Transition theory and the emotional journey to medical educator identity: A qualitative interview study.

BACKGROUND: Medical academia is in crisis, with fewer people entering and growing concern at numbers leaving. While faculty development is often seen as part of the solution, there are significant issues with faculty not engaging with and resisting development opportunities. Lack of motivation may be linked to what might be called a 'weak' educator identity. We studied medical educators' experiences of career development to gain further insights into: how professional identity may develop; individuals' accompanying emotional responses to perceived identity change; and consideration of the accompanying temporal dimensions. Drawing on new materialist sociology, we explore medical educator identity formation in terms of an affective flow that places the individual within a constantly shifting assemblage of psychological, emotional and social relations. METHOD: We interviewed 20 medical educators at various career stages, with differing strengths of medical educator self-identity. Using an adapted transition model as a basis for understanding the emotions experienced by those undergoing identity transitions, we explore the process that, for some medical educators, appears to lead to decreased motivation, ambiguous identity and disengagement, but for others results in renewed energy, a stronger and more stable professional identity and increased interest and engagement. RESULTS: By more effectively illustrating the emotional impact of the transition process leading to a more stable educator identity, we show that some individuals, especially where the change was not sought or welcomed, express their uncertainty and distress through low mood, resistance and an attempt to minimise the significance of undertaking or increasing teaching duties. DISCUSSION: Understanding the emotional and developmental phases of the transition to medical educator identity has several key implications for faculty development. Faculty development approaches should be alert to the individual educator's stage of transition since this will affect that individual's readiness to accept and respond to guidance, information and support. A renewed emphasis on early educational approaches that will support the transformational and reflective learning of the individual is needed, while traditional approaches emphasising skills and knowledge may be more useful in the later stages. Further testing of the transition model and its applicability to identity development in medical education is indicated.

Teaching sociology to undergraduate medical students.

Understanding the social basis of health and medicine and the contexts of clinical care are essential components of good medical practice. This includes the ways in which social factors such as class, ethnicity, and gender influence health outcomes and how people experience health, illness, and health care. In our Guide we describe what sociology is and what it brings to medicine, beginning with the nature of the "sociological imagination." Sociological theory and methods are reviewed to explain and illustrate the role of sociology in the context of undergraduate medical education. Reference is made to the 2016 report, A Core Curriculum for Sociology in UK Undergraduate Medical Education by Collett et al. Teaching and student learning are discussed in terms of organization and delivery, with an emphasis on practice. Sections are also included on assessment, evaluation, opportunities, and challenges and the value of a "community of practice" for sociology teachers in medical education.

What are threshold concepts and how can they inform medical education?

The notion of "threshold concepts" is being widely applied and researched in many disciplines but is rarely discussed within medical education. This article is written by three medical educators who regularly draw on threshold concept theory in their work. They explore here the nature of threshold concepts and describe how the theory can offer medical educators new perspectives in terms of how they design curricula, approach teaching and support learners.

'Everyone is trying to outcompete each other': a qualitative study of medical student attitudes to a novel peer-assessed undergraduate teamwork module.

The centrality of teamwork in ensuring the effective functioning of institutions across all sectors is undeniable. However, embedding teamwork into higher education has been hampered due to a range of deeply entrenched practices associated broadly with the foregrounding of knowledge, beliefs about the place of skill training and routines of assessment. As a result, despite an urgent need to address teamwork, little progress has been made with respect to progressing teamwork education. We have designed and evaluated a novel teamwork module delivered to fourth-year undergraduate medical students involving placements, a cocreated piece of work, reflection and summative peer assessment. This paper aimed to investigate whether the module increased students' insight into teamwork, including their own skill development, and whether their perceptions of teamwork changed. Throughout the evaluation, students played a key role, with four final-year medical students working alongside others in the multidisciplinary project team. Five distinct themes emerged from our in-depth, semi-structured interviews: (a) importance and meaning; (b) insight into skill development; (c) transferability; (d) peer assessment; and (e) resistance to teamwork education. Themes had positive and negative components, and student perceptions changed in multiple ways after experiencing a longitudinal educational opportunity to develop their teamwork skills. Before practice, students focused on superficial explanations and on where they might improve. In contrast, after practice, students conveyed deeper insights, contextualisation, focus on how they might improve, and shared structured reflection.

Students' views on the impact of peer physical examination and palpation as a pedagogic tool for teaching and learning living human anatomy.

