Why do few medical students report their experiences of mistreatment to administration?

INTRODUCTION: Over 50% of medical students worldwide report experiencing mistreatment and abuse during their clinical education, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide whether to formally report these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. METHODS: Using Constructivist Grounded Theory, we interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Data were analysed in an iterative fashion, using focused and theoretical forms of coding. RESULTS: The decision of whether to report mistreatment is only one phase in the process that students report experiencing when encountering mistreatment. This process can be understood as a journey consisting of five phases: Situating, Experiencing and Appraising, Reacting, Deciding and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. DISCUSSION: Student perceptions of trust or mistrust in their educational institution are highly influential when it comes to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organisational trust between students and the medical school.

Preparing teachers for competency-based medical education: Fundamental teaching activities.

INTRODUCTION: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. METHODS: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. RESULTS: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. CONCLUSIONS: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.

Striving for the best: WONCA global standards for continuing professional development for family doctors.

While all physicians must continue to learn new knowledge through their careers, their post-training continuing professional development (CPD) has received less attention. Problems include lack of support for physicians, frequent deviations from best practices such as mandatory participation, focus on community need, and clear conflicts of interest amongst providers. Additionally, specialists from other disciplines catering to different patient populations often provide CPD for family doctors. The Working Party on Education of the World Organisation of Family Doctors (WONCA) sought to develop global standards in CPD for family doctors. The standards were developed through an iterative process with reference to published best practices for effective CPD. Adapted for family doctors from the World Federation for Medical Education's CPD for Medical Doctors: WFME Global Standards for Quality Improvement', the WONCA CPD Standards for Family Doctors were approved by WONCA Council in November 2016. The objectives of the standards are to: (1) Provide a resource for family doctors and/or groups of family doctors to design and structure a program of CPD to reinforce lifelong learning; (2) Optimise current CPD systems such that, through more effective program design and delivery, family doctors are advancing in patient care and their discipline; (3) Offer a set of globally recognised standards developed through a family medicine perspective to provide feedback on existing CPD programs and systems and encourage international recognition of CPD activities. The WONCA Global CPD Standards should inspire best practices in family medicine CPD, assisting family doctors in providing excellent care.

Gathering, strategizing, motivating and celebrating: the team huddle in a teaching general practice.

OBJECTIVES: To understand how implementing a daily team huddle affected the function of a complex interprofessional team including learners. DESIGN: A qualitative descriptive study using semi-structured interviews in focus groups. SETTING: An academic general practice teaching practice. PARTICIPANTS: All members of one interprofessional team, including nurses, general practitioners, junior doctors, and support staff. METHOD: Focus group interviews using semi-structured guidance were transcribed and the results analysed using qualitative content analysis. MAIN FINDINGS: Four interrelated themes were identified: communication and knowledge sharing; efficiency of care; relationship and team building; and shared responsibility for team function. The implementation of the daily team huddle was seen by participants to enhance the collaboration within the team and to contribute to work life enjoyment. Participants perceived that problems were anticipated and solved quickly. Clinical updates and information about patients benefited the team including learners. Junior doctors quickly understood the scope of practice of other team members, but some felt reluctant to offer clinical opinions. CONCLUSION: The implementation of a daily team huddle was viewed as worthwhile by this large interprofessional general practice team. The delivery of patient care was more efficient, knowledge was readily distributed, and problem solving was shared across the team, including junior doctors.

OSCE circuit performance effects: Does circuit order influence scores?

It is not uncommon for medical students to raise concerns over the difficulty of a single station within an Objective Structured Clinical Examination (OSCE), particularly when they feel they were subject to an unfair situation. Indeed, test developers also share these concerns about the possibility that a single extremely difficult station may impact student performance on the station that follows. As a reaction to the concerns of both students and examiners, we conducted a study, analyzing the scores of multiple OSCEs. Although our analyses did not support the complaints of unfairness targeted at the OSCE, we feel it is a rather enlightening story nevertheless, and one worth sharing.

