencing harassment during their clinical placements indicating that harassment during clinical placement continues to be of concern in medical education. The findings indicate that further initiatives need to be designed to identify and respond to these cases of workplace harassment and that power imbalance and safe reporting appear to be further issues of concern. It was evident that students need to feel safe enough to be able to report harassment experiences to allow managers and educators to address the full extent of the problem.

Validation of the Generalized Workplace Harassment Questionnaire for Use with Medical Students.

The Generalized Workplace Harassment Questionnaire (GWHQ) has not been validated among medical students whilst they are on clinical placements. Therefore, this study aims to validate its use when applied to this cohort. A sample of 205 medical students in their clinical training phase completed the GWHQ. To examine the validity of the proposed factor structure of the validated 25-item GWHQ, which was reduced to from the original 29-item set, a confirmatory factor analysis was conducted. Model fit was appraised by evaluating the comparative fit index (CFI), the root mean square error of approximation (RMSEA), and the standardized root mean squared residual (SRMR). Spearman's rho correlation coefficients were applied to correlations between factors. With the exclusion of Item 19, the resulting fit was improved. In the revised model for a 24-item GWHQ, CFI = 0.995, RMSEA = 0.047, and SRMR = 0.115. Overall, the fit met the criteria for two fit indices and was thus deemed to be acceptable. Factor loadings ranged from 0.49 to 0.96. The Spearman's rho correlation coefficient between Verbal and Covert Hostility was high, although all correlations with Physical Hostility were weak. In conclusion, the amended 24-item version of the GWHQ is a valid instrument for appraising instances of harassment or hostility within clinical placements attended by medical students in New Zealand.

Micromanagement in clinical supervision: a scoping review.

Micromanagement in clinical supervision in health professions education generally refers to supervision characterized by unproductive excessive control and attention to detail. It can affect autonomy, competence, well-being of learners, teamwork, and ultimately patient care. Despite its potential negative impact on learners and patients, no comprehensive review of this phenomenon has been conducted. This scoping review aims to explore the breadth of extant literature concerning micromanagement in clinical supervision in health professions education and map the body of research on the topic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review (PRISMA-ScR). We searched eight databases, and the final review and analysis comprised 12 articles that examined micromanagement in clinical supervision across health professions education. Micromanagement was conceptualized as ineffective supervisory practices such as undue scrutiny, excessive control, domination, and ineffectual leadership. Conversely, alternatives to micromanagement included entrusting or granting autonomy, coaching for independent practice, and providing effective supervision and leadership. Overall, micromanagement was attributed to individual behavioral and personality factors, such as distrust, perfectionism, self-conviction, and low self-esteem. The consequences of micromanagement included inadequacies in professional development and well-being of trainees and patient care, and organizational dysfunction. Suggested solutions included entrusting or empowering trainees with encouragement and clear communication, open communication efforts by trainees, organizational management for quality supervision, and faculty's valuing both clinical and educational goals. Current literature on micromanagement-in the context of clinical supervision in health professions education-was found to be sparse, implying a need for more rigorous research and discourse on this understudied area. The findings can be used to recognize, solve, and prevent the prevalent, and often unrecognized, phenomena of micromanagement, which may improve clinical supervision, the professional development of trainees and faculty, organizational management, and ultimately patient care.

Implementation of a Web-Based Educational Intervention for Promoting Flipped Classroom Pedagogy: A Mixed-Methods Study.

