The next frontier: utilizing eLearning as an innovative approach to advance and sustain interprofessionalism.

The challenges to sustaining interprofessional education (IPE) are numerous and well-documented. These challenges include crowded curricula, scheduling conflicts, lack of physical space, faculty availability, and financial considerations. In turn, IPE is often viewed and treated as an add-on rather than an integral part of healthcare education, leading to sporadic implementation and vulnerability to institutional changes. The concept of eLearning, utilizing electronic technologies for education, emerges as a potential solution to these challenges and could serve as the "next frontier" for IPE. eLearning offers a flexible and scalable platform to deliver IPE, transcending geographical and time constraints. Recent research highlights the benefits of eLearning-based IPE, including enhanced collaboration, learner satisfaction, and clinical application. eLearning allows learners to engage in virtual simulations, reflexive exercises, and collaborative problem-solving, fostering essential skills for future healthcare teams. Interprofessional eLearning courses can seamlessly integrate into existing health professions curricula, catering to busy professionals and students. Most importantly, eLearning promotes consistent and purposeful embedding of interprofessional values and competencies throughout education, training, and professional development. In this Short Report, we utilize the Center for Advancing Interprofessional Practice, Education, and Research (CAIPER) at Arizona State University as a rudimentary "critical instance" case study for advancing and sustaining IPE through eLearning program development. CAIPER exemplifies this approach by constructing engaging evidence-based eLearning IPE courses ranging from examining and applying interprofessionalism in primary care to empathy and humility team-based training. CAIPER's eLearning courses have reached a global audience of over 65,000 learners highlighting the reach, impact, and viability of eLearning for sustainable IPE. Although further research is needed, eLearning presents a promising solution to the systemic challenges of IPE, and by embracing eLearning and embedding interprofessional eLearning courses in existing curricula, institutions can ensure the consistent, accessible, and sustainable delivery of high-quality IPE experiences.

Forming Physicians: Evaluating the Opportunities and Benefits of Structured Integration of Humanities and Ethics into Medical Education.

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students' perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be "in" medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training.

Examining Impostor Phenomenon Through the Lens of Humility: Spotlighting Conceptual (Dis)Connections.

Impostor phenomenon has gained increasing attention within the health care and health professions education literature. Although consistently depicted as a debilitating socioemotional experience, studies also suggest a strategic aspect to impostor phenomenon - denoting a conceptual ambiguity to impostor phenomenon that has yet to fully examined. Within this paper, we use humility as a conceptual sparring partner with impostor phenomenon to examine the similarities and differences between the concepts, as well as explore the various nuances associated with impostor phenomenon. By comparing and contrasting impostor phenomenon and humility from interdisciplinary perspectives and within the context of health professions specifically, we not only further refine their meaning and usage within the literature, but also spotlight key areas for future research.

Examining the U.S. premed path as an example of discriminatory design & exploring the role(s) of capital.

The college-level pathway to medical school (i.e., the "premed path") includes all coursework, extra-curriculars, shadowing, volunteering, high-stakes examination (e.g., MCAT®), and application-related processes. Although medical school admission committees routinely insist their interest in diverse and "well-rounded" applicants, the premed path (PMP), through formal and informal mechanisms, is constructed to favor those from high in socioeconomic status (SES) privileged backgrounds, and those majoring in typical premed majors such as in the Biological Sciences. In these respects, the PMP is an example of Discriminatory Design-an entity constructed and sustained in a manner that (un)intentionally discriminates against certain groups of individuals. We begin this paper by providing a brief description of the PMP (within the U.S. specifically) and conceptual and theoretical overview of the discriminatory design framework. We then explore how the PMP is an example of discriminatory design through the distinct but related role(s) of financial, social, cultural, and (what we term) (extra)curricular capital. Using data gleaned from interviews with premedical students, content analyses of the curricular structure of particular majors and publicly available data on the various "costs" associated with the PMP, we detail how the PMP is reflective of discriminatory design, spotlighting specific barriers and hurdles for certain groups of students. Given the persistent lack of representation of students from minoritized groups as well as those from diverse academic backgrounds within medical schools, our goal is to spotlight key features and processes within the PMP that actively favor the pursuit of certain majors and students from more privileged backgrounds. In turn, we conclude by offering medical schools and undergraduate institutions specific recommendations for remediating these barriers and hurdles.

