Learning and coping through reflection: exploring patient death experiences of medical students.

BACKGROUND: Existing studies have explored many aspects of medical students' experiences of patient death and propose the importance of faculty support for coping. However, UK-based literature on this subject and research concerning learning through reflection as part of coping are relatively limited. This study, through the lens of reflection, aims to explore students' experiences with patient death in a UK context. These include coping strategies, support from faculty following patient death and the relationship between these experiences and learning. Our research questions were: How do medical students cope with and learn from their experiences?How does support from ward staff and the medical school help them cope with and learn from these experiences?How can students best be supported following patient death? METHODS: We employed narrative inquiry to explore how medical students made sense of their experiences of patient death. Twelve students participated in our study via an online narrative questionnaire. Thematic analysis and complementary narrative analysis of an exemplar were applied to address our research aim. RESULTS: Coping strategies comprised internal and external strategies. Internal strategies included (1) re-interpretation of the death into a meaningful experience including lessons learned; (2) normalization; (3) staying busy and (4) enduring negative emotions. External strategies included speaking to someone, which was found to influence normalization, and lessons learned. Both satisfactory and unsatisfactory support from ward staff was identified. Satisfactory support was characterized by the inclusion of emotional and professional support. Unsatisfactory support was often characterized by a lack of emotional support. Narrative analysis further demonstrated how the experience with patient death was re-interpreted meaningfully. Students suggested that support should be structured, active, sensitive, and include peers and near-peers. CONCLUSION: Many coping strategies, internal and external, were employed in students' experiences with patient death. Student reflections, enhanced by support from ward staff, were shown to be important for learning from patient death. We encourage faculty to have regular sessions in which medical students can reflect on the death incident and discuss appropriately with others, including peers and near-peers.

Resilience: insights from medical educators.

BACKGROUND: Educators have unique opportunities to cultivate resilience in themselves and in their learners across the medical education continuum through the formal, informal and hidden curricula. Yet, there is a dearth of research exploring how medical educators conceptualise resilience, and how they foster learner resilience in medical education. METHODS: Thematic framework analysis was conducted on data collected through an online questionnaire, which was part of a larger study exploring resilience in medical educators. Open-ended questions examined educators' conceptualisations of resilience and how they reported supporting resilience in their learners. Sociodemographic characteristics were also collected to describe the sample of participants. FINDINGS: A total of 244 medical educators participated from across the UK. They predominantly conceptualised resilience as an individual process. Participants mostly reported approaches to fostering learner resilience that aligned with the formal and informal curricula. Approaches addressing the hidden curriculum were seldom mentioned. DISCUSSION: Opportunities exist for faculty development around multidimensional conceptualisations of resilience, and for medical educators to critically reflect on how their concepts of resilience may be influencing their approach to fostering learner resilience. Furthermore, the hidden curriculum could be featured as one of the multifaceted strategies to support resilience in learners

Developing a national dental education research strategy: priorities, barriers and enablers.

OBJECTIVES: This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. SETTING: Scotland. PARTICIPANTS: In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. RESULTS: Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology. CONCLUSIONS: This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation.

Exploring stakeholders' views of medical education research priorities: a national survey.

CONTEXT: Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority-setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland. METHODS: This study utilised a two-stage design to explore the views of stakeholders across the medical education continuum using online questionnaires. In Stage 1, key informants outlined their top three MER priorities and justified their choices. In Stage 2, participants rated 21 topics generated in Stage 1 according to importance and identified or justified their top priorities. A combination of qualitative (i.e. framework analysis) and quantitative (e.g. exploratory factor analysis) data analyses were employed. RESULTS: Views were gathered from over 1300 stakeholders. A total of 21 subthemes (or priority areas) identified in Stage 1 were explored further in Stage 2. The 21 items loaded onto five factors: the culture of learning together in the workplace; enhancing and valuing the role of educators; curriculum integration and innovation; bridging the gap between assessment and feedback, and building a resilient workforce. Within Stage 2, the top priority subthemes were: balancing conflicts between service and training; providing useful feedback; promoting resiliency and well-being; creating an effective workplace learning culture; selecting and recruiting doctors to reflect need, and ensuring that curricula prepare trainees for practice. Participant characteristics were related to the perceived importance of the factors. Finally, five themes explaining why participants prioritised items were identified: patient safety; quality of care; investing for the future; policy and political agendas, and evidence-based education. CONCLUSIONS: This study indicates that, across the spectrum of stakeholders and geography, certain MER priorities are consistently identified. These priority areas are in harmony with a range of current drivers in UK medical education. They provide a platform of evidence on which to base decisions about MER programmes in Scotland and beyond.

The effects of imagery on problem-solving ability and autobiographical memory.

Williams et al. (2006) found that increased imageability of cue words during an autobiographical memory task increased specificity of autobiographical memory (ABM) and improved subsequent social problem-solving (SPS). This study explored whether imagery during SPS improved SPS skill, perceived SPS ability, and the specificity of ABMs retrieved in the process of SPS in dysphoric students. Additionally, this study hypothesised that both memory specificity and perceived SPS ability would positively correlate with SPS skill. Dysphoric and non-dysphoric students solved hypothetical social problems on a modified version of the Means-End Problem-Solving task with a verbal or an imagery focus. Participants also completed a questionnaire about ABMs retrieved during SPS and rated their perceived effectiveness of their solutions. Contrary to Williams et al. (2006), the imagery focus did not improve SPS skill or influence perceived effectiveness. Additionally, in contrast to the hypothesis, the imagery group retrieved more overgeneral memories. Finally, ABM specificity did not correlate with SPS skill. However, dysphoric participants perceived specific memories to be significantly less helpful to SPS whereas non-dysphoric participants perceived specific memories to be helpful potentially supporting work on overgeneral ABM and functional avoidance.