How Student and Faculty Perceptions Differ on the Stressors that Medical Students Face.

OBJECTIVES: Medical education is notorious for the stress that students face as they strive to succeed both academically and clinically. This stress has been linked to declining academic performance and worsening mental health. To combat these negative outcomes, it is essential for medical school faculty and administration to address common stressors among medical students. No studies have addressed whether medical school faculty and students perceive stressors similarly, however. METHODS: In this two-part study, data collected from medical students in 2021 to 2022 to identify their most significant sources of stress were used to create a survey that queries the frequency and intensity of these stressors. This survey was distributed to medical students and faculty at the same institution. The responses between students and faculty were compared and student data also were analyzed by academic year to observe changes in perception that accompany progression through the medical curriculum. RESULTS: The results showed that faculty overestimated the impact of certain stressors on medical students (eg, in-house examinations, US Medical Licensing Examination Steps 1 and 2 examinations, and patient interactions). In addition, preclinical students were more concerned with finding extracurricular activities, missing opportunities, and performing research compared with clinical students. CONCLUSIONS: This study demonstrated that although faculty anticipated most medical student stressors, there are significant gaps that still need to be addressed to better reduce and respond to the stress experienced by medical students.

Current status and ongoing needs for the teaching and assessment of clinical reasoning - an international mixed-methods study from the students` and teachers` perspective.

BACKGROUND: Clinical reasoning (CR) is a crucial ability that can prevent errors in patient care. Despite its important role, CR is often not taught explicitly and, even when it is taught, typically not all aspects of this ability are addressed in health professions education. Recent research has shown the need for explicit teaching of CR for both students and teachers. To further develop the teaching and learning of CR we need to improve the understanding of students' and teachers' needs regarding content as well as teaching and assessment methods for a student and trainer CR curriculum. METHODS: Parallel mixed-methods design that used web-surveys and semi-structured interviews to gather data from both students (nsurvey = 100; ninterviews = 13) and teachers (nsurvey = 112; ninterviews = 28). The interviews and surveys contained similar questions to allow for triangulation of the results. This study was conducted as part of the EU-funded project DID-ACT ( https://did-act.eu ). RESULTS: Both the surveys and interview data emphasized the need for content in a clinical reasoning (CR) curriculum such as "gathering, interpreting and synthesizing patient information", "generating differential diagnoses", "developing a diagnostic and a treatment plan" and "collaborative and interprofessional aspects of CR". There was high agreement that case-based learning and simulations are most useful for teaching CR. Clinical and oral examinations were favored for the assessment of CR. The preferred format for a train-the-trainer (TTT)-course was blended learning. There was also some agreement between the survey and interview participants regarding contents of a TTT-course (e.g. teaching and assessment methods for CR). The interviewees placed special importance on interprofessional aspects also for the TTT-course. CONCLUSIONS: We found some consensus on needed content, teaching and assessment methods for a student and TTT-course in CR. Future research could investigate the effects of CR curricula on desired outcomes, such as patient care.

Frontline assessors' opinions about grading committees in a medicine clerkship.

BACKGROUND: Collective decision-making by grading committees has been proposed as a strategy to improve the fairness and consistency of grading and summative assessment compared to individual evaluations. In the 2020-2021 academic year, Washington University School of Medicine in St. Louis (WUSM) instituted grading committees in the assessment of third-year medical students on core clerkships, including the Internal Medicine clerkship. We explored how frontline assessors perceive the role of grading committees in the Internal Medicine core clerkship at WUSM and sought to identify challenges that could be addressed in assessor development initiatives. METHODS: We conducted four semi-structured focus group interviews with resident (n = 6) and faculty (n = 17) volunteers from inpatient and outpatient Internal Medicine clerkship rotations. Transcripts were analyzed using thematic analysis. RESULTS: Participants felt that the transition to a grading committee had benefits and drawbacks for both assessors and students. Grading committees were thought to improve grading fairness and reduce pressure on assessors. However, some participants perceived a loss of responsibility in students' grading. Furthermore, assessors recognized persistent challenges in communicating students' performance via assessment forms and misunderstandings about the new grading process. Interviewees identified a need for more training in formal assessment; however, there was no universally preferred training modality. CONCLUSIONS: Frontline assessors view the switch from individual graders to a grading committee as beneficial due to a perceived reduction of bias and improvement in grading fairness; however, they report ongoing challenges in the utilization of assessment tools and incomplete understanding of the grading and assessment process.

'Needing to be seen and heard': is this why GPs are educators?

