Exploring Diversity, Equity, and Inclusion-Related Pedagogy Across Different Professions.

PURPOSE: Diversity, equity, and inclusion (DEI) have become an important priority for academic medicine. However, several barriers challenge the effective implementation of DEI-related pedagogy. An exploration of the barriers to and enablers of DEI-related pedagogy-as they relate to professional contexts-can inform how to advance DEI in medical education. Shulman's notion of signature pedagogies offers a foundation for understanding and exploring the influence of such contexts on teaching and learning. Comparisons across professions may help make signature pedagogies more visible and may facilitate change. In this study, the authors aim to explore how the professional contexts of medicine, nursing, and teacher education approach DEI-related pedagogy. METHOD: The authors conducted a qualitative exploratory study using constructivist grounded theory methodology. Using both purposive and theoretical sampling, 24 participants from across the United States and Canada were interviewed, including physicians, nurses, and K-12 teachers in practice as well as professional educators in each discipline (May-December 2022). Interviews included a case-based elicitation approach, and data were analyzed iteratively across the data collection period using constant comparative analysis. RESULTS: Medicine and nursing tend to prioritize objectivity and seek to avoid or neutralize emotions that are intrinsic to DEI-related learning, view DEI expertise as being outside the purview of their profession, and view time for DEI as limited in a clinical learning environment. In contrast, teaching is built on the assumption that DEI expertise is co-constructed and inclusive of community voices and lived experiences. DEI-related pedagogy in teaching allowed for exploration of deep assumptions and learning about structural inequities. CONCLUSIONS: Findings suggest that assumptions and values held in professions, such as medicine and nursing, that valorize objectivity and neutrality, while stigmatizing vulnerability and suppressing emotions, may constrain DEI-related teaching and learning in such contexts.

Supportive and collaborative interdependence: Distinguishing residents' contributions within health care teams.

INTRODUCTION: Individual assessments disregard team contributions, while team assessments disregard an individual's contributions. Interdependence has been put forth as a conceptual bridge between our educational traditions of assessing individual performance and our imminent challenge of assessing team-based performance without losing sight of the individual. The purpose of this study was to develop a more refined conceptualisation of interdependence to inform the creation of measures that can assess the interdependence of residents within health care teams. METHODS: Following a constructivist grounded theory approach, we conducted 49 semi-structured interviews with various members of health care teams (e.g. physicians, nurses, pharmacists, social workers and patients) across two different clinical specialties-Emergency Medicine and Paediatrics-at two separate sites. Data collection and analysis occurred iteratively. Constant comparative inductive analysis was used, and coding consisted of three stages: initial, focused and theoretical. RESULTS: We asked participants to reflect upon interdependence and describe how it exists in their clinical setting. All participants acknowledged the existence of interdependence, but they did not view it as part of a linear spectrum where interdependence becomes independence. Our analysis refined the conceptualisation of interdependence to include two types: supportive and collaborative. Supportive interdependence occurs within health care teams when one member demonstrates insufficient expertise to perform within their scope of practice. Collaborative interdependence, on the other hand, was not triggered by lack of experience/expertise within an individual's scope of practice, but rather recognition that patient care requires contributions from other team members. CONCLUSION: In order to assess a team's collective performance without losing sight of the individual, we need to capture interdependent performances and characterise the nature of such interdependence. Moving away from a linear trajectory where independence is seen as the end goal can also help support efforts to measure an individual's competence as an interdependent member of a health care team.

Developing and evaluating a peer-based mental health literacy intervention with adolescent athletes.

Widespread adolescent involvement in organized sport means that sport contexts are well-suited to 'actively' integrate prevention programs that may promote population-level change. This mixed methods study aimed to evaluate the feasibility and acceptability of a peer-based mental health literacy intervention. The intervention (i.e., Team Talk) was presented to eleven adolescent sport teams in the United States, with a total of 174 participants. Athlete participants completed surveys immediately before and after the intervention-including measures of workshop acceptability, social identity, and help-seeking behaviors. Semi-structured interviews were also conducted with a subset of five athletes, nine parents, and two coaches. With respect to recruitment as an indicator of feasibility, club-level adoption of the intervention was low, with difficulty recruiting clubs for intervention delivery. This signals that feasibility of the intervention-as it is currently designed and implemented by the research team-is low when considering similar competitive adolescent sport clubs and delivered as team-level workshops. Meanwhile, participants reported high acceptability of the intervention, and acceptability levels across participants was predicted by contextual factors related to implementation such as session duration. Regarding limited efficacy testing with measures completed before and after the intervention session: (a) social identity scores increased following the intervention, and (b) significant differences were not identified regarding efficacy to recognize symptoms of mental disorders. Athlete, coach, and parent interview responses also described potential adaptations to mental health programs. This research demonstrates the potential utility of peer-based mental health literacy interventions, while also revealing that further implementation research is necessary to adapt mental health literacy interventions to suit diverse adolescent sport contexts.

A Scoping Review on College Student Physical Activity: How Do Researchers Measure Activity and Examine Inequities?

BACKGROUND: The purpose of this scoping review was to critically examine the design and quality of contemporary research involving college student physical activity participation, focusing on physical activity measurement, assessment of sociodemographic characteristics, and examination of inequities based on sociodemographic characteristics. METHODS: Systematic searches were conducted in 4 electronic databases. RESULTS: From 28,951 sources screened, data were extracted from 488 that met the inclusion criteria. The majority of the studies were cross-sectional in design (91.4%) and employed convenience sampling methods (83.0%). Based on the subsample of studies that reported the percentage of students meeting aerobic (n = 158; equivalent of 150 min/wk of moderate physical activity) and muscle-strengthening activity recommendations (n = 8; ≥2 times/wk), 58.7% and 47.8% of students met aerobic and muscle-strengthening recommendations, respectively. With the exception of age and sex, sociodemographic characteristics were rarely assessed, and inequities based upon them were even more scarcely examined-with no apparent increase in reporting over the past decade. CONCLUSIONS: College student physical activity levels remain concerningly low. The generalizability of findings from the contemporary literature is limited due to study design, and acknowledgement of the influence that sociodemographic characteristics have on physical activity has largely been overlooked. Recommendations for future research directions and practices are provided.

