Social Network Analysis in Undergraduate and Postgraduate Medical Education: A Scoping Review.

PURPOSE: Social network analysis (SNA) is a theoretical framework and analytical approach used to study relationships among individuals and groups. While SNA has been employed by many disciplines to understand social structures and dynamics of interpersonal relationships, little is known about its use in medical education. Mapping and synthesizing the scope of SNA in undergraduate and postgraduate medical education can inform educational practice and research. METHOD: This scoping review was based on searches conducted in Medline, Embase, Scopus, and ERIC in December 2020 and updated in March 2022. After removal of duplicates, the search strategy yielded 5,284 records, of which 153 met initial inclusion criteria. Team members conducted full-text reviews, extracted relevant data, and conducted descriptive and thematic analyses to determine how SNA has been used as a theoretical and analytical approach in undergraduate and postgraduate medical education. RESULTS: Thirty studies, from 11 countries, were retained. Most studies focused on undergraduate medical students, primarily in online environments, and explored students' friendships, information sharing, and advice seeking through SNA. Few studies included residents and attending staff. Findings suggested that SNA can be a helpful tool for monitoring students' interactions in online courses and clinical clerkships. SNA can also be used to examine the impact of social networks on achievement, the influence of social support and informal learning outside the classroom, and the role of homophily in learning. In clinical settings, SNA can help explore team dynamics and knowledge exchange among medical trainees. CONCLUSIONS: While SNA has been underutilized in undergraduate and postgraduate medical education, findings indicate that SNA can help uncover the structure and impact of social networks in the classroom and the clinical setting. SNA can also be used to help design educational experiences, monitor learning, and evaluate pedagogical interventions. Future directions for SNA research in medical education are described.

Social Dynamics of Advice-Seeking: A Network Analysis of Two Residency Programs.

Phenomenon: Residents interact with their peers and supervisors to ask for advice in response to complicated situations occurring during patient care. To provide a deeper understanding of workplace learning, this study explores the structure and dynamics of advice-seeking networks in two residency programs. Approach: We conducted a survey-based social network study. To develop the survey, we conducted focus group discussions and identified three main categories of advice: factual knowledge, clinical reasoning, and procedural skills. We invited a total of 49 emergency medicine and psychiatry residents who had completed at least six months of their training, to nominate their supervisors and peer residents, as their sources of advice, from a roster. Participants identified the number of occasions during the previous month that they turned to each person to seek advice regarding the three broad categories. We calculated the density, centrality, and reciprocity measures for each advice category at each department. Findings: The response rates were 100% (n = 21) and 85.7% (n = 24) in the emergency medicine and psychiatry departments, respectively. The advice network of emergency medicine residents was denser, less hierarchical, and less reciprocated compared to the psychiatry residents' network. In both departments, PGY-1s were the top advice-seekers, who turned to PGY-2s, PGY-3s, and supervisors for advice. The "procedural skills" network had the lowest density in both departments. There was less overlap in the sources of advice for different advice types in the psychiatry department, implying more selectivity of sources. Insights: Complex social structures and dynamics among residents vary by discipline and level of seniority. Program directors can develop tailored educational interventions informed by their departments' specific network patterns to promote a timely and effective advice-seeking culture which in turn, could lead to optimally informed patient care.

The impact of prior performance information on subsequent assessment: is there evidence of retaliation in an anonymous multisource assessment system?