Introduction: Flipped classroom pedagogy (FCP) is recognised as an effective and efficient teaching-learning method. However, nursing students and teachers may be hesitant to adopt FCP due to technophobia and time constraints linked to academic and clinical responsibilities. This necessitates the provision of promotional training for adopting FCP. However, there is a dearth of research regarding how the practice of FCP could be promoted and in demonstrating its efficacy in developing countries. Thus, this study aimed to examine the educational impact of a web-based education intervention, branded as the Flipped Classroom Navigator (FCN), for promoting FCP in nursing education in Sri Lanka. Methods: This mixed-methods study employed pre- and post-training knowledge tests, the Instructional Materials Motivation Survey (IMMS), the Perceived Transfer of Learning Questionnaire survey, and collected students' and teachers' open-ended responses to evaluate the impact of the FCN. Fifty-five undergraduate nursing students and 15 university teachers participated in the study from two state universities in Sri Lanka. Repeated-measures ANOVA, t-tests, Levene's test of homogeneity, Cohen's d, and an inductive thematic approach were employed in the data analysis. Results: Post-training knowledge test scores were significantly higher than the pre-training knowledge test scores indicating improved understanding of FCP. Participants were also highly motivated to learn in the FCN instructional materials. Participants exhibited positive attitudes towards FCN training with transfer of learning to their teaching-learning practice. The inductive thematic analysis identified the following themes: user experiences, FCN learning content, behaviour changes, and suggested improvements. Conclusion: Overall, the FCN enhanced both students' and teachers' knowledge and understanding of FCP in undergraduate nursing education. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01706-7.

Instructional media selection principles for online medical education and emerging models for the new normal.

The COVID-19 pandemic, and the resulting need to avoid in-person classes, compelled many faculty members to convert to a completely online instructional format. The literature on selecting media for medical educators, however, provided little assistance for them to make choices that facilitated learning through using alternative online instruction practices. In this study, we addressed the lack of guidance for the use of media to facilitate the effective online medical education. To optimise the transition from face-to-face educational modalities to online learning, we incorporated insights from theories of media synchronicity and learning. We considered the value of existing learning theories in influencing how we could guide entrenched face-to-face educators to online learning practice. Therefore, we employed existing theories and practice to assist in developing an algorithmic approach to guiding these educators. We reassessed the way taxonomies of learning objectives, practice-oriented learning experiences, the social and collaborative features of learning activities, and media synchronicity theory could have augmented face-to-face teaching, and influenced how these could be reconfigured to assist in the transition to online learning. Consequently, we have developed key principles to inform the continuity of design and selection of instructional media in the transition to medical online learning. We have constructed specific criteria for media selection that correspond to the 12 goals of medical learning. We found that the majority of the goals can be more enhanced by synchronous media than asynchronous versions. We discuss the role of instructional media in emergency online medical education as well as emerging models of media selection for the new normal in medical education and future directions for medical education media research.

Developing and evaluating an educational web-based tool for health professions education: the Flipped Classroom Navigator.

BACKGROUND: Flipped classroom pedagogy is a blended learning approach applied in undergraduate health professions education. However, teachers and students may require training to effectively engage in flipped classroom pedagogy. Thus, this study aimed to design, develop, and evaluate a web-based tool for fostering flipped classroom pedagogy in undergraduate health professions education. METHODS: This is an educational design-based research with a descriptive evaluation component which was conducted in two steps: (i) design & development and (ii) evaluation of an educational website. An expert panel was formed to evaluate the website by using a website evaluation questionnaire (WEQ). Descriptive statistics were employed to calculate the experts' agreement level. RESULTS: An innovative website design was used to provide access to a range of digital devices. The development process occurred concurrently in two steps: (i) website development and (ii) learning content development. The educational website was branded as the Flipped Classroom Navigator (FCN). Based on WEQ scores, the FCN obtained a good level of agreement (≥ 80%) for its' ease of use, hyperlinks, structure, relevance, comprehension, completeness, and layout. CONCLUSIONS: The FCN is an effective method for providing training to promote flipped classroom pedagogy in health professions education. The FCN achieved good evaluation scores and comments from experts. However, it is also necessary to obtain acceptance from the end-users, which could be the focus of future research. Nonetheless, the expert panel pinpointed areas for further development before introducing the FCN to end-users.

University teachers' perceptions of readiness for flipped classroom pedagogy in undergraduate nursing education: A qualitative study.

