Voices of conference attendees: how should future hybrid conferences be designed?

BACKGROUND: With conference attendees having expressed preference for hybrid meeting formats (containing both in-person and virtual components), organisers are challenged to find the best combination of events for academic meetings. Better understanding what attendees prioritise in a hybrid conference should allow better planning and need fulfilment. METHODS: An online survey with closed and open-ended questions was distributed to registrants of an international virtual conference. Responses were then submitted to descriptive statistical analysis and directed content analysis. RESULTS: 823 surveys (Response Rate = 4.9%) were received. Of the 813 who expressed a preference, 56.9% (N = 463) desired hybrid conference formats in the future, 32.0% (N = 260) preferred in-person conferences and 11.1% (N = 90) preferred virtual conferences. Presuming a hybrid meeting could be adopted, 67.4% (461/684) preferred that virtual sessions take place both during the in-person conference and be spread throughout the year. To optimise in-person components of hybrid conferences, recommendations received from 503 respondents included: prioritising clinical skills sessions (26.2%, N = 132), live international expert presentations and discussions (15.7%, N = 79) and interaction between delegates (13.5%, N = 68). To optimise virtual components, recommendations received from 486 respondents included: prioritising a live streaming platform with international experts' presentations and discussions (24.3%, N = 118), clinical case discussions (19.8%, N = 96) and clinical update sessions (10.1%, N = 49). CONCLUSIONS: Attendees envision hybrid conferences in which organisers can enable the vital interaction between individuals during an in-person component (e.g., networking, viewing and improving clinical skills) while accessing virtual content at their convenience (e.g., online expert presentations with latest advancements, clinical case discussions and debates). Having accessible virtual sessions throughout the year, as well as live streaming during the in-person component of hybrid conferences, allows for opportunity to prolong learning beyond the conference days.

Conceptualizing Educational Comparability in Distributed Health Professions Education: A Scoping Review.

PURPOSE: This study aimed to create greater clarity about the current understanding and formulate a model of how educational comparability has been used in the literature to inform practice. METHOD: The authors conducted a literature search of 9 online databases, seeking articles published on comparability in distributed settings in health professions education before August 2021, with an updated search conducted in May 2023. Using a structured scoping review approach, 2 reviewers independently screened articles for eligibility with inclusion criteria and extracted key data. All authors participated in the descriptive analysis of the extracted data. RESULTS: Twenty-four articles published between 1987 and 2021 met the inclusion criteria. Most articles were focused on medical education programs (n = 21) and located in North America (n = 18). The main rationale for discussing comparability was accreditation. These articles did not offer definitions or discussions about what comparability means. The program logic model was used as an organizing framework to synthesize the literature on practices that schools undertake to facilitate and demonstrate comparability in the design (inputs), implementation (activities), and evaluation (outcomes) of distributed education. Inputs include common learning objectives, identical assessment tools and policies, governance models that enable clear communication, and reporting structure that is supported by technological infrastructure. Activities include faculty planning meetings and faculty development training. Outcomes include student experiences and academic performances. CONCLUSIONS: This study demonstrated that a more complex understanding of the dynamics of educational processes and practices is required to better guide the practice of educational comparability within distributed education programs. In addition to highlighting the need to develop an accepted definition of educational comparability, further elucidation of the underlying dynamics among input, activities, and outcomes would help to better determine what drivers should be prioritized when considering educational change with attention to context within distributed education.

Patient Engagement in Medical Trainee Selection: A Scoping Review.