BACKGROUND: Recruitment and retention of undergraduate (UG) GP educators is vital, they are essential to educating the next generation of doctors. The expected loss of GPs as they retire and leave the profession means clinical delivery is under tension; adding to the strain on the number of GP educators. With GP educators numbers decreasing and student numbers increasing, the pressure on the system is growing. AIM: To explore the experience of the GP educator, investigate the impact participation in UG medical education has, the barriers there are, and what support educators need to continue. METHOD: This qualitative study uses individual semi-structured interviews of four active GP educators with at least 4 years of experience teaching medical students in a primary care setting; these were then transcribed and thematically analysed. RESULTS: One of the most surprising results showed that GPs' enjoyed their work as educators as it allowed them t'o be seen and heard'. One participant stated; I want 'my blood, sweat and tears to mean something to somebody [the students]'. It also allowed the GPs' to reflect on their life's work and gave them a platform to demonstrate this. CONCLUSION: The Wass report, 2016 showed that students' exposure to GPs in UG education plays a significant role in choosing a career in general practice. This exposure needs GPs to act as positive role-models. Further research is required to examine the GP educators' need to 'be seen and heard', and if this can be used to recruit/retain GP educators.

Student and educator experiences of a student-led clinic in general practice.

BACKGROUND: Giving students more responsibility for real patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) may facilitate this. Within SLCs, students take the lead role in delivering patient care while being supported and supervised by qualified clinicians. A general practice SLC was established in Dundee, with four final-year medical students and one GP involved in each clinic. AIM: This study aimed to explore students' and educators' experiences and perceptions of this SLC. METHOD: This was an exploratory case study. Semi-structured interviews were conducted with 11 students and three educators, and 18 hours of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed. RESULTS: Overall, students' and educators' experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to the students' stage of training and the supervision provided by educators. Teaching within the SLC involved individual discussions and group debriefs. Students felt a sense of belonging as a result of their relationships with their peers and educators. Challenges arose when the clinic ran behind schedule due to unexpected complex patients or lengthy individual discussions. CONCLUSION: The findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided, and that it is possible for one GP to supervise multiple students successfully.

Medical students' and GP tutors' experiences of near peer teaching in primary care: a qualitative study.

BACKGROUND: There exists a significant body of literature on the benefits of Peer Assisted Learning (PAL). Near-peer (NP) teaching can be defined as teaching delivered by senior students to younger year students. There are numerous examples in the literature of PAL projects in a non-clinical setting but little research in a clinical setting and even less in primary care. Postgraduate literature suggests that potential benefits include promotion of general practice as a career as well as increasing teaching capacity.A successful pilot led to the development of a new undergraduate NP teaching Student Selected Component (SSC) in a primary care setting. AIM: To explore the experiences of medical students and GP tutors who participated in this SSC. METHOD: Semi-structured interviews were carried out with year 5 NP student teachers, GP tutors, and year 3 students. Thematic analysis was used to analyse the qualitative data generated. RESULTS: As well as increasing teaching capacity and consolidating their own knowledge, the findings suggest an impact on the professional identity formation of NP student teachers helping them to prepare to be future doctors. The NP teaching fostered an environment of psychological safety for all students, although there was an additional element of risk management and supervision when teaching with patients. CONCLUSION: Undergraduate NP teaching has advantages for student learners, NP student teachers, GP tutors, and practices. The increased teaching capacity has implications for recruitment of practices for teaching and may promote general practice as a future career.

Current situation and influencing factors of high-level role conflict among clinical teachers: A cross-sectional study.

Role conflict is defined as pressures resulting from multiple job requirements that are perceived as incompatible. The purpose of this population-based cross-sectional study was to explore the current situation and influencing factors of high-level role conflict among clinical teachers at 4 affiliated hospitals of 3 medical universities in southern China. A self-administered online questionnaire was used for data collection through an online survey platform. Chi-square tests were used to determine significant differences for categorical variables. Binary logistic regression analysis models were performed for exploring the influencing factors of role conflict in clinical teachers. A total of 208 clinical teachers successfully completed the questionnaires. Of the respondents, 41.3% reportedly had high-level role conflict, and 58.7% had low-level role conflict. The study found that primary, intermediate, and deputy senior professional title, having a leadership position in the department, and devoting a lot of time to teaching work were associated with an increasing risk of the occurrence of high-level role conflict (all P < .05). However, undertaking moderate or few/very few clinical teaching workloads, keeping clinical teachers informed of the teaching requirements, getting guidance and help from colleagues, and thinking of the teaching work as their obligation were significantly associated with decreasing risks of high-level role conflict (all P < .05). Teaching management departments in hospitals might carry out regular and systematic professional training for clinical teachers to effectively decrease role conflict and improve the quality of clinical teaching.

