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.

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.

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.

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.

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.

An Interdepartmental Care Model to Expedite Admission from the Emergency Department to the Medical ICU.

BACKGROUND: Early evidence suggests that multidisciplinary programs designed to expedite transfer from the emergency department (ED) may decrease boarding times. However, few models exist that provide effective ways to improve the ED- to-ICU transition process. In 2012 Christiana Care Health System (Newark, Delaware) created and implemented an interdepartmental program designed to expedite the transition of care from the ED to the medical ICU (MICU). METHODS: This quasi-experimental study compared ED length of stay (LOS), MICU LOS, and overall hospital LOS before and after the MICU Alert Team (MAT) intervention program. The MAT consisted of a MICU nurse and physician assistant, with oversight by a MICU attending physician. The ED triggered the MAT after patients were stabilized and determined to require MICU admission. Following bedside face-to-face hand off, the MAT providers then assumed responsibly of a patient's care. If no MICU bed was available, the MAT cared for patients in the ED until they were transferred to the MICU. RESULTS: ED LOS was reduced by 30% (2.6 hours) from baseline (p < .001). There were no significant differences in MICU LOS (p = .26), overall hospital LOS (p = .43), or mortality (p = .59). ED LOS was shortened (p < .001) at each increasing level of MICU bed availability (31% when 0 MICU beds available; 26% when 1 or more MICU beds available). Time series analysis identified a 1.5-hour drop in ED LOS (p = .02) for patients transferred from the MICU immediately following intervention implementation and was sustained over time. CONCLUSION: Early outcomes demonstrate that the MAT intervention can reduce ED LOS for critically ill patients. Additional studies should determine optimal approaches to improve clinical outcomes.

Identifying potential engaging leaders within medical education: The role of positive influence on peers.

BACKGROUND: Previous research has paid little to no attention towards exploring methods of identifying existing medical student leaders. AIM: Focusing on the role of influence and employing the tenets of the engaging leadership model, this study examines demographic and academic performance-related differences of positive influencers and if students who have been peer-identified as positive influencers also demonstrate high levels of genuine concern for others. METHODS: Three separate fourth-year classes were asked to designate classmates that had significant positive influences on their professional and personal development. The top 10% of those students receiving positive influence nominations were compared with the other students on demographics, academic performance, and genuine concern for others. RESULTS: Besides age, no demographic differences were found between positive influencers and other students. High positive influencers were not found to have higher standardized exam scores but did receive significantly higher clinical clerkship ratings. High positive influencers were found to possess a higher degree of genuine concern for others. CONCLUSION: The findings lend support to (a) utilizing the engaging model to explore leaders and leadership within medical education, (b) this particular method of identifying existing medical student leaders, and

The (stalled) progress of interprofessional collaboration: the role of gender.

Researchers have demonstrated that team-based, collaborative care improves patient outcomes and fosters safer, more effective health care. Despite such positive findings, interprofessional collaboration (IPC) has been somewhat stunted in its adoption. Utilizing a socio-historical lens and employing expectation states theory, we explore potential reasons behind IPC's slow integration. More specifically, we argue that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women--and how these societal-level disparities are exercised and perpetuated within health care delivery. For instance, we examine not only the historical differences in occupational status of the more "gendered" professions within health care delivery teams (e.g. medicine and nursing), but also the persistent under-representation of women in the physician workforce, especially in leadership positions. Doing so reveals how gender representation, or lack thereof, could potentially lead to ineffective, mismanaged and segmented interprofessional care. Implications and potential solutions are discussed.

U.S. physician burnout and the proletarianization of U.S. doctors: A theoretical reframing.

We delve into the escalating issue of U.S. physician burnout, arguing its roots lie in the proletarianization of the U.S. medical profession-a transition driven by the loss of autonomy and control under the shadow of capitalist systems. This process, aligned with Marx's concept of proletarianization, sees physicians morph from independent practitioners to exploited workers within a wage-labor system controlled by a corporatized U.S. healthcare system. We contend that contemporary factors attributed to U.S. physician burnout-loss of control, emphasis on productivity, increased clerical demands, and a diminishing sense of work's meaning-are not novel but deeply ingrained in the medical profession's socio-historical fabric. By juxtaposing burnout with proletarianization, we highlight macro-level sources of strain and advocate for reevaluating physician work through Marxist theory and, in turn, extend the argument that addressing burnout necessitates moving beyond individual or organizational solutions to encompass broader socio-economic structures as seen through the lens of work exploitation. We conclude by discussing "class consciousness" among U.S. physicians and posit that collective awareness and action could pave the way for substantial reforms for the practice of medicine, the organization of medicine as a profession, and the burnout epidemic among U.S. physicians.

A multidimensional perspective of the mental health of preclinical medical students.

Previous research on medical students' mental health has focused almost exclusively on students' emotional well-being and/or their personal psychological functioning, neglecting the more public side of medical training - the students' social health. A total of 237 preclinical students completed surveys at the beginning and the end of their academic year assessing their emotional, psychological, and social well-being, respectively, as well as the overall negative impact medical school stressors had on their lives. Although first and second year students were found to significantly decrease in emotional well-being, first year students were found to increase in social well-being, with further analysis showing an increase among first year students specifically in the feelings of social integration and social acceptance. The overall negative impact from the stressors was found to predict the change in emotional well-being, but not other dimensions of well-being. However, the negative impact from stressors was also found to indirectly impact students' emotional well-being through negatively affecting their psychological and social well-being. The authors present the value in measuring medical students' well-being from a multidimensional perspective as well as highlight the potential "condensing" of students' social world as early as their first year of training. Recommendations are made that researchers continue to focus on the promotion and protection of students' positive mental health in the preliminary stages of medical education, as well as endorse programs that cultivate the benefits of solidarity and integration experienced by first year students.

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.

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.

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.

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.

Learning to cure, but learning to care?

Utilizing interviews with students and a key administrator, analyses of academic schedules, and observations of courses, labs, and small groups, this study examines if and how elements of the explicit preclinical curriculum may have deleterious effects on medical students' humanitarian attributes, namely empathy. Findings from this case-study of a medical school in the United States suggest that the lack of frequent formal testing in the psycho-social aspects of patient care during the preclinical years, as well as a general reduction in curriculum hours devoted to teaching the social aspects of medicine, may serve as mechanisms behind the diminution of medical students' levels of empathy and other positive attributes as found by previous research. Following the basic tenets of the Testing Effect and the assumption that assessment drives learning, it is argued that a feasible way to maintain and potentially cultivate these traits among medical students, without saturating an overwhelmed medical curriculum, would be to install periodic, formally graded exams into preclinical curriculums that evaluate empathy and the psycho-social aspects of care.

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.