RESUMO
Throughout history, race and ethnicity have been used as key descriptors to categorize and label individuals. The use of these concepts as variables can impact resources, policy, and perceptions in medical education. Despite the pervasive use of race and ethnicity as quantitative variables, it is unclear whether researchers use them in their proper context. In this Eye Opener, we present the following seven considerations with corresponding recommendations, for using race and ethnicity as variables in medical education research: 1) Ensure race and ethnicity variables are used to address questions directly related to these concepts. 2) Use race and ethnicity to represent social experiences, not biological facts, to explain the phenomenon under study. 3) Allow study participants to define their preferred racial and ethnic identity. 4) Collect complete and accurate race and ethnicity data that maximizes data richness and minimizes opportunities for researchers' assumptions about participants' identity. 5) Follow evidence-based practices to describe and collapse individual-level race and ethnicity data into broader categories. 6) Align statistical analyses with the study's conceptualization and operationalization of race and ethnicity. 7) Provide thorough interpretation of results beyond simple reporting of statistical significance. By following these recommendations, medical education researchers can avoid major pitfalls associated with the use of race and ethnicity and make informed decisions around some of the most challenging race and ethnicity topics in medical education.
Assuntos
Etnicidade , Grupos Raciais/etnologia , Projetos de Pesquisa/normas , Pesquisa/normas , Coleta de Dados/métodos , Coleta de Dados/normas , Humanos , Pesquisa/tendências , Projetos de Pesquisa/tendênciasRESUMO
Purpose: With the growing recognition of the role of coaching in competency-based medical education, many medical education training programs are investing significant resources into developing coaching programs. However, there is a lack of rigorous research on academic coaching programs in medical education and recommended coaching practices are based on expert opinion without incorporating the student perspective. The aim of this study was to investigate factors that affect a students' perception of a successful coaching experience.Materials and method: This was a qualitative study performed in November 2018 at a medical school in the United States with a formal coaching program. Appreciative inquiry was the theoretical framework used to develop the question guide. The authors facilitated two focus groups and then used Colaizzi's phenomenological analysis approach to analyze the transcripts.Results: A total of 21 students participated in the focus groups. The analysis revealed four themes that describe students' perceptions of successful coaching experiences: coach attributes, relational skills, coaching skills, and utilization of coaching. Each of these themes had specific dimensions.Conclusions: The findings from this study illuminate the student stakeholder perspectives on successful coaching relationships, and should be considered when developing a coaching program and faculty development.
Assuntos
Atitude do Pessoal de Saúde , Tutoria , Estudantes de Medicina/psicologia , Adulto , Educação de Graduação em Medicina/métodos , Feminino , Grupos Focais , Humanos , Relações Interprofissionais , Masculino , Tutoria/métodos , Faculdades de Medicina , Estados Unidos , Adulto JovemRESUMO
Study limitations represent weaknesses within a research design that may influence outcomes and conclusions of the research. Researchers have an obligation to the academic community to present complete and honest limitations of a presented study. Too often, authors use generic descriptions to describe study limitations. Including redundant or irrelevant limitations is an ineffective use of the already limited word count. A meaningful presentation of study limitations should describe the potential limitation, explain the implication of the limitation, provide possible alternative approaches, and describe steps taken to mitigate the limitation. This includes placing research findings within their proper context to ensure readers do not overemphasize or minimize findings. A more complete presentation will enrich the readers' understanding of the study's limitations and support future investigation.
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Pesquisa Biomédica/normas , Educação Médica , Humanos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Veterans have unique experiences that warrant special consideration in health care. Unfortunately, training in veteran-centred care has not been a clear focus of medical education, and only a very small proportion of medical schools include military cultural competency in their curricula. METHODS: We conducted an 80-minute focus group with six US veterans. Open-ended questions were used to elicit their perceptions of the health care that they receive, and how it can be improved. The audio-recording was transcribed verbatim and coded for thematic content. A phenomenological analytic approach was used to analyse the 31-page transcript and arrive at the final themes. RESULTS: Former service members from various periods of conflict (e.g. World War II, Vietnam, Persian Gulf) offered key insights about how to improve veterans' health care experiences. Veterans suggested that consideration of their previous military service would improve care. They lamented that the lack of military consciousness is a barrier to care. Finally, they suggested that clinicians pay close attention to the transition from service member to civilian, as reintegration to civilian life is a critical life experience. Training in veteran-centred care has not been a clear focus of medical education DISCUSSION: Veteran-centred care ensures optimal health care through ease of access to services, and through positive patient-provider interactions. Being aware of military culture can help providers to contextualise veterans' experiences and beliefs about health care seeking and illness management, particularly for invisible wounds of war, including traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).