Achieving 'something that everybody has invested in': perspectives of diverse stakeholders during co-creation of a transition to residency curriculum.

Co-creation of education within the context of student inclusion alongside diverse stakeholders merits exploration. We studied the perspectives of students and teachers from different institutions who participated in co-creating a transition to residency curriculum. We conducted post-hoc in-depth interviews with 16 participants: final-year medical students, undergraduate, and postgraduate medical education stakeholders who were involved in the co-creation sessions. Findings build on the Framework of Stakeholders' Involvement in Co-creation and identify the four key components of co-creation with diverse faculty: immersion in positive feelings of inclusivity and appreciation, exchange of knowledge, engagement in a state of reflection and analysis, and translation of co-creation dialogues into intended outcomes. Despite power dynamics, participants valued open communication, constructive feedback, mutual respect, and effective moderation. The study broadened our understanding of the co-creation process in diverse stakeholder settings. Incorporating key elements in the presence of power relations can enrich co-creation by leveraging wider expertise.

Doctoral theses at the medical faculty of Tunis from 2015 to 2017: Scientific publication rates and associated factors.

INTRODUCTION: Medical doctoral thesis publication is a way to ensure knowledge dissemination and to increase the scientific research visibility. AIM: To determine thesis-related publication's rate at the Faculty of Medicine of Tunis (FMT), and identify associated factors. METHODS: Cross-sectional retrospective study including medical theses registered at the FMT over the study period (2015-2017). All publications related to the defended thesis were collated by scanning Scopus and Google scholar databases, up to April 2022. Binary logistic regression was performed to assess associated factors to publication. Adjusted Odds Ratios (AOR) were presented with 95% confidence interval. RESULTS: Out of 878 defended theses, 11.8% (n=104) were published. Out of 130 publications in total, 90 (69.2%) interested Scopus-indexed journals with a mean Scimago Journal Rank (SJR) of 0.70. The publication was in English in 73.1% of cases. The median time between the thesis defense and the first scientific publication was 15 months. In multivariable analysis, associated factors to "at least one thesis-related publication" were the resident status of the candidate (AOR=2.35 [1.2-4.7]) and the grade assistant professor of the thesis supervisor (AOR=2.48 [1.1-5.6]). CONCLUSION: Compared to the number of defended theses, the thesis-related publication's rate at the FMT is relatively low. Thus, enhanced support for doctoral students to optimize their engagement in research and to consequently promote scientific publication is highly recommended.

Exploring the Use of Natural Language Processing to Understand Emotions of Trainees and Faculty Regarding Entrustable Professional Activity Assessments.

Background In medical education, artificial intelligence techniques such as natural language processing (NLP) are starting to be used to capture and analyze emotions through written text. Objective To explore the application of NLP techniques to understand resident and faculty emotions related to entrustable professional activity (EPA) assessments. Methods Open-ended text data from a survey on emotions toward EPA assessments were analyzed. Respondents were residents and faculty from pediatrics (Peds), general surgery (GS), and emergency medicine (EM), recruited for a larger emotions study in 2023. Participants wrote about their emotions related to receiving/completing EPA assessments. We analyzed the frequency of words rated as positive via a validated sentiment lexicon used in NLP studies. Specifically, we were interested if the count of positive words varied as a function of group membership (faculty, resident), specialty (Peds, GS, EM), gender (man, woman, nonbinary), or visible minority status (yes, no, omit). Results A total of 66 text responses (30 faculty, 36 residents) contained text data useful for sentiment analysis. We analyzed the difference in the count of words categorized as positive across group, specialty, gender, and being a visible minority. Specialty was the only category revealing significant differences via a bootstrapped Poisson regression model with GS responses containing fewer positive words than EM responses. Conclusions By analyzing text data to understand emotions of residents and faculty through an NLP approach, we identified differences in EPA assessment-related emotions of residents versus faculty, and differences across specialties.

Chronicling the Transition to Competency-Based Medical Education in a Small Subspeciality Program.

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.

Using office hour appointment data to illustrate a decline in student-faculty interaction during and after COVID-19.

