Medical Students' Self-Perceptions of Harassment During Clinical Placement.

Objectives: Exploring workplace dynamics during clinical placement is crucial to determine whether medical students are encountering safe and meaningful learning experiences. The aim of this original article is to describe medical students' reported harassment experiences whilst on clinical placement. Design: Medical students in years 4 to 6 were invited to participate in the survey. In this mixed-methods study, data collection included demographic information, responses to the Generalized Workplace Harassment Questionnaire, and qualitative commentaries. Results: Two hundred and five students completed the questionnaire. Medical students experienced harassment in areas of verbal aggression, disrespect, isolation/exclusion, threats/bribes, and physical aggression. Concerning levels of occurrence were noted for disrespect, isolation/exclusion, and verbal aggression. Conclusions: Many medical students in this study reported experiencing harassment during their clinical placements indicating that harassment during clinical placement continues to be of concern in medical education. The findings indicate that further initiatives need to be designed to identify and respond to these cases of workplace harassment and that power imbalance and safe reporting appear to be further issues of concern. It was evident that students need to feel safe enough to be able to report harassment experiences to allow managers and educators to address the full extent of the problem.

Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis.

OBJECTIVE: The aim of the study is to identify quantitative evidence for the efficacy of interprofessional learning (IPL) to improve patient outcomes. METHODS: We conducted a systematic review and meta-analysis of quantitative patient outcomes after IPL in multidisciplinary healthcare teams reported in the Medline, Scopus, PsycInfo, Embase, and CINAHL databases. RESULTS: In 2022, we screened 15,248 reports to include 20 and extracted rates of mortality and primary outcomes in conventional care groups and intervention groups (involving initiatives to promote IPL in multidisciplinary teams). The meta-analysis of the 13 studies reporting mortality outcomes demonstrated that the 7166 patients in the intervention group had a significant 28% (95% confidence interval [CI], 40%-14%; P < 0.0003) reduced risk of dying compared with the 6809 patients in the conventional care group. The meta-analysis of the 14 studies reporting other treatment-related adverse outcomes demonstrated that the 4789 patients in the intervention group had a significant 23% (95% CI, 33%-12%; P < 0.0001) reduced risk of experiencing an adverse outcome during care compared with the 4129 patients in the conventional care group. Sensitivity analysis, involving the exclusion of the 20% of individual studies with the widest 95% CIs, confirmed the precision and reliability of our findings. CONCLUSIONS: We believe that our results are the first to demonstrate significant quantitative evidence for the efficacy of IPL to translate into changes in clinical practice and improved patient outcomes. Our results reinforce earlier qualitative work of the value of IPL, but further prospective quantitative and mixed-methods research is needed to better define such benefits.

Desire paths for workplace assessment in postgraduate anaesthesia training: analysing informal processes to inform assessment redesign.

BACKGROUND: In postgraduate specialist training, workplace assessments are expected to provide the information required for decisions on trainee progression. Research suggests that meeting this expectation can be difficult in practice, which has led to the development of informal processes, or 'shadow systems' of assessment. Rather than rejecting these informal approaches to workplace assessment, we propose borrowing from sociology the concept of 'desire paths' to legitimise and strengthen these well-trodden approaches. We asked what information about trainees is currently used or desired by those charged with making decisions on trainee progression, and how is it obtained? METHODS: We undertook a qualitative study with thematic analysis of semi-structured interviews of supervisors of training across Australia and New Zealand. RESULTS: From 21 interviews, we identified four interrelated themes, the first being the local context of training sites. The other three themes represent dilemmas in the desire for authentic and representative information about the trainee: 1) how the process of gathering and documenting information can filter, transform, or limit the original message; 2) deciding when possible trainee deviation from performance norms warrants a closer look; and 3) how transparent vs covert information gathering affects the information supervisors will provide, and how control over assessment is distributed between trainee and supervisor. CONCLUSION: From these themes, we propose a set of design principles for future workplace assessment. Understanding the reasons desire paths exist can inform future assessment redesign, and may address the current disjunct between the formal workplace assessment system and what happens in practice.