PURPOSE: The stakes of medical trainee selection are high, making it ironic and somewhat paradoxical that patients and the public often get little say in selection practices. The authors sought to undertake a knowledge synthesis to uncover what is known about patient engagement across the medical trainee selection continuum. METHOD: The authors conducted a scoping review aimed at exploring the current state of practice and research on patient engagement in medical trainee selection in 2017-2021. MeSH headings and keywords were used to capture patient, community, and standardized patient engagement in selection processes across multiple health professions. The authors employed broad inclusion criteria and iteratively refined the corpus, ultimately, limiting study selection to those reporting engagement of actual patients in selection within medicine, but maintaining a broad focus on any patient contributions across the entire selection continuum. The Cambridge Framework was adapted and used to organize the included studies. RESULTS: In total, 2,858 abstracts were reviewed, and ultimately, 28 papers were included in the final corpus. The included studies were global but nascent. Most of the literature on this topic appears in the form of individual projects advocating for patient engagement in selection rather than cohesive programs with empirical exploration of patient engagement in selection. Job analysis methodology was particularly prominent for incorporating the patient voice into identifying competencies of relevance to selection. Direct patient engagement in early selection activities allowed the patient voice to assist candidates in determining their fit for medicine. CONCLUSIONS: Patient engagement has not been made a specific focus of study in its own right, leading the authors to encourage researchers to turn their lens more directly on patient engagement to explore how it complements the professional voice in medical trainee selection.

When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body-Mandated Peer Review.

PURPOSE: Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review. METHOD: Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body-mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory. RESULTS: Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees' concerns. Reasons included that most feedback was "validating," aimed at "tweaks" rather than substantial change. CONCLUSIONS: This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.

Postgraduate Selection in Medical Education: A Scoping Review of Current Priorities and Values.

PURPOSE: The process of screening and selecting trainees for postgraduate training has evolved significantly in recent years, yet remains a daunting task. Postgraduate training directors seek ways to feasibly and defensibly select candidates, which has resulted in an explosion of literature seeking to identify root causes for the problems observed in postgraduate selection and generate viable solutions. The authors therefore conducted a scoping review to analyze the problems and priorities presented within the postgraduate selection literature to explore practical implications and present a research agenda. METHOD: Between May 2021 and February 2022, the authors searched PubMed, EMBASE, Web of Science, ERIC, and Google Scholar for English language literature published after 2000. Articles that described postgraduate selection were eligible for inclusion. 2,273 articles were ultimately eligible for inclusion. Thematic analysis was performed on a subset of 100 articles examining priorities and problems within postgraduate selection. Articles were sampled to ensure broad thematic and geographical variation across the breadth of articles that were eligible for inclusion. RESULTS: Five distinct perspectives or value statements were identified in the thematic analysis: (1) Using available metrics to predict performance in postgraduate training; (2) identifying the best applicants via competitive comparison; (3) seeking alignment between applicant and program in the selection process; (4) ensuring diversity, mitigation of bias, and equity in the selection process; and (5) optimizing the logistics or mechanics of the selection process. CONCLUSIONS: This review provides insight into the framing and value statements authors use to describe postgraduate selection within the literature. The identified value statements provide a window into the assumptions and subsequent implications of viewing postgraduate selection through each of these lenses. Future research must consider the outcomes and consequences of the value statement chosen and the impact on current and future approaches to postgraduate selection.

Thresholds of becoming: an exploration of threshold concepts as a means to support professional identity formation in competency-based curricula.

Inherent in every clinical preceptor's role is the ability to understand the learning needs of individual trainees, enabling them to meet their potential. Competency-based medical education frameworks have been developed to this end, but efforts to identify behaviours and activities that define competence are based on mapping knowledge, skills and ability, which can be difficult to integrate into a comprehensive picture of who the trainee is becoming. Professional identity formation, in contrast, prioritizes attention to who trainees are becoming, but provision of detailed guidance to preceptors on how to best support this form of development is challenging. The tension that results limits our ability to optimally support learners as strengths in competency development may mask professional identity development gaps and vice versa. To address this tension, this paper examines how the theory of threshold concepts - troublesome ideas that, once appreciated, fundamentally change how you understand and approach a particular activity - can shine light on professional identity formation and its relationship with developing competence. The recognition and identification of threshold concepts is offered as a means to improve our ability to identify, discuss and support behaviours and actions that impact the learner's capacity to act competently as they develop their identity at various stages of training.

Cliques within the crowd: identifying medical conference attendee subgroups by their motivations for participation.

