Is research on professional identity formation biased? Early insights from a scoping review and metasynthesis.

OBJECTIVE: Despite a recent surge in literature identifying professional identity formation (PIF) as a key process in physician development, the empiric study of PIF in medicine remains in its infancy. To gain insight about PIF, the authors examined the medical literature and that of two other helping professions. METHODS: The authors conducted a scoping review and qualitative metasynthesis of PIF in medicine, nursing and counselling/psychology. For the scoping review, four databases were searched using a combination of keywords to identify empiric studies on PIF in trainees. After a two-step screening process, thematic analysis was used to conduct the metasynthesis on screened articles. RESULTS: A total of 7451 titles and abstracts were screened; 92 studies were included in the scoping review. Saturation was reached in the qualitative metasynthesis after reviewing 29 articles. CONCLUSION: The metasynthesis revealed three inter-related PIF themes across the helping professions: the importance of clinical experience, the role of trainees' expectations of what a helping professional is or should be, and the impact of broader professional culture and systems on PIF. Upon reflection, most striking was that only 10 of the 92 articles examined trainee's sociocultural data, such as race, ethnicity, gender, sexual orientation, age and socio-economic status, in a robust way and included them in their analysis and interpretation. This raises the question of whether conceptions of PIF suffer from sociocultural bias, thereby disadvantaging trainees from diverse populations and preserving the status quo of an historically white, male medical culture.

An exploration of relational aggression in the nursing workplace.

OBJECTIVE: This study provides a 1st look at relational aggression (RA) and the consequences among nurses. BACKGROUND: Interpersonal hostility, bullying, and a toxic work environment (WE) can impact patient care delivery as well as nurses' personal health and job satisfaction. METHODS: The Relational Aggression Assessment Scale, measuring aggressors, victims, and bystanders, was used to measure RA in a sample of 842 nurses. Additional variables measured included a demographic profile, job satisfaction, and intent to leave. RESULTS: Nurses were most likely to identify with victim behaviors, but a minority of nurses reported relying on aggressor behaviors and bystander behaviors. There was a positive correlation among aggressor, victim, and bystander items, suggesting overlap in roles. CONCLUSIONS: A few relationally aggressive individuals can create a toxic WE. Interventions to address RA among nurses must be tested, as well as strategies for improving job satisfaction and promoting healthy WEs through positive relationships.

Ethics pocket cards: an educational tool for busy clinicians.

The adage "an ounce of prevention is worth a pound of cure" is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees.

The negative impact of organizational cynicism on physicians and nurses.

Despite the potentially severe consequences that might result, there is a paucity of research on organizational cynicism within US health care providers. In response, this study investigated the effect of cynicism on organizational commitment, job satisfaction, and interest in leaving the hospital for another job in a sample of 205 physicians and 842 nurses. Three types of cynicism were investigated: trait (dispositional), global (directed toward the hospital), and local (directed toward a specific unit or department). Findings indicate that all 3 types of cynicism were negatively related to affective organizational commitment and job satisfaction, but positively related to interest in leaving. In both nurse and physician samples, cynicism explained about half of the variance in job satisfaction and affective commitment, which is the type of commitment managers are most eager to promote. Cynicism accounted for about a quarter and a third of the variance in interest in leaving the hospital for nurses and physicians, respectively. Trait, global, and local cynicism each accounted for unique variance in affective commitment, job satisfaction, and interest in leaving, with global cynicism exerting the largest influence on each outcome. The implications for managers are that activities aimed at decreasing organizational cynicism are likely to increase affective organizational commitment, job satisfaction, and organizational tenure.

A New Construct in Undergraduate Medical Education Health Humanities Outcomes: Humanistic Practice.

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

The Experience of Medical Scribing: No Disparities Identified.

Introduction: The chronic failure to significantly increase the number of underrepresented minorities (URM) in medicine requires that we look for new mechanisms for channelling URM students through pre-medical education and into medical school. One potential mechanism is medical scribing, which involves a person helping a physician engage in real-time documentation in the electronic medical record. Methods: As a precursor to evaluating this mechanism, this survey pilot study explored individuals' experiences working as a medical scribe to look for any differences related to URM status. Of 248 scribes, 159 (64% response rate) completed an online survey. The survey was comprised of 11 items: demographics (4 items), role and length of time spent as a scribe (2 items), and experience working as a scribe (5 items). Results: The vast majority (>80%) of participants reported that working as a medical scribe gave them useful insight into being a clinician, provided valuable mentoring, and reinforced their commitment to pursue a career in medicine. The experiences reported by scribes who identified as URM did not differ from those reported by their majority counterparts. Discussion: It remains to be seen whether medical scribing can serve as an effective pipeline for URM individuals to matriculate into medical school. But the present findings suggest that the experience of working as a medical scribe is a positive one for URM.

Can an Arts Course Help Mitigate Medical Student Burnout?

Introduction: Burnout in healthcare providers begins early, with about half of medical students experiencing symptoms of burnout, and as many as one-quarter experiencing depression. While organizational, systemic-level changes certainly contribute to mitigation, organizationally sponsored individual-level changes may also play a significant role. Although the nature of the burnout epidemic and its impact on trainee wellness is fairly well understood, and interventions have been studied, there remains a gap in the empirical research examining the impact of the arts on medical student well-being. Methods: We designed a convergent mixed methods study to evaluate whether a 9-month course for fourth-year medical students called Art as Self Care (AASC) would help trainees develop habits that supported their well-being. An online survey was used to collect data at the beginning and end of each academic year on two consecutive cohorts of students. A focus group explored students' experience with and perceptions about the course. Results: Qualitative results indicated that the AASC course provided positive distraction that is calming and allowed students to shift focus from the stresses of daily medical school life. Our quantitative results suggest that art might provide a slight protective effect in medical students: whereas 22% of the non-AASC students saw a worsening of their psychological distress across the fourth year of medical school, this was observed in only 13% of the AASC students. Discussion: Our study presents pilot and feasibility data to better inform future research and practice around the use of art to support medical student well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01604-y.