Assuntos
Competência Cultural , Educação Médica/organização & administração , Assistência Centrada no Paciente/organização & administração , Veteranos/psicologia , Grupos Focais , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Pesquisa Qualitativa , Estados UnidosRESUMO
PROBLEM: The traditional approach to physicians' history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient's ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients. INTERVENTION: In 2015-2016, we introduced medical students to a 6-domain (biomedical and psychiatric conditions, behavioral health, living environment/resources, social support, and functional status) approach to history taking and instructed them to elicit information from each domain alongside the traditional approach. Students were required to obtain information from each domain in one admitting history or one daily progress note, discuss their findings with the attending physician, and involve members of the medical team in addressing concerns and barriers in the care of that patient. Students' history notes were reviewed for completeness and compared to those from a student control group. Students also completed a 10-question evaluation of the model. CONTEXT: The intervention was conducted during a 1-month rotation on a hospitalist general medicine service from May 2015 through August 2016. OUTCOME: Patient history and daily progress notes were collected from 38 fourth-year intervention students and compared to 24 control students on the same service from the previous year. Compared to control students, intervention students provided more patient information (p ≤ .001) in all nonbiomedical domains except behavioral health. Intervention students reported that the 6-domain model helped them identify clinical information that could be addressed with existing resources and prompted involvement of social workers, pharmacists, and nurses in care planning. They also indicated the framework added clinically valuable information and enhanced team-based care. LESSONS LEARNED: A domain-based framework can be used by medical students to identify clinically relevant behavioral conditions and social determinants of health tailored to individual patients while avoiding long standardized checklists. Arguably, routine collection of behavioral and social determinants of health is a necessary first step in enhancing physicians' awareness and skills in working with health care teams to address nonbiomedical determinants of patients' health.
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Anamnese , Estudantes de Medicina/psicologia , Lista de Checagem , Currículo , Educação de Graduação em Medicina , Estudos de Viabilidade , Disparidades nos Níveis de Saúde , Humanos , Anamnese/métodos , Anamnese/normas , Determinantes Sociais da Saúde , Inquéritos e QuestionáriosRESUMO
The medical education community has devoted a great deal of attention to the development of professionalism in trainees within the context of clinical training-particularly regarding trainees' handling of ethical dilemmas related to clinical care. The community, however, knows comparatively less about the development of professional behavior in medical students during the preclerkship years. In medical schools with flexible testing, students take quizzes or examinations in an unproctored setting at a time of their choosing-as long as it falls within a specified window of time. Unproctored, flexible testing offers students early opportunities to develop appropriate professional behavior. In this Perspective, the authors outline different flexible testing models from three institutions-University of Virginia School of Medicine, University of Michigan Medical School, and Icahn School of Medicine at Mount Sinai-all of which offer various levels of testing flexibility in relation to time and location. The authors' experiences with these models suggest that preclinical medical students' early development of professional behavior requires scaffolding by faculty and staff. Scaffolding involves setting clear, specific expectations for students (often through the form of an honor code), as well as active engagement and discussion with learners about the expectations and procedures for self-regulation in the academic environment.
Assuntos
Profissionalismo , Identificação Social , Estudantes de Medicina/psicologia , Currículo/normas , Currículo/tendências , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/tendências , Avaliação Educacional/métodos , Avaliação Educacional/normas , Humanos , Fatores de TempoRESUMO
PURPOSE: Mentorship is a critical aspect of personal and professional development in academic medicine and helps to improve career satisfaction, productivity, and social networking. However, individuals from communities underrepresented in medicine (URiM) across the training continuum experience difficulty obtaining mentors, even prior to college. The value of near-peer mentorship is less well studied in medicine relative to other fields. The purpose of this mixed methods study is to explore the mentorship experiences of high school student protégés and their medical student mentors, as well as provide a description of the key features of the Doctors of Tomorrow (DOT) program. METHODS: From November 2014 to September 2015, the authors used focus groups and critical incident narratives with 9th grade high school students as well as focus groups and semi-structured interviews with medical students to examine mentor-protégé experiences in the Doctors of Tomorrow (DOT) program. In 2016, thirty-one medical student mentors were asked to complete an online survey about their mentor experiences. Focus group and interview data were audio-recorded and transcribed verbatim. All data were coded using thematic analysis and recurring codes were organized into categories, then compared, scrutinized and arranged into broader themes by all authors. RESULTS: The analysis of data from 70 medical students and 52 high school students revealed that mentors and protégés valued their mentor relationships based on regular in-person and electronic contact, shared common non-academic interests, and the anticipated prolonged nature of the relationship. Mentors also reported they initiated contact with their protégés every 2-3 weeks and monthly outside of program events, with email communication as the most common modality. CONCLUSIONS: Near-peer relationships between high school and medical students may be an innovative strategy to promote health care careers, increase access to mentorship and develop meaningful mentorship relationships for URiM high school students.
