Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum.

BACKGROUND: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. METHODS: We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. RESULTS: The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. CONCLUSIONS: We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.

Exploring stakeholder perspectives regarding the implementation of competency-based medical education: a qualitative descriptive study.

Introduction: Competency-based medical education (CBME) offers perceived advantages and benefits for postgraduate medical education (PGME) and the training of competent physicians. The purpose of our study was to gain insights from those involved in implementing CBME in two residency programs to inform ongoing implementation practices. Methods: We conducted a qualitative descriptive study to explore the perspectives of multiple stakeholders involved in the implementation of CBME in two residency programs (the first cohort) to launch the Royal College's Competence by Design model at one Canadian university. Semi-structured interviews were conducted with 17 participants across six stakeholder groups including residents, department chairs, program directors, faculty, medical educators, and program administrators. Data collection and analysis were iterative and reflexive to enhance the authenticity of the results. Results: The participants' perspectives organized around three key themes including: a) contextualizing curriculum and assessment practices with educational goals of CBME, b) coordinating new administrative requirements to support implementation, and c) adaptability toward a competency-based program structure, each with sub-themes. Conclusion: By eliciting the perspectives of different stakeholder groups who experienced the implementation processes, we developed a common understanding regarding facilitators and challenges for program directors, program administrators and educational leaders across PGME. Results from our study contribute to the scholarly conversation regarding the key aspects related to CBME implementation and serve to inform its ongoing development and application in various educational contexts.

Introduction: La formation médicale axée sur les compétences (FMAC) offre des avantages et des bénéfices perçus pour les études médicales postdoctorales et la formation de médecins compétents. Le but de notre étude était d'apprendre des personnes impliquées dans l'implantation de la FMAC dans deux programmes de résidence afin d'informer les pratiques de mise en œuvre en cours. Méthodes: Nous avons réalisé une étude qualitative descriptive pour explorer les perspectives de plusieurs parties prenantes impliquées dans la mise en œuvre de la FMAC dans deux programmes de résidence (la première cohorte) visant à mettre en place le modèle Compétence par conception du Collège royal dans une université canadienne. Des entrevues semi-structurés ont été menés auprès de 17 participants issus de six groupes de parties prenantes, notamment des résidents, des chefs de département, des directeurs de programme, des membres de la faculté, des éducateurs médicaux et des administrateurs de programme. La collecte et l'analyse des données étaient itératives et réflexives afin d'enrichir l'authenticité des résultats. Résultats: Les perspectives des participants se sont organisées autour de trois thèmes clés, à savoir : a) contextualiser les pratiques de curriculum et d'évaluation avec les objectifs d'apprentissage de la FMAC, b) coordonner les nouvelles exigences administratives pour soutenir la mise en œuvre, et c) s'adapter à une structure de programme axée sur les compétences, chacun avec des sous-thèmes. Conclusion: En recueillant les perspectives des différents groupes de parties prenantes ayant vécu les processus de mise en œuvre, nous avons développé une compréhension commune des facilitateurs et des défis pour les directeurs de programme, les administrateurs de programme et les leaders éducatifs dans la formation médicale postdoctorale. Les résultats de notre étude contribuent à la conversation savante concernant les aspects clés liés à la mise en œuvre de la FMAC et servent à informer son développement et son application en cours dans différents contextes éducatifs.

Exploring medical students' use of principles of self-explanation and structured reflection during clerkship.

Background: While educators observe gaps in clerkship students' clinical reasoning (CR) skills, students report few opportunities to develop them. This study aims at exploring how students who used self-explanation (SE) and structured reflection (SR) for CR learning during preclinical training, applied these learning strategies during clerkship. Methods: We conducted an explanatory sequential mixed-methods study involving medical students. With a questionnaire, we asked students how frequently they adopted behaviours related to SE and SR during clerkship. Next, we conducted a focus group with students to explore why they adopted these behaviours. Results: Fifty-two of 198 students answered the questionnaire and five participated in a focus group. Specific behaviours adopted varied from 50% to 98%. We identified three themes about why students used these strategies: as "just in time" learning strategies; to deepen their understanding and identify gaps in knowledge; to develop a practical approach to diagnosis. A fourth theme related to the balance between learning and assessment and its consequence on adopting SE behaviours. Conclusions: Students having experienced SE and SR regularly in preclinical training tend to transpose these strategies into the clerkship providing them with a practical way to reflect deliberately and capture learning opportunities of the unpredictable clinical context.