Conferences enable rapid information sharing and networking that are vital to career development within academic communities. Addressing diverse attendee needs is challenging and getting it wrong wastes resources and dampens enthusiasm for the field. This study explores whether, and how, motivations for attendance can be grouped in relation to preferences to offer guidance to organizers and attendees. A pragmatic constructivist case study approach using mixed methods was adopted. Semi-structured interviews completed with key informants underwent thematic analysis. Survey results outlining attendees' perspectives underwent cluster and factor analysis. Stakeholder interviews (n = 13) suggested attendees could be grouped by motivations predictable from level of specialisation in a field and past engagement with conferences. From n = 1229 returned questionnaires, motivations were clustered into three factors: learning, personal and social. Three groups of attendees were identified. Group 1 (n = 500; 40.7%) was motivated by all factors. Group 2 (n = 345; 28.1%) was mainly motivated by the learning factor. Group 3 (n = 188; 15.3%) scored the social factor highest for in-person conferences and the learning factor highest for virtual meetings. All three groups expressed a preference for hybrid conferences in the future. This study indicates that medical conference attendees can be clustered based on their learning, personal and social motivations for attendance. The taxonomy enables organizers to tailor conference formats with guidance on how to utilize hybrid conferences, thereby enabling better catering to attendees' desires for knowledge gain relative to networking.

Technology and clinician-learner interaction: how clinicians expect introduction of a new electronic health record to affect educational practice.

INTRODUCTION: Electronic health records (EHRs) are increasingly common platforms used in medical settings to capture and store patient information, but their implementation can have unintended consequences. One particular risk is damaging clinician-learner-interactions, but very little has been published about how EHR implementation affects educational practice. Given the importance of stakeholder engagement in change management, this research sought to explore how EHR implementation is anticipated to affect clinician-learner interactions, educational priorities and outcomes. METHODS: Semi-structured interviews were conducted with a group of practicing oncologists who work in outpatient clinics while also providing education to medical student and resident trainees. Data regarding perceived impact on the teaching dynamic between clinicians and learners were collected prior to implementation of an EHR and analyzed thematically. RESULTS: Physician educators expected EHR implementation to negatively influence their engagement in teaching and the learning they themselves normally gain through teaching interactions. Additionally, EHR implementation was expected to influence learners by changing what is taught and the students' role in clinical care and the educational dynamic. Potential benefits included harnessing learners' technological aptitude, modeling adaptive behaviour, and creating new ways for students to be involved in patient care. CONCLUSION: Anticipating the concerns clinicians have about EHR implementation offers both potential to manage change to minimize disruptions caused by implementation and a foundation from which to assess actual educational impacts.

Transitioning to Telehealth: The Multifaceted Impact of a Midcareer Transition in Practice.

PURPOSE: The medical education continuum is interrupted by several transition periods that can adversely affect performance. Most of what has been learned about such periods focuses upon movement from one stage of training to another and movement from training to practice. Established physicians, however, experience transitions throughout their careers at idiosyncratic times and with little assistance. Better understanding how physicians experience transition, where they struggle and how they adapt, would enable better support to be provided. We investigated the COVID-19-forced transition in clinical practice to virtual care, particularly its effect on physician roles and the ways that established physicians faced challenges they encountered when transitioning to virtual care. METHOD: Ten semistructured interviews were conducted between November 2020 and February 2021 with physicians across different specialties and practice contexts who transitioned their practice to virtual care during the COVID-19 pandemic. Interview data were analyzed iteratively using "generic qualitative methodology" with constant comparison to identify themes in relation to observations. RESULTS: The transition to telehealth had implications that extended beyond the patient encounter, appearing to affect all aspects of the physician's practice. To reflect that, CanMEDS was chosen as a useful organizing framework. The effects, captured in the theme "changes to the physician's roles," were nuanced, illustrated a consistent need to adapt to context, and could be framed positively or negatively or both. Additionally identified themes were labeled "physicians' mental health" and "strategies to mitigate challenges." These themes highlighted that, despite the effort involved and novelty of the situation, all participants found remarkably similar ways of grappling with the challenges faced. CONCLUSIONS: While the basic roles of the physician do not appear to have changed through the transition to telehealth, our findings indicated that these roles were redefined in fundamental ways in response to changing societal needs.