Few studies have engaged in data-driven investigations of the presence, or frequency, of what could be considered retaliatory assessor behaviour in Multi-source Feedback (MSF) systems. In this study, authors explored how assessors scored others if, before assessing others, they received their own assessment score. The authors examined assessments from an established MSF system in which all clinical team members - medical students, interns, residents, fellows, and supervisors - anonymously assessed each other. The authors identified assessments in which an assessor (i.e., any team member providing a score to another) gave an aberrant score to another individual. An aberrant score was defined as one that was more than two standard deviations from the assessment receiver's average score. Assessors who gave aberrant scores were categorized according to whether their behaviour was preceded by: (1) receiving a score or not from another individual in the MSF system (2) whether the score they received was aberrant or not. The authors used a multivariable logistic regression model to investigate the association between the type of score received and the type of score given by that same individual. In total, 367 unique assessors provided 6091 scores on the performance of 484 unique individuals. Aberrant scores were identified in 250 forms (4.1%). The chances of giving an aberrant score were 2.3 times higher for those who had received a score, compared to those who had not (odds ratio 2.30, 95% CI:1.54-3.44, P < 0.001). Individuals who had received an aberrant score were also 2.17 times more likely to give an aberrant score to others compared to those who had received a non-aberrant score (2.17, 95% CI:1.39-3.39, P < 0.005) after adjusting for all other variables. This study documents an association between receiving scores within an anonymous multi-source feedback (MSF) system and providing aberrant scores to team members. These findings suggest care must be given to designing MSF systems to protect against potential downstream consequences of providing and receiving anonymous feedback.

Understanding and Embracing Culture in International Faculty Development.

Introduction: Research on international faculty development programs (IFDPs) has demonstrated many positive outcomes; however, participants' cultural backgrounds, beliefs, and behaviors have often been overlooked in these investigations. The goal of this study was to explore the influences of culture on teaching and learning in an IFDP. Method: Using interpretive description as the qualitative methodology, the authors conducted semi-structured interviews with 15 Fellows and 5 Faculty of a US-based IFDP. The authors iteratively performed a constant comparative analysis to identify similar patterns and themes. Transformative Learning Theory informed the analysis and interpretation of the results. Results: This research identified three themes related to the influences of culture on teaching and learning. First, cultural differences were not seen as a barrier to learning; instead, they tended to act as a bridge to cultural awareness and network building. Second, some cultural differences produced a sense of unease and uncertainty, which led to adaptations, modifications, or mediation. Third, context mattered, as participants' perspectives were also influenced by the program culture and their professional backgrounds and experiences. Discussion: The cultural diversity of health professions educators in an IFDP did not impede learning. A commitment to future action, together with the ability to reflect critically and engage in dialectical discourse, enabled participants to find constructive solutions to subtle challenges. Implications for faculty development included the value of enhanced cultural awareness and respect, explicit communication about norms and expectations, and building on shared professional goals and experiences.

Validity of constructed-response situational judgment tests in training programs for the health professions: A systematic review and meta-analysis protocol.

BACKGROUND: Situational judgments tests have been increasingly used to help training programs for the health professions incorporate professionalism attributes into their admissions process. While such tests have strong psychometric properties for testing professional attributes and are feasible to implement in high-volume, high-stakes selection, little is known about constructed-response situational judgment tests and their validity. METHODS: We will conduct a systematic review of primary published or unpublished studies reporting on the association between scores on constructed-response situational judgment tests and scores on other tests that measure personal, interpersonal, or professional attributes in training programs for the health professions. In addition to searching electronic databases, we will contact academics and researchers and undertake backward and forward searching. Two reviewers will independently screen the papers and decide on their inclusion, first based on the titles and abstracts of all citations, and then according to the full texts. Data extraction will be done independently by two reviewers using a data extraction form to chart study details and key findings. Studies will be assessed for the risk of bias and quality by two reviewers using the "Quality In Prognosis Studies" tool. To synthesize evidence, we will test the statistical heterogeneity and conduct a psychometric meta-analysis using a random-effects model. If adequate data are available, we will explore whether the meta-analytic correlation varies across different subgroups (e.g., race, gender). DISCUSSION: The findings of this study will inform best practices for admission and selection of applicants for training programs for the health professions and encourage further research on constructed-response situational judgment tests, in particular their validity. TRIAL REGISTRATION: The protocol for this systematic review has been registered in PROSPERO [CRD42022314561]. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022314561.

Reopening of a school of dentistry in the era of COVID-19 pandemic, "Step-by-step" approach.