Challenging the clinically-situated emotion-deficient version of empathy within medicine and medical education research.

In this paper, we argue that the notion of a clinically-situated empathy (e.g. physician empathy), is potentially problematic as it perpetuates an emotion-deficient version of empathy within medicine and medicine education research. Utilizing classic and contemporary empathy theory from various social science disciplines, we discuss how empathy in the general sense differs conceptually from clinically-situated empathy-paying particular attention to the role of emotional contagion. To highlight this contrast, we draw upon Hojat et al.'s model of physician empathy and how this body of work reflects broader medical-cultural norms that problematize the role and impact of emotions within the clinical encounter. Alternatively, we present a more encompassing model of empathy drawing upon the fields of social-psychology and social-neuroscience in order to bring the notion of "feeling with" and emotional contagion more specifically, into medical education, medical education research, and medicine more generally.

A qualitative assessment of emergency medicine residents' receptivity to feedback.

BACKGROUND: Effective feedback is the cornerstone of competency-based education. The emergency department (ED) is a unique learning and feedback environment. Developing our understanding of emergency medicine (EM) residents' experiences around feedback will improve resident training and inform EM faculty development programs. OBJECTIVE: This qualitative study explores the feedback culture and practices in EM and resident's experiences and attitudes toward feedback in this specific training environment. METHODS: At a large categorical EM program, 15 residents voluntarily participated in semistructured interviews regarding feedback. These individual interviews were performed by a nonphysician investigator and transcripts underwent an inductive multistep coding process. Transcripts were analyzed to identify common factors influencing feedback and then comparisons were made between residents to explore the interconnectedness of identified factors and further categorize consistent themes. RESULTS: Factors inherent to the ED environment make the delivery of effective feedback challenging. Residents also revealed that feedback-seeking/-avoidant behavior and receptivity to feedback are multifactorial. Residents actively seek feedback when they feel that they performed well but tend to avoid feedback interactions when they expect constructive feedback. Finally, residents filter feedback based on attending personality and perceived practice style as well as their own desired practice style. CONCLUSIONS: It is important for program leaders to understand their residents' experiences with feedback and engage both faculty and residents in conversations around feedback delivery and receptivity. An improved understanding of these experiences might also reveal barriers to performance assessment and guide efforts to improve the accuracy and reliability of resident evaluations.

COVID-19 and team-based healthcare: The essentiality of theory-driven research.

There is evidence to suggest enhanced teamness, heightened interprofessional values and practices, and even the potential for dilution of occupational status hierarchies within healthcare practice and delivery during the time of COVID-19. It is essential that we study these emergent changes using the lens of multilevel theory to better understand these recent developments and their current and future implications for interprofessional practice, education, and policy. Within this article, we first offer a brief overview of secondary data to highlight these COVID-19-specific shifts to provide context and perspective. We then outline prominent micro, meso, and macro-level theories, and propose accompanying rudimentary hypotheses and related general research questions to help guide, and ideally accelerate IPE and IPCP research related to this crisis. Our goal is to not only spotlight key areas for future research during and post COVID-19 but also provide a "starter kit" to encourage more theory-driven research (and theory-expansion) in the IPE and IPCP fields.

Myths and social structure: The unbearable necessity of mythology in medical education.

