Unmasking imposter syndrome: individual responsibility or repercussions of systemic oppression?

In contemporary and popular discourse, imposter syndrome is frequently outlined as an individual problem that can be overcome. Rather than the locus of responsibility being placed on the individual, we posit that neoliberal academic institutions contribute to imposter syndrome by (de)legitimising certain forms of knowledge.

Academic Productivity of Equity-Deserving Physician Scholars During COVID-19: A Scoping Review.

PURPOSE: The COVID-19 pandemic presented new barriers and exacerbated existing inequities for physician scholars. While COVID-19's impact on academic productivity among women has received attention, the pandemic may have posed additional challenges for scholars from a wider range of equity-deserving groups, including those who hold multiple equity-deserving identities. To examine this concern, the authors conducted a scoping review of the literature through an intersectionality lens. METHOD: The authors searched peer-reviewed literature published March 1, 2020, to December 16, 2021, in Ovid MEDLINE, Ovid Embase, and PubMed. The authors excluded studies not written in English and/or outside of academic medicine. From included studies, they extracted data regarding descriptions of how COVID-19 impacted academic productivity of equity-deserving physician scholars, analyses on the pandemic's reported impact on productivity of physician scholars from equity-deserving groups, and strategies provided to reduce the impact of the COVID-19 pandemic on academic productivity of physician scholars from equity-deserving groups. RESULTS: Of 11,587 unique articles, 44 met inclusion criteria, including 15 nonempirical studies and 29 empirical studies (22 bibliometrics studies, 6 surveys, and 1 qualitative study). All included articles focused on the gendered impact of the pandemic on academic productivity. The majority of their recommendations focused on how to alleviate the burden of the pandemic on women, particularly those in the early stages of their career and/or with children, without consideration of scholars who hold multiple and intersecting identities from a wider range of equity-deserving groups. CONCLUSIONS: Findings indicate a lack of published literature on the pandemic's impact on physician scholars from equity-deserving groups, including a lack of consideration of physician scholars who experience multiple forms of discrimination. Well-intentioned measures by academic institutions to reduce the impact on scholars may inadvertently risk reproducing and sustaining inequities that equity-deserving scholars faced during the pandemic.

Educating future physicians for francophone official language minority communities in Canada: a case study.

Background: Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour. Methods: Our qualitative instrumental single case study explored participants' experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach. Results: Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs. Conclusions: Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.

Contexte: Plus d'un million de Canadiens francophones vivent dans des communautés de langue officielle en situation minoritaire (CLOSM) hors Québec. L'accessibilité de soins linguistiquement appropriés aux CLOSM est limitée. Par conséquent, la qualité des services qui leur sont offerts en souffre. Le programme FrancoDoc a été créé en 2015 pour aider à combler cette lacune sur le plan de l'équité en matière de santé. Il vise à offrir aux étudiants en médecine francophones ou francophiles dont l'anglais est la principale langue d'enseignement les moyens d'améliorer leurs compétences en français médical. Cependant, on sait peu de choses sur les possibilités et les limites de cette initiative éducative. Méthodes: Notre étude qualitative instrumentale de cas unique a exploré les expériences des participants au programme FrancoDoc, tout en examinant les facteurs qui influencent la prestation de services de santé linguistiquement appropriés aux CLOSM. Nous avons mené des entrevues semi-structurées avec des étudiants en médecine de tout le Canada et nous en avons analysé le contenu thématiquement en utilisant une approche réflexive et inductive. Résultats: Quatre thèmes principaux ont été dégagés des 12 entrevues réalisées : les facteurs facilitant l'apprentissage du français; les obstacles à l'apprentissage du français; les facteurs contextuels influençant la prestation de soins de santé linguistiquement appropriés; et les recommandations visant à améliorer l'enseignement en soins de santé de manière à préparer les apprenants à servir les CLOSM. Conclusions: Bien que très motivés par le programme FrancoDoc, les étudiants participants se heurtent à des obstacles comme les contraintes de temps, la programmation irrégulière des activités, le manque d'occasions d'apprentissage clinique régulier et la réticence des facultés de médecine. Or, pour remplir leurs obligations envers les CLOSM qu'elles servent, il est essentiel que les facultés de médecine reconnaissent la langue comme un déterminant social spécifique de la santé et qu'elles offrent un soutien solide aux initiatives comme le programme FrancoDoc.

Re-thinking "I"dentity in medical education: genealogy and the possibilities of being and becoming.