INTRODUCTION: The COVID-19 pandemic has a great impact on all aspects of higher education worldwide. In Iran, after several months of lockdown, all dental schools coped with the challenge of "reopening." School of Dentistry of Tehran University of Medical Sciences (TUMS) planned to facilitate the process of reopening using a "step-by-step" approach. The aim of this study was sharing our experiences of reopening of the school during the pandemic. METHODS: TUMS School of Dentistry planned a "step-by-step" approach of reopening of school to both provide infrastructure of online education for theoretical credits and reassure all staff and students about infection control for practical courses. Also, a two-section survey on students' satisfaction with a variety of aspects of reopening process and the clinical performance of students in different clinical courses was conducted. RESULTS: Findings showed 65.1% of the students, attended the survey, were satisfied with reopening of the school. Also, 86.4% were satisfied with the new online method of education for theoretical courses. Regarding personal protective equipment (PPE) provided for the students, 22.9% and 56.5% of them were satisfied and moderately satisfied, respectively. Additionally, 78.2% of the students were satisfied with the newly developed online assessment method. CONCLUSION: Although reopening of schools during COVID-19 pandemic seems enigmatic for all authorities and students, the "step-by-step" plan designed by TUMS School of dentistry including emotional and infrastructural prerequisites might be a reliable method for all people, who are in charge of management of dental school in uncertain crisis.

Challenges of the Medical Ethics PhD curriculum in Iran: A qualitative study.

Background: Bioethics is the foundation of medical practices, and can be applied in the different levels of medicine. In Iran, Medical Ethics started to be taught in the form of PhD course in Tehran University of Medical Sciences (TUMS) in 2007. Although many aspects of this plan are successfully implemented, some deficits also are frequently pointed out by many professors and students. The purpose of this study was to recognize the deficits and weaknesses of the current curriculum. Methods: This study was a qualitative descriptive type which was conducted based on semi-structured deep interview with open questions. The sample population of this research was composed of faculty members in Medical Ethics department of TUMS, students and graduates of PhD in Medical Ethics and also, the experts who worked on codification of the initial curriculum. Results: Overall, eleven individuals were interviewed. In general, "Practical application", "Feeling the Need", "Professional Doctorate", "Human Sciences", "Paramedical", "Possible", "Impossible", "Defining the Discipline Nature", "Student Attraction", "Professor", "Training", "Evaluation Procedure", "Student Admission", "Educational Content", "Teaching Method", :Student Evaluation", and "Course Management" were the main themes. Conclusion: With regard to the deficiencies in Medical Ethics training and also, the problems identified through interviews, it seems that a great deal of problems are possible to solve if Medical Ethics is considered an interdisciplinary field instead a monodisciplinary one. One of the main purposes in interdisciplinary fields is investigating, analyzing and introducing measures for issues and problems that cannot be known and solved by a single discipline.

Exploring clinical educators' perceptions of role modeling after participating in a role modeling educational program.

INTRODUCTION: Role modeling significantly affects medical students' values, attitudes, and professional behaviors. Role modeling is a complex and multidimensional process that necessitates accurate perception and adequate knowledge and skills. However, most clinical educators do not have adequate awareness and knowledge about the positive and negative effects of role modeling. We aimed to explore clinical educators' perceptions of role modeling after participating in a role modeling educational program. METHODS: This qualitative study was conducted on eighteen clinical educators who were voluntarily participated in a three-month role modeling educational program. Data were collected using reflection paper writing and were analyzed through conventional content analysis. RESULTS: Data analysis resulted in the development of three main categories, namely closer attention to role modeling and effort for its promotion, deliberate effort to display role modeling, and creating a positive environment to increase the effectiveness of role modeling. CONCLUSIONS: Clinical educators have limited role modeling knowledge and skills, and hence, educational programs are required to improve their role modeling knowledge, attitudes, and skills. Role modeling educational programs should aim at developing educators' awareness and knowledge about role modeling, develop their reflection and self-control abilities, and sensitize them to the importance of deliberate use of role modeling.

Turning unprofessional behaviors around using Holmes' reflection approach: a randomized controlled study.