Contexte: Alors que les éducateurs observent des lacunes dans les compétences de raisonnement clinique (RC) des étudiants en externat, ces derniers font état de peu d'occasions de les développer. Cette étude vise à explorer comment les étudiants qui ont utilisé l'auto-explication (AE) et la réflexion structurée (RS) pour l'apprentissage du raisonnement clinique pendant la formation préclinique, ont appliqué ces stratégies d'apprentissage pendant l'externat. Méthodes: Nous avons mené une étude séquentielle explicative à méthodes mixtes auprès d'étudiants en médecine. À l'aide d'un questionnaire, nous avons demandé aux étudiants à quelle fréquence ils adoptaient des comportements liés à la AE et à la RS pendant l'externat. Ensuite, nous avons organisé un groupe de discussion avec les étudiants afin d'explorer les raisons pour lesquelles ils ont adopté ces comportements. Résultats: Cinquante-deux étudiants sur 198 ont répondu au questionnaire et cinq ont participé à un groupe de discussion. Les comportements spécifiques adoptés variaient de 50 % à 98 %. Nous avons identifié trois thèmes concernant les raisons pour lesquelles les étudiants ont utilisé ces stratégies : comme stratégies d'apprentissage "juste à temps"; pour approfondir leur compréhension et identifier les lacunes dans les connaissances ; pour développer une approche pratique du diagnostic. Un quatrième thème concernait l'équilibre entre l'apprentissage et l'évaluation et ses conséquences sur l'adoption de comportements liés à l'AE. Conclusions: Les étudiants qui ont fait l'expérience de l'AE et de la RS régulièrement au cours de leur formation préclinique ont tendance à transposer ces stratégies dans l'externat, ce qui leur fournit un moyen pratique de réfléchir délibérément et de saisir les opportunités d'apprentissage dans un contexte clinique imprévisible.

[Mapping the research activities on social accountability in health of an emerging international community]. / Cartographier les activités de recherche en responsabilité sociale en santé d'une communauté internationale en émergence.

We used environmental analysis to document the nature and characteristics of research on social accountability (SA) in health conducted by members of an emerging international Francophone network on SA. We developed a questionnaire focusing on research inputs, activities, and outputs, which could serve as a reference in other institutions and networks. The results provide a better understanding of SA research within the international Francophone community. Networks that aim to promote research among their members should carry out such mapping to leverage the strengths of the community and act as catalysts and stepping stones for future research.

[Teaching in a pandemic: the transformation of teaching and clinical supervision]. / Enseigner en situation de pandémie : La transformation de l'enseignement et de la supervision clinique.

Introduction: The COVID-19 pandemic is an event that deeply impacts our personal, professional, and collective lives. How do we teach in these times of great upheaval? What are the main changes that have occurred? Method: Using the Cartel logic, four professors and a qualitative researcher carried out an autoethnographic research aimed at documenting the main changes that have occurred in the teaching of family medicine in their respective practices located in four different academic family medicine groups at the University of Sherbrooke. Results: Five key moments in teaching that occurred during a pandemic were identified: a) the declaration of a pandemic, b) the approach with the graduating/advanced cohort of residents, c) the anticipation and preparation for the arrival of new residents, d) arrival of first year residents and e) adaptation to the second wave. For each moment, we present the issues encountered in our care and teaching practices under three transversal relational axes: the relationship of humans to their cultural context, the patient-doctor relationship, and the teacher-resident relationship. Conclusion: Our analysis shows that the transmission of medical knowledge and the art of medicine cannot take place without specific attention to the overall cultural context, the contextual relationship of clinical care, and the teaching relationship. Our study also makes it possible to recommend the opening of spaces for reflection and dialogue in our teaching environments.