BACKGROUND: Flipped classroom pedagogy is an innovative blended teaching-learning method. Prevailing evidence about flipped classroom pedagogy shows it is an effective and beneficial teaching method from the students' perspective. There is a dearth of evidence about teachers' perceptions of the flipped classroom and its implementation in low-resourced educational contexts. PURPOSE: To assess the university teachers' perceptions of readiness for adopting flipped classroom pedagogy in the Sri Lankan undergraduate nursing education context. METHODS: An exploratory qualitative study using focus group discussions was conducted in three public universities in Sri Lanka. The participants were 24 university teachers who were involved in undergraduate nursing education programmes in Sri Lanka. Four focus group interviews were conducted. Data were transcribed and analysed using inductive thematic analysis. RESULTS: Four themes emerged. Three themes explained the teachers' perceptions of readiness for implementing flipped classrooms: educational technology, acceptability of the flipped classroom pedagogy, and the educational environment. A further theme refers to future requirements for implementing the flipped classroom. CONCLUSIONS: The study revealed teachers' readiness to use flipped classroom pedagogy. Nevertheless, limited resources and existing teacher-centric practice were identified as challenges to implement the flipped classroom.

Medical Students' Quality of Life and Its Association with Harassment and Social Support.

OBJECTIVES: To explore the associations between self-reported quality of life (QoL) and harassment and the potential moderating effect of social support. DESIGN: Senior medical students were invited to participate in a survey consisting of a background section, the World Health Organisation QoL questionnaire (New Zealand version), a version of the generalised workplace harassment questionnaire, and the multidimensional scale of perceived social support. A series of multivariate statistical analyses were conducted. RESULTS: Two hundred and five students completed the online survey (response rate = 25%). The findings indicated a high incidence of verbal (90%) and covert harassment (87%), with relatively low levels of physical harassment (6%) and manipulation (6%). The correlational analyses indicated that low levels of QoL were associated with high levels of verbal and covert harassment and high levels of social support were directly associated with high levels of QoL. The moderation models indicated that social support conditionally influences the impact of verbal and covert harassment on social and psychological QoL. CONCLUSIONS: These findings imply that medical students experiencing harassment in clinical learning environments likely experienced lowered levels of QoL. Social support may moderate, in certain instances, the adverse impact of harassment on QoL.

Assess the feasibility of flipped classroom pedagogy in undergraduate nursing education in Sri Lanka: A mixed-methods study.

BACKGROUND: The nursing education system has evolved with an increased emphasis on student-centred education, such as implementing flipped classroom pedagogy. Given the promising positive educational outcomes, the trend of using flipped classroom pedagogy has become increasingly popular in undergraduate nursing education. However, little is known about how these flipped classroom methods impact on nursing educational practices in limited-resource settings situated in South Asia. OBJECTIVE: To assess the feasibility of implementing flipped classroom pedagogy in undergraduate nursing education from the nursing students' perspective. METHODS: This mixed-methods study employed a quantitative survey and six focus group discussions conducted in three state universities in Sri Lanka. The Nursing Students' Readiness for Flipped Classroom (NSR-FC) questionnaire was used to collect quantitative data. The semi-structured focus group discussions were conducted by using 18 reflective and open-ended questions. Descriptive statistics and multivariate analysis of variance methods were employed when analysing quantitative data. An inductive thematic analysis approach was used to summarize the focus group discussions. RESULTS: The questionnaire survey revealed that nursing students reported high levels of personal, technical, and pedagogical readiness across all three universities, while environmental readiness was perceived as low. The inductive thematic analysis identified three themes, namely: enablers, challenges, and benefits. Specifically, nursing students valued the student-centred approach. They were ready to utilize their own devices to overcome limited technological provision; however, a short training session about how to engage in the flipped classroom was desirable. Also, their exposure to basic educational technology was perceived as adequate and they were aware of the positive outcomes of flipped classroom pedagogy. CONCLUSION: Nursing students were ready to enrol in a flipped classroom programme. The provision of technological resources in the education environment was identified as a great challenge for flipped classroom implementation. Overall, the findings indicate there are promising feasibilities for the flipped classroom implementation.

Medical Students' Experience of Harassment and Its Impact on Quality of Life: a Scoping Review.