Many medical schools around the world have included professionalism training in their formal curriculum. However, these efforts may not be adequate; given the exposure of students to unprofessional behaviors in the clinical settings. In the present study, we aimed to design, implement, and evaluate a longitudinal program to improve professionalism among medical students upon their transition to clinical settings. A total of 75 medical students were enrolled in the study and randomly assigned to two groups. The control group did not receive any training, while for the intervention group; a 10-hour program through 16 weeks was organized based on the Holmes' reflection approach. The effectiveness of the program was evaluated by measuring three outcomes in both groups. Data analysis was performed using paired t-test and Multiple Linear Regression. Scores of judgment of professionalism increased in the intervention group (from 7.56 to 10.17; P< 0.001), while there was no significant improvement in the control group's scores. Students' attitudes towards professionalism and their professional behaviors did not change significantly. Based on our findings, the Holmes reflection approach helps students improve their cognitive base of professionalism. Long-term follow-up and further qualitative studies will help us better understand the effects of this approach on other desirable outcomes.

Development of a comprehensive communication skills curriculum bases on intervention mapping in response to an urgent need for community health workers' education reform: A study protocol.

BACKGROUND: Communication skills are one of the most important competencies required for community health workers (CHWs); however, there is no systematic evidence-based communication training course for them. In this study, we aim to develop a comprehensive communication skills curriculum for CHWs based on the intervention mapping (IM) approach. MATERIALS AND METHODS: We used the IM approach to develop a systematic evidence-based communication skills curriculum for CHWs. First, we will determine the required competencies (by a literature search, a qualitative study, and a Delphi study), and then, we will develop a questionnaire for need assessment, and finally, we will implement the course and evaluate its efficacy by conducting a randomized controlled trial. This study was designed according to the steps of IM. CONCLUSION: This protocol reports an example of developing a training course using IM. This course could be applied for similar health workers across the world, as well as the CHWs.

Improving Role Modeling in Clinical Teachers: A Narrative Literature Review.

INTRODUCTION: Students observe role models and learn from them in a variety of educational settings. Although it is known that role models impact on professional and character development of students, some clinical teachers are poor role models. We conducted a review to summarize evidence that could help clinical teachers promote their role modeling. METHODS: We performed a review search and by using specific keywords (curriculum, role model*, faculty development, teach*, program* and education), through electronic databases (PubMed, EMBASE, and ERIC). We obtained 320 qualitative and quantitative studies. Having removed the duplicate references, we read 244 titles and excluded irrelevant ones. Eighty-two articles were retained and the abstract of each was read. Finally, 20 articles were included. RESULTS: According to the results of our review, three major themes were identified: 1) features of a good role model composed of teaching, clinical, and personal-interpersonal skills 2) self-improvement of role modeling, and 3) faculty development programs. CONCLUSIONS: Role models have a profound effect on the attitudes and behaviors of medical students. It is important for clinical teachers to make an intentional effort to articulate what aspects they are modeling. This study can help faculty members be an effective role model. Also, finding of this review could form the foundation of a faculty development program in order to foster role modeling in clinical settings.

Psychometric properties of the mini peer assessment tools (Mini-PAT) in emergency medicine residents.

Background: A few studies have been done regarding the validity and reliability of the Mini-Peer Assessment Tool across various specialties. This study was conducted to determine the reliability, content and construct validity of Mini-Peer Assessment Tool to assess the competency of emergency medicine residents. Methods: This study was carried out to investigate the psychometric properties of the mini-PAT tool to evaluate the professional competencies of emergency medicine residents in educational hospitals affiliated to Tehran University of Medical Sciences. The initial Mini-Peer Assessment Tool was translated into Persian. After that, the content validity index and content validity ratio determined by consulting 12 professors of emergency medicine. The construct validity was determined with exploratory factor analysis and investigation of the correlation coefficient on 31 self and 248 peer assessment cases. The reliability of the mini peer assessment tool was determined by internal consistency and item deletion by using Cronbach's alpha coefficient. Reliability was also assessed by determining the agreement between the two tools of self-assessment and peer assessment by using the diagram Bland and Altman. Results: The results showed content validity ratio (CVR) of the items ranged from 0.56 to 0.83, and the content validity index (CVI) of the items ranged from 0.72 to 0.90. The reliability of the self-assessment and peer-assessment tools were 0.83 and 0.95 respectively and there was a relative agreement between the self-assessment method and the peer assessment method. Finally, the tool underwent exploratory factor analysis resulting extraction into two factors namely 'clinical competencies' and 'human interactions' in the peer assessment tool. In the self-assessment tool, the factors of 'good practice' and 'technical competence' were extracted. Conclusion: The results of the present study provided evidence of the adequacy of content validity, reliability of the contextually customized mini-peer assessment tool in assessing the competencies of emergency medicine residents.