Student-faculty interaction (SFI) is an important indicator of student engagement that positively associates with academic achievement and retention. Quantitative information regarding the impact of emergency remote teaching (ERT) during COVID-19 on SFI is limited. This retrospective, observational cohort study tests the hypothesis that COVID-19 ERT negatively affected SFI in a gender-dependent manner. Electronic records of office hour (OH) appointments, used to measure SFI, for first-year medical students across three time periods, before, during and after COVID, were obtained and analyzed. A concerning, marked decline in SFI during and after the COVID-19 pandemic is noted. Before COVID, significantly more women (75.20%) made at least one OH appointment compared with men (40.54%). During COVID, the proportion of women making an OH appointment (69.71%) was statistically indistinguishable from women before COVID-19. In contrast, significantly fewer men during COVID (10.34%) than before COVID made an OH appointment. On return to face-to-face teaching, no rebound effect was observed. Compared with before COVID gender-matched peers, fewer men and women after COVID made OH appointments. Discipline-based analyses show that for all three time periods physiology emerged as the content area in which students made most OH appointments. The reduction in SFI observed, combined with the consistency with which the participants in our study indicated a need for assistance with the physiology discipline, emphasizes the importance of active promotion of faculty support and deliberate efforts to reconnect with students in the post-COVID context.NEW & NOTEWORTHY Applying readily available data, we quantify a persistent, negative impact of the shift to emergency remote teaching (ERT) on a measure of student-faculty interaction (SFI) among first-year medical students. A gender-based component to these effects is also discussed. Before, during, and after COVID, physiology emerged as the most engaged-with discipline as measured by office hour (OH) appointment volume.

Exploring 40 years of Korean medical education conference themes.

PURPOSE: The Korean Society of Medical Education (KSME) was founded in 1983 and celebrated its 40th anniversary in 2023. This study examines the evolution of topics discussed at KSME conferences from 1971 through 2023, highlighting shifts in the focus of medical education. METHODS: We analyzed 90 KSME conferences over 5 decades (1970s, 1980s, 1990s, 2000s, and 2010s), categorizing the topics into three eras based on emerging themes and continuity. RESULTS: Consequently, 37 topics covered at the conference were categorized. Ten topics continuously appeared from the 1970s to the 2010s, including future directions of medical education, teaching methods, faculty development, and curriculum. The topics from the 1970s to the 1990s included 14 areas, such as medical education evaluation, non-undergraduate curriculum, community-related, and research. Thirteen new topics emerged after the 2000s, such as social accountability, student support, professionalism, and quality improvements. The most common topics under innovations in medical education, a case of curriculum innovation at universities that began after 2000, were clinical clerkship, curriculum development, and medical humanities. CONCLUSION: KSME's selection of conference topics has been strategically aligned with societal needs and the evolving landscape of medical education. Future topics should continue to address relevant societal and educational challenges.

Needs and gaps of faculty development for medical schools.

PURPOSE: Current faculty development (FD) programs are mostly limited to medical education and often lack a comprehensive and systematic structure. Therefore, the present study aimed to explore the current status and needs of FD programs in medical schools to provide a basis for establishing FD strategies. METHODS: We conducted an online survey of medical school FD staff and professors regarding FD. Frequency, regression, and qualitative content analyses were conducted. FD programs were categorized into the classification frameworks. RESULTS: A total of 17 FD staff and 256 professors at 37 medical schools participated. There are gaps between the internal and external FD programs offered by medical schools and their needs, and there are gaps between the programs the professors participated in and their needs. Recent internal and external FD programs in medical schools have focused on educational methods, student assessment, and education in general. Medical schools have a high need for leadership and self-development, and student assessment. Furthermore, professors have a high need for leadership and self-development, and research. The number of participants, topics, and needs of FD programs varied depending on the characteristics of individual professors. CONCLUSION: Medical schools should expand their FD programs to meet the needs of individuals and the changing demands of modern medical education. The focus should be on comprehensive and responsive programs that cover various topics, levels, and methods. Tailored programs that consider professors' professional roles, career stages, and personal interests are essential for effective FD.

Exploring the responses of preclinical medical students and professors to flipped learning for the development of clinical reasoning.

PURPOSE: This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation. METHODS: The study was conducted at a medical school in Korea, where the "clinical reasoning method" course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students' experiences in more detail. RESULTS: In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning. CONCLUSION: The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.

Experiences of Leaders in Diversity, Equity, and Inclusion in US Academic Health Centers.

Importance: The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI). Objective: To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges. Design, Setting, and Participants: This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021. Exposure: Formal DEI role. Main Outcomes and Measures: Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office. Results: A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support. Conclusions and Relevance: In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.