Professional identity formation has emerged as a key topic for medical education research, with contributions from perspectives of psychological development and socialization opening up needed conversations in the field. Yet mainstream training practices may have the unintended effects of educating for a physician typology that may be too narrow to account for the complexity of learners' personal identities. Alternative approaches, such as Foucauldian genealogy, offer ways to empirically investigate how the legitimate contours of being and becoming have come to be as they are, how they shape professional identities, and to which degree their borders may be made more inclusive. Drawing upon an example of the contemporary practice of competency-based medical education in the Canadian context, this paper considers how genealogy's methodological tools of critical distancing, the dispositif, and problematization may help reveal how educational practices shape the identities of physicians-in-training in ways both intended and unintended. From this perspective it becomes apparent that any attempt to explore professional identity is incomplete without also considering that a trainee's evolving sense of self is inexorably bound up with forces of knowledge, power, and ethics that shape them into becoming certain kinds of physician subjects rather than others. In mapping this terrain, a genealogical approach determines how we reached the now in which we find ourselves and how we might transform it, such that we may shift the possibilities afforded to health professionals to establish professional identities aligned with their personal identities in ways that maximize inclusivity and minimize marginalization.

Contextual Competence: How residents develop competent performance in new settings.

INTRODUCTION: Medical education continues to diversify its settings. For postgraduate trainees, moving across diverse settings, especially community-based rotations, can be challenging personally and professionally. Competent performance is embedded in context; as a result, trainees who move to new contexts are challenged to use their knowledge, skills and experience to adjust. What trainees need to adapt to and what that requires of them are poorly understood. This research takes a capability approach to understand how trainees entering a new setting develop awareness of specific contextual changes that they need to navigate and learn from. METHODS: We used constructivist grounded theory with in-depth interviews. A total of 29 trainees and recent graduates from three internal medicine training programmes in Canada participated. All participants had completed at least one community-based rotation geographically far from their home training site. Interviews were recorded, transcribed and anonymised. The interview framework was adjusted several times following initial data analysis. RESULTS: Contextual competence results from trainees' ability to attend to five key stages. Participants had first to meet their physiological and practical needs, followed by developing a sense of belonging and legitimacy, which paved the way for a re-constitution of competence and appropriate autonomy. Trainee's attention to these stages of adaptation was facilitated by a process of continuously moving between using their knowledge and skill foundation and recognising where and when contextual differences required new learning and adaptations. DISCUSSION: An ability to recognise contextual change and adapt accordingly is part of Nussbaum and Sen's concept of capability development. We argue this key skill has not received the attention it deserves in current training models and in the support postgraduate trainees receive in practice. Recommendations include supporting residents in their capability development by debriefing their experiences of moving between settings and supporting clinical teachers as they actively coach residents through this process.

Offering welcome in the kingdom of the sick: A physician guide to hospitality.

RATIONALE, AIMS AND OBJECTIVES: The onset of acute illness may be accompanied by a profound sense of disorientation for patients. Addressing this vulnerability is a key part of a physician's purview, yet well-intended efforts to do so may be impeded by myriad competing tasks in clinical practice. Resolving this dilemma goes beyond appealing to altruism, as its limitless demands may lead to physician burnout, disillusionment, and a narrowed focus on the biomedical aspects of care in the interest of self-preservation. The authors propose an ethic of hospitality that may better guide physicians in attending to the comprehensive needs of patients that have entered "the kingdom of the sick." METHODS: Using philosophical methods, the authors explore what compels people to present to emergent medical attention and why altruism may not offer physicians a sustainable way to address the vulnerabilities that occur in such situations. They then present the concept of hospitality from a Derridean perspective and use it to interpret a narrative case of an on-call paediatrician caring for an infant with bronchiolitis to demonstrate how this approach may be practically implemented in the acute care hospital context. RESULTS: Hospitality allows physicians to acknowledge that clinical presentations that are routine in their world may be disorienting and frightening to patients experiencing them acutely. Further, it recognizes that the vulnerability that accompanies acute illness may be compounded by the unfamiliarity of the hospital environment in which patients have sought support. CONCLUSION(S): While it is unlikely that anything physicians do will make the hospital a place where patients and caregivers will desire to be, hospitality may focus their efforts upon making it less unwelcoming. Specifically, it offers an orientation that supports patients in navigating the disorienting and unfamiliar terrains of acute illness, the hospital setting in which help is sought, and engagement with the health care system writ large.

Growth curves: The experiences of Canadian paediatricians in their first 5 years of independent practice.