The utility of mini-Clinical Evaluation Exercise in undergraduate and postgraduate medical education: A BEME review: BEME Guide No. 59.

Background: This BEME review aims at exploring, analyzing, and synthesizing the evidence considering the utility of the mini-CEX for assessing undergraduate and postgraduate medical trainees, specifically as it relates to reliability, validity, educational impact, acceptability, and cost.Methods: This registered BEME review applied a systematic search strategy in seven databases to identify studies on validity, reliability, educational impact, acceptability, or cost of the mini-CEX. Data extraction and quality assessment were carried out by two authors. Discrepancies were resolved by a third reviewer. Descriptive synthesis was mainly used to address the review questions. A meta-analysis was performed for Cronbach's alpha.Results: Fifty-eight papers were included. Only two studies evaluated all five utility criteria. Forty-seven (81%) of the included studies met seven or more of the quality criteria. Cronbach's alpha ranged from 0.58 to 0.97 (weighted mean = 0.90). Reported G coefficients, Standard error of measurement, and confidence interval were diverse and varied based on the number of encounters and the nested or crossed design of the study. The calculated number of encounters needed for a desirable G coefficient also varied greatly. Content coverage was reported satisfactory in several studies. Mini-CEX discriminated between various levels of competency. Factor analyses revealed a single dimension. The six competencies showed high levels of correlation with statistical significance with the overall competence. Moderate to high correlations between mini-CEX scores and other clinical exams were reported. The mini-CEX improved students' performance in other examinations. By providing a framework for structured observation and feedback, the mini-CEX exerts a favorable educational impact. Included studies revealed that feedback was provided in most encounters but its quality was questionable. The completion rates were generally above 50%. Feasibility and high satisfaction were reported.Conclusion: The mini-CEX has reasonable validity, reliability, and educational impact. Acceptability and feasibility should be interpreted given the required number of encounters.

Enhancement of role modelling in clinical educators: A randomized controlled trial.

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling.Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the 'Positive Doctor Role Modelling' framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior.Results: In the intervention group (N = 18), the mean score of satisfaction was 4.7 (SD = 0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33-4.34), comparing to the control group (3.53-3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program.Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling.

Validating Self-Reflection and Insight Scale to Measure readiness for Self-Regulated Learning.

BACKGROUND: Professional behavior of physicians is under scrutiny by medical associations, media, and patients; therefore, medical students are expected to be self-directed learners rather than the passive ones. One of the useful strategies for professional development and life-long learning of students is self-regulated learning. Self-regulation concept and lifelong learning commitment are in the heart of medical practice. Therefore, this study aimed to evaluate the validity of Self-Reflection and Insight Scale (SRIS) to inspect the medical students' readiness for self-regulation. MATERIALS AND METHODS: SRIS was translated according to the Sousa and Rojjanasrirat guideline. To examine the reliability and validity evidence of the scale, 136 medical students from Tehran University of Medical Sciences completed the questionnaire. Internal consistency and intraclass correlation were used to examine the reliability evidence, as well as qualitative content validity, and confirmatory factor analysis and exploratory factor analysis (EFA) were used to examine the construct validity of the scale. RESULTS: The content validity of the scale was verified. Cronbach's alpha and the Interclass Correlation Coefficient value for the four-factor model was 0.87 and 0.79, respectively. Goodness-of-fit indices displayed acceptable and poor values (P = 0.0001, χ2 = 373.51, df = 167, Root Mean Square Error Of Approximation = 0.096, standardized root mean square residual = 0.12). EFA was conducted; a well-structured model was achieved through the EFA. The new four-factor model was extracted as the best model by performing EFA. CONCLUSION: SRIS Persian version is saturated with four factors and has desirable content validity and constructs reliability.