Educational role of nurse practitioners in a family practice centre: perspectives of learners and nurses.

OBJECTIVE: To examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional educational dynamics in a clinical teaching setting. DESIGN: A qualitative descriptive approach, using purposive sampling. SETTING: A family practice centre that is associated with an academic department of family medicine and is based in an urban area in southern Ontario. PARTICIPANTS: First-year (8 of 9) and second-year (9 of 10) family medicine residents whose training program was based at the family practice centre, and all NPs (4 of 4) who worked at the centre. METHODS: Semistructured interviews were conducted, which were audiotaped and transcribed. An iterative approach was used for coding and analysis. Data management software guided organization and analysis of the data. MAIN FINDINGS: Four interconnected themes were identified: role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. Although residents recognized NPs' value in team functioning and areas of specialized knowledge, they were unclear about NPs' scope of practice. Depending on residents' level of training, residents tended to respond differently to teaching by NPs. More of the senior residents believed they needed to think like physicians and preferred clinical teaching from physician teachers. Junior residents valued the step-by-step instructional approach used by NPs, and they had a decreased sense of vulnerability when being taught by NPs. Training in teaching skills was helpful for NPs. Barriers to providing optimal education included opportunity, time, and physician attitudes. CONCLUSION: The lack of an intentional orientation of family medicine residents to NPs' scope of practice and educational role can lead to difficulties in interprofessional education. More explicit recognition of the evolving professional identity of family medicine residents might decrease resistance to teaching by NPs and ensure that interprofessional teaching and learning strategies are effective. Faculty development opportunities for all educators are required to manage these issues, both to ensure teaching competencies and to reinforce positive interprofessional collaboration.

Enhancing learning approaches: practical tips for students and teachers.

BACKGROUND: In an integrated curriculum such as problem-based learning (PBL), students need to develop a number of learning skills and competencies. These cannot be achieved through memorization of factual knowledge but rather through the development of a wide range of cognitive and noncognitive skills that enhance deep learning. AIM: The aim of this article is to provide students and teachers with learning approaches and learning strategies that enhance deep learning. METHODS: We reviewed current literature in this area, explored current theories of learning, and used our experience with medical students in a number of universities to develop these tips. RESULTS: Incorporating the methods described, we have developed 12 tips and organized them under three themes. These tips are (1) learn how to ask good questions, (2) use analogy, (3) construct mechanisms and concept maps, (4) join a peer-tutoring group, (5) develop critical thinking skills, (6) use self-reflection, (7) use appropriate range of learning resources, (8) ask for feedback, (9) apply knowledge learnt to new problems, (10) practice learning by using simulation, (11) learn by doing and service learning, and (12) learn from patients. CONCLUSIONS: Practicing each of these approaches by students and teachers and applying them in day-to-day learning/teaching activities are recommended for optimum performance.

Conceptualization of Competency-Based Medical Education Terminology in Family Medicine Postgraduate Medical Education and Continuing Professional Development: A Scoping Review.

PURPOSE: To examine the extent, range, and nature of how competency-based medical education (CBME) implementation terminology is used (i.e., the conceptualization of CBME-related terms) within the family medicine postgraduate medical education (PGME) and continuing professional development (CPD) literature. METHOD: This scoping review's methodology was based on Arksey and O'Malley's framework and subsequent recommendations by Tricco and colleagues. The authors searched 5 databases and the gray literature for U.S. and Canadian publications between January 2000 and April 2017. Full-text English-language articles on CBME implementation that focused exclusively on family medicine PGME and/or CPD programs were eligible for inclusion. A standardized data extraction form was used to collect article demographic data and coding concepts data. Data analysis used mixed methods, including quantitative frequency analysis and qualitative thematic analysis. RESULTS: Of 470 unique articles identified, 80 (17%) met the inclusion criteria and were selected for inclusion in the review. Only 12 (15%) of the 80 articles provided a referenced definition of the coding concepts (i.e., referred to an article/organization as the definition's source), resulting in 19 highly variable-and 12 unique- referenced definitions of key terms used in CBME implementation (competence, competency, competency-based medical education). Thematic analysis of the referenced definitions identified 15 dominant themes, among which the most common were (1) a multidimensional and dynamic concept that encompasses a variety of skill components and (2) being able to use communication, knowledge, technical skills, clinical reasoning, judgment, emotions, attitudes, personal values, and reflection in practice. CONCLUSIONS: The construction and dissemination of shared definitions is essential to CBME's successful implementation. The low number of referenced definitions and lack of consensus on such definitions suggest more attention needs to be paid to conceptual rigor. The authors recommend those involved in family medicine education work with colleagues across medical specialties to develop a common taxonomy.