Medical Students' Quality of Life and Its Association with Harassment and Social Support.

OBJECTIVES: To explore the associations between self-reported quality of life (QoL) and harassment and the potential moderating effect of social support. DESIGN: Senior medical students were invited to participate in a survey consisting of a background section, the World Health Organisation QoL questionnaire (New Zealand version), a version of the generalised workplace harassment questionnaire, and the multidimensional scale of perceived social support. A series of multivariate statistical analyses were conducted. RESULTS: Two hundred and five students completed the online survey (response rate = 25%). The findings indicated a high incidence of verbal (90%) and covert harassment (87%), with relatively low levels of physical harassment (6%) and manipulation (6%). The correlational analyses indicated that low levels of QoL were associated with high levels of verbal and covert harassment and high levels of social support were directly associated with high levels of QoL. The moderation models indicated that social support conditionally influences the impact of verbal and covert harassment on social and psychological QoL. CONCLUSIONS: These findings imply that medical students experiencing harassment in clinical learning environments likely experienced lowered levels of QoL. Social support may moderate, in certain instances, the adverse impact of harassment on QoL.

Key dimensions of innovations in workplace-based assessment for postgraduate medical education: a scoping review.

BACKGROUND: Specialist training bodies continue to devise innovative methods of gathering information on trainee workplace performance to meet the requirements of competency-based medical education. We reviewed recent innovations in workplace-based assessment (WBA) tools to identify strengths, weaknesses, and trade-offs inherent in their design and use. METHODS: In this scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched databases between 2009 and 2019 for WBA tools with novel characteristics not typically seen in traditional WBAs. These included innovations in rating scales, ways of collecting information, technological innovations, ways of triggering WBAs, and approaches to compiling and using information. RESULTS: We identified 30 innovative WBA tools whose characteristics could be categorised into seven dimensions: frequency of assessment, granularity (unit of performance assessed), coverage of the curriculum, rating method, initiation of the WBA, information use, and incentives. These dimensions had multiple interdependencies and trade-offs, often balancing generating assessment data with available resources. Philosophical stance on assessment also influenced WBA choice, for example prioritising trainee-centred learning (i.e. initiation of WBA and transparency of assessment data), perceptions of assessment and feedback as burdensome or beneficial, and holistic vs reductionist views on assessment of performance. CONCLUSIONS: Our synthesis of the literature on innovative WBAs provides a framework for categorising tool characteristics across seven dimensions, systematically teasing apart the considerations in design and use of workplace assessments. It also draws attention to the trade-offs inherent in tool design and selection, and enables a more deliberate consideration of the tool characteristics most appropriate to the local context.

Cultural and Environmental Predictors of Pre-European Deforestation on Pacific Islands.

The varied islands of the Pacific provide an ideal natural experiment for studying the factors shaping human impact on the environment. Previous research into pre-European deforestation across the Pacific indicated a major effect of environment but did not account for cultural variation or control for dependencies in the data due to shared cultural ancestry and geographic proximity. The relative importance of environment and culture on Pacific deforestation and forest replacement and the extent to which environmental impact is constrained by cultural ancestry therefore remain unexplored. Here we use comparative phylogenetic methods to model the effect of nine ecological and two cultural variables on pre-European Pacific forest outcomes at 80 locations across 67 islands. We show that some but not all ecological features remain important predictors of forest outcomes after accounting for cultural covariates and non-independence in the data. Controlling for ecology, cultural variation in agricultural intensification predicts deforestation and forest replacement, and there is some evidence that land tenure norms predict forest replacement. These findings indicate that, alongside ecology, cultural factors also predict pre-European Pacific forest outcomes. Although forest outcomes covary with cultural ancestry, this effect disappears after controlling for geographic proximity and ecology. This suggests that forest outcomes were not tightly constrained by colonists' cultural ancestry, but instead reflect a combination of ecological constraints and the short-term responses of each culture in the face of those constraints.