COVID-19 as the tipping point for integrating e-assessment in higher education practices.

The COVID-19 pandemic provoked an urgency for many educators to integrate digital information and communication technologies in their educational practices. We explored how faculty members tackled the task of adapting their assessment practices during the pandemic to identify what is required to sustain and favour future quality development and implementation of e-assessment in higher education. Employing a qualitative descriptive approach, we conducted semi-structured interviews with thirty-one individuals six months into the COVID-19 pandemic. We identified four major themes in participants' discourse about the integration of e-assessment during the COVID-19 pandemic: (a) the considerations they had for the potential consequences on students and how they considered this while deciding how to move forward, (b) the preoccupations for the potential for cheating, (c) the importance of pedagogical alignment, and (d) the affordances available to them. While the COVID-19 pandemic highlighted the fact that higher education institutions were not prepared for a pivot to- or greater integration of- e-assessment, it also provided the tipping-point to do so. In other words, it offered an unprecedented opportunity to critically appraise and change assessment practices, this opportunity was also a very challenging balancing act of considering the social consequences of assessment, and the alignment within set affordances.

Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques.

Implication Statement We developed physiotherapist-led interprofessional (IP) workshops for medical students each dedicated to a specific anatomical region. The workshops alternated between theoretical presentations from a physiotherapist about basic musculoskeletal (MSK) assessment techniques and hands-on practice in small groups with feedback from Master's-level physiotherapy students (MPT). The workshops created an optimal IP learning environment where medical students can learn MSK assessment techniques and MPTs can apply their knowledge and clinical skills. Academic institutions with physiotherapy and medical programs seeking to develop IP learning activities should foster opportunities for IP collaboration between physiotherapy and undergraduate medical education. Énoncé des implications de la recherche Nous avons créé, à l'intention des étudiants en médecine, des ateliers interprofessionnels (IP) dirigés par un physiothérapeute, chacun axé sur une région anatomique spécifique. Des ateliers théoriques sur les méthodes d'évaluation de base de l'appareil musculo-squelettique (MS) sont donnés en alternance avec des travaux pratiques en petits groupes, lors desquels des étudiants à la maîtrise en physiothérapie (M. Pht.) offrent une rétroaction aux participants. Les ateliers fournissent un environnement optimal pour l'apprentissage IP qui permet aux étudiants en médecine de se familiariser avec les méthodes d'évaluation de l'appareil MS, et aux étudiants M. Pht. d'appliquer leurs connaissances et leurs habiletés cliniques. Les établissements d'éducation offrant des programmes de physiothérapie et de médecine de premier cycle qui cherchent à mettre en place des activités d'apprentissage IP devraient favoriser la collaboration entre ces deux programmes.

Defining the key skills required to perform advanced laparoscopic procedures: a qualitative descriptive study.

BACKGROUND: Simulation is widely used to teach and assess fundamental laparoscopic skills; however, program directors have reported that current simulation programs do not meet the needs for trainees and surgeons learning advanced laparoscopic procedures (ALP). The purpose of our study was to identify the key skills required to perform ALP, to serve as the basis to establish an advanced laparoscopic skills training program. METHODS: Semi-structured interviews were conducted with attending surgeons, fellows, and senior residents in general surgery, gynaecology, and urology. The questions were developed through an iterative process using relevant literature, expert opinions, and in consultation with a qualitative researcher. Interviews were conducted in person, over the phone, or by videoconference, and inductive thematic analysis was performed. RESULTS: 25 interviews were conducted with 16 attending surgeons and 9 fellows/residents from 9 institutions in Canada and USA. Twenty-one skills were identified to be important when performing ALP. The skills most commonly described by faculty were the following : (a) suturing, (b) dissection, (c) procedural expertise, (d) retraction and exposure, and (e) familiarity with relevant anatomy as viewed through the laparoscope. The skills most commonly described by trainees were the following: (a) suturing, (b) dissection, (c) procedural expertise, (d) trocar positioning, and (e) patient factors. There was a large difference between the importance the faculty attributed to the 'Retraction and Exposure' skill compared to the trainees. CONCLUSION: This study identified key skills that are important when performing ALP. In order to address the current needs of trainees/surgeons learning ALP, this work provides the building blocks for the development of an advanced laparoscopic surgery simulation program.