Using a novel small-group approach to enhance feedback skills for community-based teachers.

BACKGROUND: As medical education expands into distant settings, challenges in providing faculty development to busy clinical teachers increase-especially for those who have difficulty accessing sessions offered at academic centers. DESCRIPTION: Sixty-five clinical teachers participated in six small-group workshops, using a printed module on the topic of delivering feedback. The modules included teaching-learning "cases," tools, and a summary of medical literature. The group facilitator did not require expertise in delivering feedback. Surveys inquired about impact immediately after the session and at 3 months. EVALUATION: Analysis confirmed that participants found the workshop format valuable, and the majority committed to making changes in their approaches to providing feedback. At follow-up, most participants reported that planned changes had been implemented. CONCLUSIONS: A low-tech approach to faculty development, using facilitated small-group discussion of a specially prepared educational module, is feasible for any site and can enhance teaching approaches in both urban and rural practice settings.

Interprofessional education in academic family medicine teaching units: a functional program and culture.

PROBLEM ADDRESSED: The new family health teams (FHTs) in Ontario were designed to enable interprofessional collaborative practice in primary care; however, many health professionals have not been trained in an interprofessional environment. OBJECTIVE OF PROGRAM: To provide health professional learners with an interprofessional practice experience in primary care that models teamwork and collaborative practice skills. PROGRAM DESCRIPTION: The 2 academic teaching units of the FHT at McMaster University in Hamilton, Ont, employ 6 types of health professionals and provide learning environments for family medicine residents and students in a variety of health care professions. Learners engage in formal interprofessional education activities and mixed professional and learner clinical consultations. They are immersed in an established interprofessional practice environment, where all team members are valued and contribute collaboratively to patient care and clinic administration. Other contributors to the success of the program include the physical layout of the clinics, the electronic medical record communications system, and support from leadership for the additional clinical time commitment of delivering interprofessional education. CONCLUSION: This academic FHT has developed a program of interprofessional education based partly on planned activities and logistic enablers, and largely on immersing learners in a culture of long-standing interprofessional collaboration.

Exploring Faculty Developers' Experiences to Inform Our Understanding of Competence in Faculty Development.

PURPOSE: Now a mainstay in medical education, faculty development has created the role of the faculty developer. However, faculty development research tends to overlook faculty developers' roles and experiences. This study aimed to develop an empirical understanding of faculty developer competence by digging deeper into the actions, experiences, and perceptions of faculty developers as they perform their facilitator role. METHOD: A constructivist grounded theory approach guided observations of faculty development activities, field interviews, and formal interviews with 31 faculty developers across two academic institutions from 2013 to 2014. Analysis occurred alongside and informed data collection. Themes were identified using a constant comparison process. RESULTS: Consistent with the literature, findings highlighted the knowledge and skills of the faculty developer and the importance of context in the design and delivery of faculty development activities. Three novel processes (negotiating, constructing, and attuning) were identified that integrate the individual faculty developer, her context, and the evolution of her competence. CONCLUSIONS: These findings suggest that faculty developer competence is best understood as a situated construct. A faculty developer's ability to attune to, construct, and negotiate her environment can both enhance and minimize the impact of contextual variables as needed. Thus, faculty developers do not passively experience context; rather, they actively interact with their environment in ways that maximize their performance. Faculty developers should be trained for the adaptive, situated use of knowledge.