OBJECTIVES: Completing training is a rite of passage common to all physicians, yet our knowledge of the components in postgraduate paediatric education that equip learners for successful transition to practice is limited. In order to optimally design training programs, it is critical to develop a better sense of what early career paediatricians (ECPs) experience as they navigate this time of transition. METHODS: We created and distributed a 23-question survey via e-mail to 481 Canadian ECPs in September 2017, specifically to those who received Royal College certification in 2011 or later. Survey responses were obtained confidentially through an online platform (Survey Monkey). Descriptive statistics and thematic analysis were used to analyze responses to closed-ended and free text questions, respectively. RESULTS: Response rate was 42% with nearly 70% of the respondents self-identifying as general paediatricians. Factors facilitating transition to practice included: dedicated mentorship; supportive new colleagues and workplace environment; and ease of finding work. Identified challenges included: billing, finances, and practice management; adjusting to a different scope of practice and learning local resources; managing comfort level; and achieving work-life balance. Nearly half of the respondents expressed interest in mentoring new ECP colleagues. CONCLUSIONS: Our findings suggest that ECPs find clear value in mentorship, but desire further support to adapt to new practice contexts and activities. As a result, we must consider strategies in both individual programs and nationally that effectively prepare learners prior to transition and align with needs in the first years of independent practice.

Pedagogical validity: The key to understanding different forms of 'good' teaching.

The interrelationship of pedagogical skills, educational ends, and underlying values and assumptions constitute a teacher's 'pedagogical validity' - who they are as a teacher and why they teach the way they do. If reflection, judgment, and improvement are to be helpful, they must have regard for a more complete understanding of what frames a teacher's pedagogical validity. This article briefly describes four kinds of pedagogical validity that teachers draw upon when explaining or justifying their notion of 'good' teaching. Teachers generally have some part of each, but most of us draw upon one or two more than all four as we define ourselves as teachers and make sense of our teaching.

Embracing standardisation and contextualisation in medical education.

CONTEXT: The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. METHODS: The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency-based medical education), and provide concrete examples drawn from the literature. RESULTS: Standardization offers many rewards: its common articulations and assumptions promote patient safety, foster continuous quality improvement, and enable the spread of best practices. Standardization may also contribute to greater fairness, equity, reliability and validity in high stakes processes, and can provide stakeholders, including the public, with tangible reassurance and a sense of the stable and timeless. At the same time, contextual variation in medical education can afford myriad learning opportunities, and it can improve alignment between training and local workforce needs. The inevitable diversity of contexts for learning and practice renders any absolute standardization of programs, experiences, or outcomes an impossibility. CONCLUSIONS: The authors propose a number of ways to examine the interplay of contextual diversity and standardization and suggest three ways to move beyond an either/or stance. In reconciling the laudable goals of standardization and the realities of the innumerable contexts in which we train and deliver care, we are better positioned to design and deliver a medical education system that is globally responsible and locally engaged.

The Contextual Curriculum: Learning in the Matrix, Learning From the Matrix.

Changes in the health care landscape over the last 25 years have led to an expansion of training sites beyond the traditional academic health sciences center. The resulting contextual diversity in contemporary medical education affords new opportunities to consider the influence of contextual variation on learning. The authors describe how different contextual patterns in clinical learning environments-patients, clinical and educational practices, physical geography, health care systems, and culture-form a contextual learning matrix. Learners' participation in this contextual matrix shapes what and how they learn, and who they might become as physicians.Although competent performance is critically dependent on context, this dependence may not be actively considered or shaped by medical educators. Moreover, learners' inability to recognize the educational affordances of different contexts may mean that they miss critical learning opportunities, which in turn may affect patient care, particularly in the unavoidable times of transition that characterize a professional career. Learners therefore need support in recognizing the variability of learning opportunities afforded by different training contexts. The authors set out the concept of the contextual curriculum in medical education as that which is learned both intentionally and unintentionally from the settings in which learning takes place. Further, the authors consider strategies for medical educators through which the contextual curriculum can be made apparent and tangible to learners as they navigate a professional trajectory where their environments are not fixed but fluid and where change is a constant.

Thrown into the world of independent practice: from unexpected uncertainty to new identities.

One of the most exciting yet stressful times in a physician's life is transitioning from supervised training into independent practice. The majority of literature devoted to this topic has focused upon a perceived gap between clinical and non-clinical skills and interventions taken to address it. Building upon recent streams of scholarship in identity formation and adaptation to new contexts, this work uses a Heideggerian perspective to frame an autoethnographical exploration of the author's transition into independent paediatric practice. An archive of reflective journal entries and personal communications was assembled from the author's first 3 years of practice in four different contexts and analyzed using Heidegger's linked existentials of understanding, attunement and discourse. Insights from his journey suggest this period is a time of anxiety and vulnerability when one questions one's competence and very identity as a medical professional. At the same time, it illustrates the inseparable link between practitioners and the network of relationships in which they are bound, how these relationships contextually vary and how recognizing and tuning to these differences may allow for a more seamless transition. While this work is the experience of one person, its insights support the ideas that change is a constant in professional practice and competence is contextual. As a result, developing educational content that inculcates contextual flexibility and an increased comfort level with uncertainty may prepare our trainees not just to navigate the unavoidable novelty of transition, but lay the groundwork for professional identities attuned to engage more broadly with change itself.