Training currently practicing members of the ethics consultation service: one institution's experience.

Most hospitals and nursing homes have individuals who engage in ethics consultation, and most do so with very little, if any, training. The goal of this article is not to advance the scholarly literature on training clinical ethics consultants, but instead to provide a road map for individuals doing ethics consultation who would like more training. In this way, I hope to advance the field in some small way, by educating, empowering, and encouraging small- to medium-sized hospitals to train the members of their ethics committee who engage in ethics consultation.

The prism model: advancing a theory of practice for arts and humanities in medical education.

INTRODUCTION: The arts and humanities have transformative potential for medical education. Realizing this potential requires an understanding of what arts and humanities teaching is and what it aims to do. A 2016 review of exclusively quantitative studies mapped three discursive positions (art as intrinsic to, additive to or curative for medicine) and three epistemic functions (art for mastering skills, perspective taking, and personal growth and activism). A more inclusive sample might offer new insights into the position and function of arts and humanities teaching in medical education. METHODS: Informed by this 2016 framework, we conducted discursive and conceptual analyses of 769 citations from a database created in a recent scoping review. We also analyzed the 15 stakeholder interviews from this review for recurring themes. These three analyses were iteratively compared and combined to produce a model representing the complex relationship among discursive functions and learning domains. RESULTS: The literature largely positioned arts and humanities as additive to medicine and focused on the functions of mastering skills and perspective taking. Stakeholders emphasized the intrinsic value of arts and humanities and advocated their utility for social critique and change. We offer a refined theory of practice-the Prism Model of four functions (mastering skills, perspective taking, personal insight and social advocacy)-to support more strategic use of arts and humanities in medical education across all learning domains. DISCUSSION: The Prism Model encourages greater pedagogical flexibility and critical reflection in arts and humanities teaching, offering a foundation for achieving its transformative potential.

How Are the Arts and Humanities Used in Medical Education? Results of a Scoping Review.

PURPOSE: Although focused reviews have characterized subsets of the literature on the arts and humanities in medical education, a large-scale overview of the field is needed to inform efforts to strengthen these approaches in medicine. METHOD: The authors conducted a scoping review in 2019 to identify how the arts and humanities are used to educate physicians and interprofessional learners across the medical education continuum in Canada and the United States. A search strategy involving 7 databases identified 21,985 citations. Five reviewers independently screened the titles and abstracts. Full-text screening followed (n = 4,649). Of these, 769 records met the inclusion criteria. The authors performed descriptive and statistical analyses and conducted semistructured interviews with 15 stakeholders. RESULTS: The literature is dominated by conceptual works (n = 294) that critically engaged with arts and humanities approaches or generally called for their use in medical education, followed by program descriptions (n = 255). The literary arts (n = 197) were most common. Less than a third of records explicitly engaged theory as a strong component (n = 230). Of descriptive and empirical records (n = 424), more than half concerned undergraduate medical education (n = 245). There were gaps in the literature on interprofessional education, program evaluation, and learner assessment. Programming was most often taught by medical faculty who published their initiatives (n = 236). Absent were voices of contributing artists, docents, and other arts and humanities practitioners from outside medicine. Stakeholders confirmed that these findings resonated with their experiences. CONCLUSIONS: This literature is characterized by brief, episodic installments, privileging a biomedical orientation and largely lacking a theoretical frame to weave the installments into a larger story that accumulates over time and across subfields. These findings should inform efforts to promote, integrate, and study uses of the arts and humanities in medical education.

Patients' expressed and unexpressed needs for information for informed consent.

Informed consent is the practical application of the principle of autonomy, and two of the five core features of informed consent are related to information. Researchers have reported on patients' expressed needs for information, such as their stated desires for the quantity of and the source of information. A separate body of research has examined patients' unexpressed needs for information from the perspective of cognitive psychology, such as the emotional tone and order of information. This article suggests that the autonomy of patients is best served by meeting their expressed and unexpressed information needs for in tandem.

Does Pre-clerkship Medical Humanities Curriculum Support Professional Identity Formation? Early Insights from a Qualitative Study.

There is a lack of consensus about the outcomes of medical humanities training. In this qualitative study, the authors analyzed pre-clerkship small group discussions to assess the nature of learning in medical humanities. Twenty-two medical students (12 females and 10 males) in three humanities small groups consented to participate. The authors used inductive thematic analysis to qualitatively analyze the text from 13 weeks of curriculum. Findings indicate that students reflect about negotiating the clinician-patient relationship within the stressful environment characteristic of today's healthcare systems, that they worry about sacrificing their personal values in pursuit of honoring professional expectations, and that they encounter and commonly confront ambiguity. These themes were used to develop a descriptive framework of humanities small groups as a structure and safe space for the early development of professional identity.

Why Pull the Arrow When You Cannot See the Target? Framing Professionalism Goals in Medical Education.

Professionalism is essential for a successful physician-patient relationship and widely acknowledged as an intrinsic and important component of medical education for learners at all levels, from medical school to residency to continuing medical education. The problem is defining the educational end points for learners and then determining how to assess these outcomes. This Invited Commentary focuses on what medical educators can and should do to refine the vision of professionalism in medical education. The authors propose a multistep process in which learners, educators, and the public are engaged in articulating clearly and definitively the end points of professionalism education.