CONTEXT: Myth busting engages scholars in the critical examination of commonly accepted but poorly evidenced claims with the goal of instilling quality and trust in knowledge making. The debunking of such knowledge "myths" and associated misguided practices purportedly serves to avert resources and attention from wasteful and dangerous scholarship. We address the myth that "all myths in medical education deserve to be busted". METHODS: Using a critical narrative approach, we searched the medical education literature for orientations to myths and myth busting, and reviewed this literature analytically drawing from the sociology of science and Merton's concepts of manifest and latent functions. The results of this analysis are presented in the form of a narrative that deploys the articles reviewed to explore the utility of myth busting for medical education reform and begins with a brief exploration of the etymology of "myth" and how meaning making is related to symbols, practices and storytelling. RESULTS: Our analysis revealed the important function of myths in the social practice of medical education and practice. A deconstruction of five salient examples of the contemporary myth in medical education (the myth of the "ideal candidate", the myth of "cut-throats", the myth of "cadaver stories", the myth of "learning styles", and the myth of "patient information leaflets") demonstrates that myths continue to have material effects even after they have been busted. CONCLUSIONS: Our analysis makes evident that myth busting disrupts, renegotiates and reconstitutes socio-epistemic relationships rather than simply correcting falsehoods. We also argue that myths play important and inescapable roles in the social practice of medical education and the negotiation of values, and in constructing the conditions for group change and transformation. Imperatives related to humanism, compassion and patient engagement offer a healthy humanising counter-mythologising that we suggest must survive any contemporary myth-busting endeavour aimed at improving medical education practice.

Health Professions Students' Perceptions of Their IPE Program: Potential Barriers to Student Engagement with IPE Goals.

BACKGROUND: Extensive evaluative efforts are underway to explore nuances of interprofessional education (IPE). Few studies, however, have utilized methodology that includes multiple interviews with students of various health disciplines, thereby potentially concealing factors that may be impacting students' attitudes and perceptions of IPE. By focusing on the students' perspectives, this case study explores potential barriers and facilitators to students' engagement with their IPE program. METHODS: In-depth, semi-structured interviews were conducted with 20 students from six health disciplines at the ends of years 1 and 2 of their IPE program. Data were analyzed utilizing multi-step coding processes to identify patterns of students' perceptions and attitudes. FINDINGS: Elements that were internal and external to the IPE program (e.g., assignments, time constraints, lack of accountability, anticipatory socialization, and insufficient professional identity formation) were found to impact students' perceptions of the program and possibly their engagement with IPE goals. CONCLUSIONS: This case study sheds new light on how factors related to an IPE program's structure and implementation, as well as factors outside the program, may affect students' perceptions of IPE and perhaps even their willingness and ability to engage in interprofessionalism.

Why It's Unjust to Expect Location-Specific, Language-Specific, or Population-Specific Service from Students with Underrepresented Minority or Low-Income Backgrounds.

In this case we meet Amanda, a medical student of Native and Latin American ethnicity who receives financial aid. Her friends are surprised by her interest in an elite residency program. They suggest, rather, that with her language skills, ethnic background, and interest in social justice, she has a responsibility to work with underserved patient populations. In our commentary, we consider issues raised by the case and explore Amanda's friends' underlying expectations and assumptions that perpetuate the very inequities that the resolution of the case purports to address. We also identify the role of privilege and address the "burden of expectation" that appears to be associated with underrepresented minority (URM) medical students and normative assumptions about their career paths.

Strategies to Engage Community Partners in Research used by Delaware-CTR ACCEL.

Community-engagement is a key step in conducting research which is impactful for patients and communities. The Delaware Clinical and Translational Research (DE-CTR), Accelerating Clinical and Translational Research (ACCEL) program has implemented several successful approaches to engage our community, and to educate and motivate our researchers in this area. Increased participation in community-engaged research and community-based participatory research was accomplished through DE-CTR/ACCEL using multiple methods detailed in this manuscript. The community engagement infrastructure has fostered community involvement in translational research including capacity development, implementation, evaluation and dissemination. Academic-community partnerships for research, such as those implemented in ACCEL will be crucial to addressing health disparities and health priorities.

Lived Experiences of Racially and Ethnically Underrepresented Minority BSN Students: A Case Study Specifically Exploring Issues Related to Recruitment and Retention.