A scoping review of approaches for measuring 'interdependent' collaborative performances.

INTRODUCTION: Individual assessment disregards the team aspect of clinical work. Team assessment collapses the individual into the group. Neither is sufficient for medical education, where measures need to attend to the individual while also accounting for interactions with others. Valid and reliable measures of interdependence are critical within medical education given the collaborative manner in which patient care is provided. Medical education currently lacks a consistent approach to measuring the performance between individuals working together as part of larger healthcare team. This review's objective was to identify existing approaches to measuring this interdependence. METHODS: Following Arksey & O'Malley's methodology, we conducted a scoping review in 2018 and updated it to 2020. A search strategy involving five databases located >12 000 citations. At least two reviewers independently screened titles and abstracts, screened full texts (n = 161) and performed data extraction on twenty-seven included articles. Interviews were also conducted with key informants to check if any literature was missing and assess that our interpretations made sense. RESULTS: Eighteen of the twenty-seven articles were empirical; nine conceptual with an empirical illustration. Eighteen were quantitative; nine used mixed methods. The articles spanned five disciplines and various application contexts, from online learning to sports performance. Only two of the included articles were from the field of Medical Education. The articles conceptualised interdependence of a group, using theoretical constructs such as collaboration synergy; of a network, using constructs such as degree centrality; and of a dyad, using constructs such as synchrony. Both descriptive (eg social network analysis) and inferential (eg multi-level modelling) approaches were described. CONCLUSION: Efforts to measure interdependence are scarce and scattered across disciplines. Multiple theoretical concepts and inconsistent terminology may be limiting programmatic work. This review motivates the need for further study of measurement techniques, particularly those combining multiple approaches, to capture interdependence in medical education.

Network centrality, group density, and strength of social identification in college club sport teams.

OBJECTIVE: With the underlying rationale that social identification is related to psychological health and well-being, we aimed to understand how social connections and group structure within college club sport teams relate to students' perceptions of social identification. METHOD: We sampled 852 student-athletes from 35 intact same-sex college club sport teams. Using social network analyses derived from teammates' reports of connections with one another (i.e., time spent outside of sport, and teammate friendships), we computed: outdegree centrality (i.e., self-reported connections with teammates), indegree centrality (i.e., nominations from others), and group-level density. Multilevel models were fit to test the relative effects of outdegree centrality, indegree centrality, and group-level team density on athletes' social identification strength. RESULTS: Outdegree centrality, indegree centrality, and team density were all positively related to the strength of athletes' social identification with their sport team. Examining model results step-by-step, incoming nominations of social connections (i.e., indegree) were associated with social identification beyond the effects of self-reported outdegree centrality. Furthermore, team-level density was significantly related to social identification after accounting for the individual-level effects of centrality. CONCLUSION: Sport is a domain where participants can build social connections with peers, and sport groups offer a salient source for social identification. The current findings indicate that athletes who have greater social connections with teammates may form a stronger sense of social identification. Alongside theoretical contributions to a social identity approach to studying small groups, the current study highlights the utility of studying small groups using social network methodologies.

Growing into "Us": Trajectories of Social Identification with College Sport Teams Predict Subjective Well-Being.

BACKGROUND: Groups are often a source of social identification that may elicit subjective well-being. When joining and maintaining membership of groups such as sport clubs, it is anticipated that members will experience varying trajectories of identification strength, but it is unclear how these trajectories may relate to well-being. METHOD: Participants were 697 college students (64% female), nested within 35 club-level sport teams. The current study longitudinally assessed students' social identification with sport teams at three timepoints (3-month lags) across a school year to examine the extent that growth trajectories in identification strength predicted indices of well-being (i.e. life satisfaction, happiness, and subjective health) at the end of the school year. RESULTS: Multilevel latent growth modeling revealed that end-of-year well-being was positively predicted by social identification intercepts (b = .24, p = .010) and growth trajectories (b = .75, p < .001). Accounting for baseline identification, steeper increases in social identification (upward trajectories) predicted greater well-being. CONCLUSIONS: Findings support established theory that social identification relates to well-being, while adding novel insights that students may experience unique benefits when their social identity strengthens over the course of a school year. Considering recent declines in college student well-being, groups like sport teams represent a source for social identification that should be fostered throughout the course of one's group membership.

Adolescent Sport Participation and Symptoms of Anxiety and Depression: A Systematic Review and Meta-Analysis.

Sport may protect against symptoms of mental disorders that are increasingly prevalent among adolescents. This systematic review explores the relationship between adolescent organized sport participation and self-reported symptoms of anxiety and depression. From 9,955 records screened, 29 unique articles were selected that included 61 effect sizes and 122,056 participants. Effects were clustered into four categories based on the operationalization of sport involvement: absence or presence of involvement, frequency of involvement, volume of involvement, and duration of participation. Results from the random-effects meta-analyses indicated that symptoms of anxiety and depression were significantly lower among sport-involved adolescents than in those not involved in sport, although this effect size was small in magnitude. Meta-regression was used to identify how age and sex explained heterogeneity in effects. Although these results do not signify a causal effect, they do support theorizing that sport participation during adolescence may be a protective environment against anxiety and depressive symptoms.