An exploration of "real time" assessments as a means to better understand preceptors' judgments of student performance.

Clinical supervisors are known to assess trainee performance idiosyncratically, causing concern about the validity of their ratings. The literature on this issue relies heavily on retrospective collection of decisions, resulting in the risk of inaccurate information regarding what actually drives raters' perceptions. Capturing in-the-moment information about supervisors' impressions could yield better insight into how to intervene. The purpose of this study, therefore, was to gather "real-time" judgments to explore what drives preceptors' judgments of student performance. We performed a prospective study in which physicians were asked to adjust a rating scale in real-time while watching two video-recordings of trainee clinical performances. Scores were captured in 1-s increments, examined for frequency, direction, and magnitude of adjustments, and compared to assessors' final entrustability judgment as measured by the modified Ottawa Clinic Assessment Tool. The standard deviation in raters' judgment was examined as a function of time to determine how long it takes impressions to begin to vary. 20 participants viewed 2 clinical vignettes. Considerable variability in ratings was observed with different behaviours triggering scale adjustments for different raters. That idiosyncrasy occurred very quickly, with the standard deviation in raters' judgments rapidly increasing within 30 s of case onset. Particular moments appeared to generally be influential, but their degree of influence still varied. Correlations between the final assessment and (a) score assigned upon first adjustment of the scale, (b) upon last adjustment, and (c) the mean score, were r = 0.13, 0.32, and 0.57 for one video and r = 0.30, 0.50, and 0.52 for the other, indicating the degree to which overall impressions reflected accumulation of raters' idiosyncratic moment-by-moment observations. Our results demonstrated that variability in raters' impressions begins very early in a case presentation and is associated with different behaviours having different influence on different raters. More generally, this study outlines a novel methodology that offers a new path for gaining insight into factors influencing assessor judgments.

To a fault.

Are first impressions misleading? This commentary explores that question by drawing on the more general cognitive psychology literature aimed at understanding when, why, and how any non-analytic reasoning process can help or hurt decision-making.

Effect of station format on the psychometric properties of Multiple Mini Interviews.

BACKGROUND: Given the widespread use of Multiple Mini Interviews (MMIs), their impact on the selection of candidates and the considerable resources invested in preparing and administering them, it is essential to ensure their quality. Given the variety of station formats used and the degree to which that factor resides in the control of training programmes that we know so little about, format's effect on MMI quality is a considerable oversight. This study assessed the effect of two popular station formats (interview vs. role-play) on the psychometric properties of MMIs. METHODS: We analysed candidate data from the first 8 years of the Integrated French MMIs (IF-MMI) (2010-2017, n = 11 761 applicants), an MMI organised yearly by three francophone universities and administered at four testing sites located in two Canadian provinces. There were 84 role-play and 96 interview stations administered, totalling 180 stations. Mixed design analyses of variance (ANOVAs) were used to test the effect of station format on candidates' scores and stations' discrimination. Cronbach's alpha coefficients for interview and role-play stations were also compared. Predictive validity of both station formats was estimated with a mixed multiple linear regression model testing the relation between interview and role-play scores with average clerkship performance for those who gained entry to medical school (n = 462). RESULTS: Role-play stations (M = 20.67, standard deviation [SD] = 3.38) had a slightly lower mean score than interview stations (M = 21.36, SD = 3.08), p < 0.01, Cohen's d = 0.2. The correlation between role-play and interview stations scores was r = 0.5 (p < 0.01). Discrimination coefficients, Cronbach's alpha and predictive validity statistics did not vary by station format. CONCLUSION: Interview and role-play stations have comparable psychometric properties, suggesting format to be interchangeable. Programmes should select station format based on match to the personal qualities for which they are trying to select.