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2.
J Grad Med Educ ; 11(4 Suppl): 47-63, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428259

RESUMO

Background: With increasing physician mobility, there is interest in how medical schools and postgraduate medical education institutions across the world develop and maintain the competence of medical teachers. Published reviews of faculty development (FD) have predominantly included studies from the United States and Canada. Objective: We synthesized the international FD literature (beyond the US and Canada), focusing on FD type, intended audience, study format, effectiveness, differences among countries, and potential unique features. Methods: We identified English-language publications that addressed FD for medical faculty for teaching and related activities, excluding US and Canadian publications. Results: A search of 4 databases identified 149 publications, including 83 intervention studies. There was significant growth in international FD publications for the most recent decade, and a sizable number of studies were from developing economies and/or resulted from international collaborations. Focal areas echo those in earlier published reviews, suggesting the international FD literature addresses similar faculty needs and organizational concerns. Conclusions: The growth in publications in recent years and a higher proportion of reporting on participant reactions, coupled with less frequent reporting of results, transfer to practice, and impact on learners and the organization, suggest this is an evolving field. To enhance international FD, educators and researchers should focus on addressing common needs expressed by faculty, including curriculum design and evaluation, small group teaching, assessing professionalism and providing feedback. Future research should focus on approaches for developing comprehensive institutional FD programs that include communities of learning and practice and evaluating their impact.


Assuntos
Competência Clínica , Docentes de Medicina , Saúde Global , Publicações Periódicas como Assunto , Desenvolvimento de Pessoal , Currículo , Educação Médica , Humanos , Internato e Residência , Profissionalismo
4.
Med Teach ; 41(4): 391-397, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31008675

RESUMO

Aim: This perspective is part of a series of articles that are outcomes of a consensus conference, that seek to offer a comprehensive examination of the clinical learning environment (CLE), using different academic disciplines and areas of focus termed "avenues." The education dimensions of the CLE are discussed in detail in this perspective, along with critical linkages to the other avenues. Methods: Using iterative presentations, discussion and small group work, in October 2018, the consensus conference participants explored the education, psychological, sociocultural, diversity and inclusion, digital and architectural aspects of the CLE. Results: The education avenue of the CLE includes elements of teaching and learning such as the curriculum, clinical experiences, the assessment system, educational program governance, trainee selection, faculty development, and program evaluation and improvement. Within the educational domain, we focus on organizational and personal/social aspects of the CLE, including (1) curriculum design and deployment, including placement of trainees in clinical settings, organizational culture, practices and policies, and accreditation and regulatory requirements from the organizational domain (2) the education system, including assessment, program evaluation and organization and governance; and (3) elements from the personal and social domains, including peer-to-peer, trainee-faculty, and trainee-patient relationships that influence how and what postgraduate trainees learn, trainee selection, informal and hidden curricula, and trainees' perceptions of their learning environment. Conclusions: We provide suggestions for further research and recommendations for addressing challenges and facilitating improvement in the educational aspects of the CLE, along with actionable practice points.


Assuntos
Meio Ambiente , Pessoal de Saúde/educação , Aprendizagem , Meio Social , Ensino/organização & administração , Competência Clínica/normas , Currículo , Avaliação Educacional/métodos , Docentes/educação , Docentes/organização & administração , Humanos , Relações Interpessoais , Cultura Organizacional , Desenvolvimento de Pessoal/organização & administração , Ensino/psicologia , Ensino/normas
5.
Med Teach ; 41(4): 366-372, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30880530

RESUMO

Learning in a clinical context is foundational in the training of health professionals; there is simply no alternative. The subject of the clinical learning environment (CLE) is at the forefront of discussions. In this introduction to a themed issue on the CLE, we present an expanded conceptual model that approaches the CLE through six different lenses, termed "avenues:" architectural, digital, diversity and inclusion, education, psychological, and sociocultural, with each avenue represented by a paper. The aim is to facilitate dialog around the contributions of different academic disciplines to research on the CLE. Collectively the papers highlight the overlap between the various "avenues" in how they influence each other, and how they collectively have shaped the work to understand and improve the CLE. The expectation is that the various avenues can add to existing knowledge and create new ideas for interventions to improve the clinical learning environment across nations for learners and teachers with the ultimate aim of improving patient care. Research and efforts to improve the CLE are critical to learning, professional socialization and well-being for trainees as they learn and participate in patient care, and to the quality of care they will deliver over decades of practice after graduation.