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Escolha da Profissão , Diversidade Cultural , Mentores , Médicos , Instituições Acadêmicas , Estudantes de Medicina , Adolescente , Etnicidade , Feminino , Grupos Focais , Humanos , Masculino , Grupos Minoritários , Desenvolvimento de Programas , Estados Unidos , Recursos Humanos , Adulto JovemRESUMO
BACKGROUND: Despite their placement in Veterans Health Administration centers nationwide, residents' training and assessment in veteran-centered care is variable and often insufficient. OBJECTIVE: We assessed residents' ability to recognize and address mental health issues that affect US military veterans. METHODS: Two unannounced standardized patient (SP) cases were used to assess internal medicine residents' veteran-centered care skills from September 2014 to March 2016. Residents were assessed on 7 domains: military history taking, communication skills, assessment skills, mental health screening, triage, and professionalism, using a 36-item checklist. After each encounter, residents completed a questionnaire to assess their ability to recognize knowledge deficits. Residents' mean scores were compared across training levels, between the 2 cases, and by SP gender. We conducted analysis of variance (ANOVA) tests to analyze mean performance differences across training levels and descriptive statistics to analyze self-assessment questionnaire results. RESULTS: Ninety-eight residents from 2 internal medicine programs completed the encounter and 53 completed the self-assessment questionnaire. Residents performed best on professionalism (0.92 ± 0.20, percentage of the maximal score) and triage (0.87 ± 0.17), and they scored lowest on posttraumatic stress disorder (0.52 ± 0.30) and military sexual trauma (0.33 ± 0.39). Few residents reported that they sought out training to enhance their knowledge and skills in the provision of services and support to military and veteran groups beyond their core curriculum. CONCLUSIONS: This study suggests that additional education and assessment in veteran-centered care may be needed, particularly in the areas of posttraumatic stress disorder and military sexual trauma.
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Competência Clínica/normas , Medicina Interna/educação , Internato e Residência , Assistência Centrada no Paciente/normas , Veteranos/psicologia , Feminino , Hospitais de Veteranos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Simulação de Paciente , Relações Médico-Paciente , Autoavaliação (Psicologia) , Inquéritos e QuestionáriosRESUMO
Medical school admissions interviews are used to assess applicants' nonacademic characteristics as advocated by the Association of American Medical Colleges' Advancing Holistic Review Initiative. The objective of this study is to determine whether academic metrics continue to significantly influence interviewers' scores in holistic processes by blinding interviewers to applicants' undergraduate grade point averages (uGPA) and Medical College Admission Test (MCAT). This study examines academic and demographic predictors of interview scores for two applicant cohorts at the University of Michigan Medical School. In 2012, interviewers were provided applicants' uGPA and MCAT scores; in 2013, these academic metrics were withheld from interviewers' files. Hierarchical regression analysis was conducted to examine the influence of academic and demographic variables on overall cohort interview scores. When interviewers were provided uGPA and MCAT scores, academic metrics explained more variation in interview scores (7.9%) than when interviewers were blinded to these metrics (4.1%). Further analysis showed a statistically significant interaction between cohort and uGPA, indicating that the association between uGPA and interview scores was significantly stronger for the 2012 unblinded cohort compared to the 2013 blinded cohort (ß = .573, P < .05). By contrast, MCAT scores had no interactive effects on interviewer scores. While MCAT scores accounted for some variation in interview scores for both cohorts, only access to uGPA significantly influenced interviewers' scores when looking at interaction effects. Withholding academic metrics from interviewers' files may promote assessment of nonacademic characteristics independently from academic metrics.
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Teste de Admissão Acadêmica/estatística & dados numéricos , Avaliação Educacional/normas , Entrevistas como Assunto/normas , Critérios de Admissão Escolar/estatística & dados numéricos , Faculdades de Medicina/normas , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Análise de Regressão , Estados Unidos , Adulto JovemRESUMO
PROBLEM: The proportion of students who experience mistreatment is significantly higher than the proportion of students who report mistreatment. Identifying ways to improve students' reporting of these incidents is one strategy for increasing opportunities to achieve resolution and prevent future occurrences. APPROACH: The authors applied a modified A3 Lean framework to examine medical student reporting of mistreatment behaviors at the University of Michigan Medical School (UMMS) in 2013-2016. The A3 Lean framework is a stepwise approach that involves outlining the background to establish the context of the problem, describing the current condition, identifying the goal or desired outcome, analyzing causes of the problem, providing proposed countermeasures for improvement, and creating follow-up plans. The authors identified three reasons for the difference between students' experiences and reporting of mistreatment and developed five countermeasures/action plan items to address this difference. OUTCOMES: The proportion of students reporting mistreatment at UMMS increased 21.4% between 2013 and 2016. Compared with 2013, more students in 2016 indicated not reporting because the incident did not seem important enough or because they resolved the issue on their own. NEXT STEPS: The authors have enlisted the support of the health system's human resources department and presented the inaugural grand rounds on improving the learning environment in 2016. Among other things, they are also partnering with this team to add questions about student mistreatment and civility to the annual employee engagement survey distributed to all 20,000 employees.