The lived experiences of 12 traditionally aged underrepresented minority BSN students in a predominantly white university were explored using a qualitative, semi-structured, e-questionnaire approach. A multistep analysis procedure of the data identified barriers, including negative interactions with and lack of diversity of faculty and peers, deficiency of cultural competency training, lack of academic and financial support, and negative family behaviors. Identified facilitators include a strong desire to be a nurse, family member in the health care profession, and proximity to home. Novel findings include highly polarized responses regarding interactions with faculty and peers and the drive to be a nurse as a unique aspect of general determination.

Remote and interdisciplinary research in surgical knowledge production.

BACKGROUND: Surgical knowledge production has changed dramatically in the last 30 y, moving away from investigations by individual surgeon researchers and toward remote and interdisciplinary research. We investigated how surgeons make decisions about engaging in research and identify motivators, facilitators, and barriers to conducting research in an increasingly challenging environment. MATERIALS AND METHODS: We performed a qualitative analysis of semistructured interviews with surgeons from academic medical centers across the United States. We asked participants to describe their experiences and opinions regarding remote and interdisciplinary collaborations. RESULTS: Of 64 surgeon researchers invited, 21 (33%) agreed and participated in semistructured interviews. Each interview lasted an average (standard deviation) of 29 min (12). Surgeons were motivated by both internal and external factors, including some that might be identified as barriers. The internal desire to improve care and the need for collaboration to address increasingly complex questions requiring larger samples sizes emerged as most significant to interview participants. Social networks were identified as the dominant facilitator of multisite research, with technology playing a supporting role. Barriers to remote and interdisciplinary research ranged from individual, "micro" level barriers, through structural barriers that include institutional level challenges and competing priorities, to macrolevel system and policy-level barriers. CONCLUSIONS: Surgeons clearly recognize the importance of high-quality research aligned with current paradigms of clinical care and are using remote and interdisciplinary collaboration to improve the quality of the science they produce and align their work with the demand for increasingly high levels of evidence.

Predicting Peer Nominations Among Medical Students: A Social Network Approach.

PURPOSE: Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations. METHOD: In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations. A total of 211 (81%) of 260 graduating medical students from the Sidney Kimmel Medical College responded to the peer nomination question. Data were analyzed using a relational contingency table and an ANOVA density model. RESULTS: Although peer nominations did not cluster around gender, age, or class rank, those students within an accelerated program, as well as those entering certain specialties, were more likely to nominate each other. The authors suggest that clerkships in certain specialties, as well as the accelerated program, may provide structured opportunities for students to connect and integrate, and that these opportunities may have an impact on peer nomination. The findings suggest that social network analysis is a useful approach to examine various aspects of peer nomination processes. CONCLUSIONS: The authors discuss implications regarding harnessing social cohesion within clinical clerkships, the possible development of siloed departmental identity and in-group favoritism, and future research possibilities.

Alternative Framings, Countervailing Visions: Locating the "P" in Professional Identity Formation.

Professional identity formation in medical education is referenced increasingly as an object for educational reform. The authors introduce core concepts from two largely untapped literatures on identity and formation, contrasting framings on occupational preparation from within the organizational socialization literature with issues of socialization and professional acculturation from a military sciences perspective.The organizational sciences literature emphasizes socializing a workforce to "fit in," raising questions about how organization values might clash with core professional values concerning patient primary and social justice. The military literature, in turn, advances the notions of professional identity as a collective property, and that a particular social other (the public) must participate in shaping the group's identity as a profession.The authors extrapolate from these reviews that the training of physicians-as-professionals, and thus issues of socialization and identity formation, require intentionality and specificity around these contrasting issues. In turn, they argue that medical educators must attend to socializing trainees to a professional group identity while at the same time producing health care professionals who retain the capacity to resist the bureaucratic application of standardized solutions to contemporary problems. Educators must thus strive to identify the skills, knowledge, and attitudes necessary that will allow physicians-qua-professionals to function as a quasi-subversive work force and to disrupt the very system that helped to shape their identity, so that they may fulfill their mission to their patients.