BACKGROUND: Modern medical education teaching and learning approaches now lay emphasis on students acquiring knowledge, skills and attitudes relevant to medical practice. AIMS: To explore students' perceived impacts of using hands-on approaches involving peer/life model physical examination and palpation in teaching and learning living human anatomy on their practice of physical examination of real patients. METHODS: This study used exploratory focus groups and a questionnaire survey of years 3-5 medical students. RESULTS: The focus group discussions revealed new insights into the positive impacts of the hands-on approaches on students' clinical skills and professional attitudes when dealing with patients. Students' exposure to the hands-on approaches helped them to feel comfortable with therapeutically touching unclothed patients' bodies and physically examining them in the clinical environment. At least 60% of the questionnaire survey respondents agreed with the focus group participants on this view. Over 75% also agreed that the hands-on experiences helped them develop good professional attitudes in their encounter with patients. CONCLUSIONS: This study highlights the perceived educational value of the hands-on approaches as a pedagogic tool with a positive impact on students' clinical skills and professional attitudes that helps in easing their transition into clinical practice.

Assessing sociology and psychology in UK undergraduate medical education: Square peg in a round hole?

This article was migrated. The article was marked as recommended. Background: Attention has turned in recent years to the broader inclusion of sociology and psychology in medical curricula. Despite this, there is limited published evidence about how best to assess these subjects. This lack of evidence is significant given that most medical schools are likely to include some form of assessment of sociology and psychology, and that sociology and psychology are included in areas examined in admissions tests and in licensing exams. Methods: We ran three one day workshops in the UK (London, Edinburgh and Manchester, June - July 2019), to consult with educators involved in sociology and psychology teaching in medicine on: what methods are being used to assess sociology and psychology in UK undergraduate medical education, and the challenges and opportunities experienced. 36 participants attended the workshops, representing 19 of the 33 UK medical schools. Following the workshops, we collated the notes and presentations in order to develop a summary of current assessment practices and synthesis of the main themes identified. Results: There were many examples of good practice and development of innovative assessments, particularly in the early years of the programmes. At the same time, participants raised several challenges and tensions in relation tothe method, timing, and placement of sociology and psychology assessment. Participants reported that many of these issues related to dominant assessment cultures in medical education. As a result, assessing sociology and psychology in medicine can seem like fitting a square peg into a round hole. Solutions to these challenges may require wider changes to assessment practices and cultures. Conclusion: The challenges shared by participants are evident; nonetheless, there are important opportunities. Our participants were unanimous in their desire to become involved in dialogue and consultation about assessment. This article, reporting on the views of UK SBS educators, is a positive step towards creating a more robust evidence base upon which to engage in these conversations and inform best practice in sociology and psychology assessment.

Teaching, research or balanced? An exploration of the experiences of biomedical scientists working in UK medical schools.

Driven by demand for high standards in university education, efforts have been made in the UK to address the perceived imbalance between teaching and research. However, teaching is still perceived by many as having less credibility and is attributed less importance. The purpose of our research was to explore how distinct types of academic job profiles ('research' or 'education' focused, or 'balanced') impact on biomedical scientists' perceptions of the lecturer role. Specifically, we investigated the experiences of biomedical scientists in 'post-1990' medical schools, which are known for their commitment to excellence in both research and education. We conducted 22 face-to-face, semi-structured interviews with biomedical scientists in five schools. Focusing on experiences of work, the interviews covered: 'motivations', 'role expectations', 'teaching', 'research' and 'career'. The recorded qualitative data were transcribed and then analysed thematically. Our results, offering an insight into the working lives of biomedical scientists in medical education, suggest that in settings with a dual emphasis on education and research, individuals on 'balanced' contracts can experience a strong pull between research and teaching. In addition to posing significant challenges with respect to workload management, this can impact profoundly on professional identity. In contrast to the balanced role, 'research' or 'education' focused roles appear to have clearer requirements, leading to higher employee satisfaction. We conclude that to assist the educational mission of Higher Education, attention should be paid to balanced contracts, to (a) ensure employee support, (b) mitigate against negative perceptions of teaching, and ultimately, (c) guard against staff attrition.

The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors.

CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self-selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. RESULTS The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. CONCLUSIONS Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing 'meaningful' contact with patients and increasing opportunities to 'act up' to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements.

The role of living models in the teaching of surface anatomy: some experiences from a UK Medical School.