OBJECTIVES: Medical students' experiences of harassment and its influence on quality of life were examined. DESIGN: A set of databases were employed in this review, and using ATLAS.ti, a set of emergent themes were identified. RESULTS: The initial search identified 4580 potential articles for review. The inclusion and exclusion criteria reduced the list to 48 articles. Two predominant emergent themes were categorised as 'Antecedents' of 'harassment' and 'Consequences' on quality of life. CONCLUSIONS: Harassment likely has an adverse impact on quality of life, although more empirical research is required to establish more definitive links between the two variables.

Exploring the pedagogical design features of the flipped classroom in undergraduate nursing education: a systematic review.

BACKGROUND: In recent years, technological advancement has enabled the use of blended learning approaches, including flipped classrooms. Flipped classrooms promote higher-order knowledge application - a key component of nursing education. This systematic review aims to evaluate the empirical evidence and refereed literature pertaining to the development, application and effectiveness of flipped classrooms in reference to undergraduate nursing education. METHODS: A PRISMA systematic review protocol was implemented to investigate the literature pertaining to the development, implementation and effectiveness of flipped classroom pedagogy in undergraduate nursing education. Seven databases (Scopus, PsycINFO, CINAHL, ERIC, MEDLINE, Cochrane, Web of Science) were utilised to survey the salient literature. Articles were appraised with respect to their level of evidence, the origin of study, study design, the aims/s of the study, and the key outcomes of the study. A qualitative synthesis was then conducted to summarise the study findings. RESULTS: The initial search identified 1263 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 27 articles were considered for the final review, most of which were conducted in the USA and South Korea. A range of research designs were applied to measure or discuss the outcomes and design features of the flipped classroom pedagogy when applied to undergraduate nursing education. The review indicated that a common operational flipped classroom model involves three key components, namely pre-classroom activities, in-classroom activities and post-classroom activities, guided by two instructional system design principles. The review predominantly identified positive learning outcomes among undergraduate nursing students, after experiencing the flipped classroom, in terms of skills, knowledge and attitudes. However, a few studies reported contrasting findings, possibly due to the incompatibility of the flipped classroom pedagogy with the traditional learning culture. CONCLUSIONS: Current evidence in this systematic review suggests that incorporating the flipped classroom pedagogy could yield positive educational outcomes in undergraduate nursing education. There are promising pedagogical models available for adapting or developing the flipped classroom pedagogy in undergraduate nursing education.

Video learning strategies affecting achievement, learning approach, and lifelong learning in a flipped periodontology course.

OBJECTIVE: To explore how video learning strategies influence students' Flipped learning (FL) achievement, deep approach to learning (DAL) and lifelong learning (LL) orientations and how DAL and LL can be promoted. METHODS: Data were collected from 65 dental students enrolled in a 21-week clinical periodontology course. Partial least squares structural equation modeling was conducted to investigate factors and pathways affecting FL achievement, DAL, and LL. RESULTS: FL achievement was predicted by repeated and in-advance video learning strategies. In-advance, meticulous, and expanded video learning strategies directly influenced DAL, and indirectly influenced LL via DAL. LL was not affected by any of the video learning strategies but by the DAL. CONCLUSION: This study implies that mere implementation of FL may not guarantee more developed DAL and enhanced LL. Redesigning a course with FL should entail revisiting and revising student assessment. LL is an inclusive approach that requires the long-term cultivation of meaning, experience, insight, learning, and practice.

Effects of Fear of COVID-19 on Mental Well-Being and Quality of Life among Saudi Adults: A Path Analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has been very disruptive, and thus is likely to result in substantial challenges to mental health. OBJECTIVES: This study aimed to investigate the effects of fear of COVID-19 on the mental well-being and quality of life among Saudi adult population and to evaluate the impact of perceived social support. MATERIALS AND METHODS: This cross-sectional study used an anonymous online survey, where participants were administered the Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, European Health Interview Survey-Quality of Life and Medical Outcomes Study Social Support Survey. A path analysis was used to investigate the proposed theoretical domain structure linking fear of COVID-19 with perceived social support, mental well-being and quality of life. RESULTS: A total of 1029 Saudi adults with a mean age of 33.7 years (SD 11.5) responded to the survey. Descriptive analysis showed that this sample was fearful of COVID-19, anxious and depressed but, at the same time, reported high quality of life and perceived social support scores. Path analysis indicated that increased fear of COVID-19 was directly associated with diminished mental well-being, which in turn was associated with lower quality of life. The beneficial effects of perceived social support were stronger on quality of life than on mental well-being. No direct link was found between fear of COVID-19 and quality of life. CONCLUSION: These findings emphasize the importance of having effective social systems in place to minimize the impact of the COVID-19 pandemic on mental well-being and quality of life.