Community engagement: A central feature of NOSM's socially accountable distributed medical education.

BACKGROUND: Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM's distinctive model, Distributed Community Engaged Learning (DCEL). METHODS: Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies. RESULTS: Community engagement contributes throughout the lifecycle stages of preadmission, admission, and undergraduate medical education. High school students from 70 Northern Ontario communities participate in NOSM's week-long Health Sciences Summer Camps. The MD admissions process involves approximately 128 volunteers assessing written applications and over 100 volunteer interviewers. Thirty-six Indigenous communities host first year students and third-year students learn their core clinical medicine in 15 communities, throughout Northern Ontario. In general, learners and communities report net benefits from participation in NOSM programs. CONCLUSION: Community engagement makes a key contribution to the success of NOSM's socially accountable distributed medical education.

Resetting the compass: exploring the implicit messages of orientation to a community-engaged medical school.

BACKGROUND: Although students' transition into medical school is a critical step in their professional journey, orientation has been relatively under-researched, particularly with regard to its intersections with schools' social missions. This paper reports on a study looking at the implicit messages of orientation to the Northern Ontario School of Medicine's undergraduate program. METHODS: An extended mixed methods study was conducted to look at different aspects of the School's Orientation Week. The term "hidden curriculum" was used to shape inquiry, both in its broad sense of implicit educational experiences and messages and in its more specific sense of the educational messages sent by a medical school's culture and activities. Data were collected using participant surveys, focus groups, and interviews. Transcripts and free-text survey responses were analyzed to identify underlying themes. RESULTS: Orientation Week was generally well received and was generally perceived by different stakeholders (such as students, school leaders, and community members) as a positive and necessary undertaking. However, there were points of contention and confusion that created a hidden curriculum with respect to participants' identities, both as students and as future health professionals. CONCLUSION: Orientation to undergraduate medical training can be successfully linked to a school's social mission, but in doing so it can send complex and unintended messages to the participants that may be perceived quite differently based on their circumstances and expectations.

Discourses of student orientation to medical education programs.

BACKGROUND: Although medical students' initial orientation is an important point of transition in medical education, there is a paucity of literature on the subject and major variations in the ways that different institutions orient incoming medical students to their programs. METHODS: We conducted a discourse analysis of medical education orientation in the literature and on data from a survey of peer institutions' approaches to orientation. RESULTS: These two discourses of orientation had clear similarities, in particular, the critical role of ceremony and symbols, and the focus on developing professionalism and physician identities. There were also differences between them, in particular, in the way that the discourse in the literature focused on the symbolic and professional aspects of orientation; something we have called 'cultural orientation'. Meanwhile, those who were responsible for orientation in their own institutions tended to focus on the practical and social dimensions. CONCLUSION: By examining how orientation has been described and discussed, we identify three domains of orientation: cultural, social, and practical. These domains are relatively distinct in terms of the activities associated with them, and in terms of who is involved in organizing and running these activities. We also describe orientation as a liminal activity system on the threshold of medical school where incoming students initially cross into the profession. Interestingly, this state of ambiguity also extends to the scholarship of orientation with only some of its aspects attracting formal enquiry, even though there is a growing interest in transitions in medical education as a whole. We hope, therefore, that this study can help to legitimize enquiry into orientation in all its forms and that it can begin to situate the role of orientation more firmly within the firmament of medical education practice and research.