BACKGROUND: Despite recommendations stemming from the 1930s espousing the value of a living anatomy component in undergraduate medical education, living anatomy remains relatively under described. AIM: In this article, we explore the role of the living anatomy model in living anatomy teaching. METHOD: Our report is based on a larger ethnographic study of living anatomy classes, undertaken at Peninsula Medical School between 2002 and 2004. A Research Fellow participated as an observer in 24 Year One and Year Two anatomy classes in which living anatomy models were employed. The findings are based on field notes and conversations with models, students and tutors. RESULTS AND CONCLUSIONS: Within the supervised context of the anatomy class the living models assisted students in the learning of structure, function, surface anatomy and body variation. Far from being 'passive sites' for the students to practice their anatomical knowledge, the living models were active participants in class, assisting students with their communication skills, sharing anatomical knowledge, offering guidance to staff and sharing their past medical history and experiences. Living anatomy models can foster an additional dimension of humanitarian thinking within the anatomy class; however, further research needs to focus on the power messages implicit in the organization of sessions.

Improving communication for learning with students: expectations, feedback and feedforward.

This article was migrated. The article was marked as recommended. The aim of this paper is to draw together numerous strands from within the literature and our own practice to provide advice for improving communication about learning with students in undergraduate medical education. There is an assumption within higher education that assessment drives learning and, as such, assessment forms the focal points for communication between teachers and students. However, a broader approach is required to avoid misunderstandings and maximise the successful engagement with learning of everyone involved. It is important to plan a clear communication strategy that incorporates and enables identification with the unique values of the particular school. Where communication about learning is overtly discussed there are three main areas to consider: (1) management of expectations (sometimes referred to as feed up or feed in) that needs to include not only the use of authentic formative assessments, but also the viewpoints of both teachers and students. (2) Feedback and (3) Feedforward, both need to be considered from the perspectives of student and teacher. All communication needs to be inclusive, it's structures must provide scaffolding for respectful exchanges of information, and this will have clear practical consequences for the activities within the school.

Empowering students with the hidden curriculum.

BACKGROUND: The hidden curriculum (HC) refers to unscripted, ad hoc learning that occurs outside the formal, taught curriculum and can have a powerful influence on the professional development of students. While this learning may be positive, it may conflict with that taught in the formal curriculum. Medical schools take a range of steps to address these negative effects; however, the existence and nature of the concept tends to be hidden from students. METHODS: Since 2007, our medical school has incorporated into its small group programme an educational activity exploring the concept of the hidden curriculum. We undertook a qualitative evaluation of our intervention, conducting a thematic analysis of students' wiki reflections about the HC. We also analysed students' responses to a short questionnaire about the educational approach used. FINDINGS: The majority of students felt that the HC session was important and relevant. Most appeared able to identify positive and negative HC experiences and consider how these might influence their learning and development, although a few students found the concept of the HC hard to grasp. DISCUSSION: Revealing and naming the hidden curriculum can make students aware of its existence and understand its potential impact. The hidden curriculum may also be a useful tool for triggering debate about issues such as power, patient centredness, personal resilience and career stereotypes in medicine. Supporting students to think critically about HC experiences may empower them to make active choices about which messages to take on board. The hidden curriculum can have a powerful influence on the professional development of students.

"Over my dead body?": the influence of demographics on students' willingness to participate in peer physical examination.

This study aims to explore quantitatively and qualitatively students' attitudes towards peer physical examination (PPE) and the influence of demographics on students' willingness to participate in PPE. A total of 296 first-year medical students from two consecutive cohorts at the Peninsula Medical School, UK completed the EFS questionnaire. Quantitative data from the questionnaire were analysed using univariate (i.e. Mann-Whitney and chi-squared tests) and multivariate statistics (i.e. stepwise multiple regression) and qualitative data were analysed using theme analysis. At least 92% of Peninsula Medical School students were willing to examine all 11 body parts (except breast and inguinal regions) of peers of same and opposite gender. Qualitative data support this by highlighting students' positive attitudes towards PPE. PPE was more acceptable within rather than across gender and students generally felt more comfortable examining their peers than being examined by peers. Qualitative data outline the range of student concerns with PPE. Significant relationships existed between students' attitudes towards PPE and various variables: gender, age and religious faith. The findings demonstrate that students may show a greater willingness to participate in PPE than previously thought. Further research is required to explore more fully the barriers to PPE.