The efficacy of mindful practice in improving diagnosis in healthcare: a systematic review and evidence synthesis.

Despite a variety of definitions of mindfulness, over the past 20 years there have been increasing claims that mindful practice is helpful in improving the accuracy of clinical diagnosis. We performed a systematic review and evidence synthesis in order to: determine the nature and definitions of mindful practice and associated terms; evaluate the quality of evidence for the benefits of mindful practice; and conclude whether mindful practice may reduce diagnostic error. We screened 14397 refereed reports from the five common literature databases, to include 33 reports related to the use of mindful practice in clinical diagnosis. Our evidence synthesis contained no randomised controlled trials (level I evidence) of mindful practice, the majority of supporting evidence (26 reports or 79%) comprised conceptual commentary or opinion (level IV evidence). However, 2 supporting reports constituted controlled studies without randomisation (level IIa), 1 report was quasi-experimental (level IIb), and 4 reports were comparative studies (level III). Thus, we may tentatively conclude that mindful practice appears promising as a method of improving diagnostic accuracy, but that further definitive studies of efficacy are required. We identified a taxonomy of 71 terms related to mindful practice, 7 of which were deemed core terms due to being each cited 5 times or more. The 7 core terms appear to be sufficient to describe the findings at higher levels of evidence in our evidence synthesis, suggesting that future definitive studies of mindful practice should focus on these common core terms in order to promote more generalisable findings.

Facilitating educational experiences in a paediatric handover: A qualitative case study.

AIM: Handovers have been established as a valuable educational tool; nevertheless, a paucity of literature exists evaluating contributors to the educational experience. Our study aimed to investigate participants' educational experiences based on a paediatric handover, and the facilitators and barriers towards teaching and learning during this process. METHODS: A case study was conducted using semi-structured interviews. Data were collected exploring participants' perspectives of their educational experiences within a handover. An inductive, thematic content analysis was performed to identify key themes, assisted by nVivo software. RESULTS: Four key themes contributing to the educational experience within a handover were identified related to the organisation of a handover, team dynamics, teaching and learning moments and tensions between the clinical tasks and education. A model is proposed aimed at optimising education within this context. CONCLUSIONS: Our study identified contributing factors towards the educational experiences at handovers and provides strategies to optimise these.

The role of online videos in teaching procedural skills to post-graduate medical learners: A systematic narrative review.

Objective: Online videos are commonly used in medical education. The aim of this review was to investigate the role of online instructional videos in teaching procedural skills to postgraduate medical learners.Methods: This systematic narrative review was conducted according to the PRISMA guidelines. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, ERIC and Google Scholar were searched. Full texts that applied to online videos, postgraduate medical learners and procedural skills were included without language restrictions. The methodological quality of the studies was evaluated using a validated tool. A thematic analysis of the studies was carried out using a general inductive approach.Results: A total of 785 articles were retrieved and the full text was reviewed for 66 articles that met the inclusion and exclusion criteria of the study. Twenty papers that were relevant to the role of online videos in postgraduate medical education of procedural skills were used for this review. They were heterogenous in the outcomes collected and the evidence was of variable quality. There was strong evidence for the use of online videos for procedural skill knowledge acquisition and retention. Online videos were used for various purposes, such as supervision, assessment, postoperative debriefing, providing feedback, and promoting reflection.Conclusion: Online videos are a valuable educational tool especially for procedural skill knowledge acquisition and retention. Future research needs to be carried out on the appropriate use of platforms in disseminating and using online videos, identifying the factors surrounding the learners, video characteristics, and data protection.