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Educação de Graduação em Medicina , Má Conduta Profissional , Estudantes de Medicina , Assédio não Sexual/estatística & dados numéricos , Humanos , Michigan , Faculdades de Medicina , Visitas de PreceptoriaRESUMO
PROBLEM: Addressing the medical concerns of veterans in both civilian health care systems and the Veterans Affairs (VA) health care system, where staff are familiar with issues of military reintegration, remains difficult but is increasingly important. APPROACH: In 2013, the authors developed and implemented a faculty development workshop for practicing clinicians using the documentary Where Soldiers Come From. The workshop included topics on unconscious bias, the service member trajectory, health care disparities, and strategies for overcoming barriers to treating veterans with posttraumatic stress disorder and traumatic brain injury. The workshop engaged faculty in the following active-learning techniques: images in education; trigger video; critical thinking and reflective writing; think-pair-share; and large-group discussion. The workshop has been conducted at three locations with 46 health care professionals. OUTCOMES: Thirty-one of 37 (84%) participants who completed the workshop evaluation were VA employees. The evaluation results show 25/32 (78.1%) participants indicated the workshop activities changed their knowledge, attitudes, and/or skills; 22/34 (64.7%) stated they had a better understanding of how to develop a care plan for veterans; and 27/34 (79.4%) stated they gained a better understanding of how to prepare for issues around returning veterans. NEXT STEPS: To address the issue of veteran-centered care education more broadly, the authors have developed a massive open online course for health professionals, using most of the content from this workshop, which will be offered in spring 2016. Another important next step will be to deliver this workshop to and collect evaluation data from non-VA providers.
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Família/psicologia , Casamento/psicologia , Médicos/psicologia , Cônjuges/psicologia , Feminino , Humanos , MasculinoRESUMO
PURPOSE: Physicians and their spouses experience challenges to their relationships, some of which are shared with the general population and others of which are unique to the field of medicine. Trainees and junior faculty members remain curious about how they will balance their careers alongside marriage and family obligations. This study explores the challenges and strengths of dual- and single-physician relationships. METHOD: In 2009, using appreciative inquiry as a theoretical framework, the authors conducted in-depth qualitative interviews with 25 individuals: 12 women and 13 men; 10 from dual-physician and 15 from single-physician relationships. A phenomenological analytic approach was used to arrive at the final themes. RESULTS: Four themes emerged during the interviews: "We rely on mutual support in our relationships," "We recognize the important roles of each family member," "We have shared values," and "We acknowledge the benefit of being a physician to our relationships." CONCLUSIONS: These findings illustrate that physicians identify strategies to navigate the difficult aspects of their lives. Learn ing from others' best practices can assist in managing personal relationships and work-life balance. These data can also be useful when counseling physicians on successful relationship strategies. As systems are developed that improve wellness and focus on role models for work-life balance, it will be important for this topic to be integrated into formal curricula across the continuum of medical education.
Assuntos
Família/psicologia , Casamento/psicologia , Médicos/psicologia , Cônjuges/psicologia , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Papel (figurativo) , Apoio Social , Valores Sociais , Trabalho/psicologiaRESUMO
OBJECTIVES: Determine postgraduate first-year (PGY-1) trainees ability to perform patient care handoffs and associated medical school training. METHODS: About 173 incoming PGY-1 trainees completed an OSCE handoff station and a survey eliciting their training and confidence in conducting handoffs. Independent t-tests compared OSCE performance of trainees who reported receiving handoff training to those who had not. Analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities, with significance set at p<0.05. RESULTS: About 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Mean handoff performance score was 69.5%. Trainees who received instruction or feedback during medical school had higher total and component handoff performance scores (p<0.05); they were also more confident in their handoff abilities (p<0.001). Trainees with higher self-assessed skills and preparedness performed better on the OSCE (p<0.05). CONCLUSIONS: This study provides evidence that incoming trainees are not well prepared to perform handoffs. However, those who received instruction during medical school perform better and are more confident on standardized performance assessments. Given communication failures lead to uncertainty in patient care and increases in medical errors, medical schools should incorporate handoff training as required instruction.