Assuntos
Meio Ambiente , Pessoal de Saúde/educação , Aprendizagem , Meio Social , Acreditação/normas , Competência Clínica/normas , Diversidade Cultural , Avaliação Educacional/normas , Humanos , Fatores de Tempo
6.
Med Teach ; 41(4): 380-384, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30794757

RESUMO

Aim: While diversity, equity, and inclusion are much proclaimed aspirational goals in education programs, the clinical learning environment (CLE) frequently falls short of meaningful incorporation of these concepts in processes, policies, and local culture. In this paper, we explore how inclusion, diversity, and equity can and should be defined and operationalized within medical education. Methods: Three cases, organized around Hafferty's curricular framework (formal, informal, and hidden), we illustrate lapses and potential best practices in inclusion in the CLE. Results: The essential "best-practice" of programs inclusive of diverse individuals is the design of policies, processes, and behavioral norms co-creatively with all community members. Potential pitfalls to greater inclusion include nostalgic reference to "the past", a neutrality that is operationalized without the rudder of explicit values and not recognizing that ethical obligations between teachers, learners, and programs are at the heart of the discussion of how inclusive learning and work environments are built. Conclusion: Inclusive CLE's provide space for co-creation, understand the need to ensure the voices of the vulnerable (i.e. learners) are heard and valued and through this promote the flourishing of diverse human capital, in keeping with a model that views diversity as a key attribute or organizational excellence.


Assuntos
Diversidade Cultural , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Aprendizagem , Meio Social , Competência Clínica/normas , Meio Ambiente , Humanos , Grupos Minoritários/psicologia , Local de Trabalho/psicologia
7.
Med Teach ; 41(4): 398-402, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30761935

RESUMO

Purpose: We examined studies of the clinical learning environment from the fields of sociology and organizational culture to (i) offer insight into how workplace culture has informed research on postgraduate trainee learning and professional development; (ii) highlight limitations of the literature; and (iii) suggest practical ways to apply sociocultural concepts to challenges in the learning environment. Materials and methods: Concepts were explored by participants at a consensus conference in October 2018. Results: We identified three enduring foci for research using a sociocultural lens: the hidden curriculum, exploration of medical errors, and the impact of time pressures on the relational nature of clinical education. Limitations included the lower value attributed to informal learning and a pejorative valuation of the hidden curriculum; and disconnect between practices in clinical settings and the priorities of the larger organization. Conclusions: Research on the learning environment using a sociocultural lens suggest workplace goals, norms and practices determined which learners engage in learning-relevant activities, to what extent, and the degree of guidance provided, with these factors creating "tacit" curricula that may support or compete with formal learning goals. We close with guidance on how sociocultural constructs could inform research to improve the learning environment.


Assuntos
Aculturação , Internato e Residência/organização & administração , Aprendizagem , Cultura Organizacional , Local de Trabalho/psicologia , Competência Clínica/normas , Diversidade Cultural , Currículo , Meio Ambiente , Humanos , Internato e Residência/normas , Erros Médicos/prevenção & controle , Pesquisa Qualitativa , Meio Social , Sociologia , Estudantes de Medicina/psicologia , Fatores de Tempo , Confiança , Local de Trabalho/organização & administração
8.
J Grad Med Educ ; 10(2): 235-241, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29686769

RESUMO

Background : Medical errors and patient safety are major concerns for the medical and medical education communities. Improving clinical supervision for residents is important in avoiding errors, yet little is known about how residents perceive the adequacy of their supervision and how this relates to medical errors and other education outcomes, such as learning and satisfaction. Methods : We analyzed data from a 2009 survey of residents in 4 large specialties regarding the adequacy and quality of supervision they receive as well as associations with self-reported data on medical errors and residents' perceptions of their learning environment. Results : Residents' reports of working without adequate supervision were lower than data from a 1999 survey for all 4 specialties, and residents were least likely to rate "lack of supervision" as a problem. While few residents reported that they received inadequate supervision, problems with supervision were negatively correlated with sufficient time for clinical activities, overall ratings of the residency experience, and attending physicians as a source of learning. Problems with supervision were positively correlated with resident reports that they had made a significant medical error, had been belittled or humiliated, or had observed others falsifying medical records. Conclusions : Although working without supervision was not a pervasive problem in 2009, when it happened, it appeared to have negative consequences. The association between inadequate supervision and medical errors is of particular concern.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Erros Médicos/estatística & dados numéricos , Corpo Clínico Hospitalar , Autorrelato , Adulto , Feminino , Humanos , Masculino , Inquéritos e Questionários
12.
J Grad Med Educ ; 9(6): 791-797, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29270282

RESUMO

Background: In 2013, the Accreditation Council for Graduate Medical Education (ACGME) transitioned into a new accreditation system to reduce burden, focus on outcomes, and promote innovation and improvement. One component is a self-study that includes aims, an environmental assessment, and setting improvement priorities. The ACGME initiated voluntary site visits following the self-study. Objective: We explored common themes in program aims and assessment of their environment. Methods: Using grounded theory, inductive and deductive qualitative methods, and truth grounding, we analyzed data from voluntary site visits of 396 core and subspecialty programs between June 2015 and September 2017, with a focus on common themes. Results: We report common themes for aims and the dimensions of the environmental assessment. Themes for strengths include a collegial, supportive learning environment; responsive leaders; and experiences that prepare residents for unsupervised practice. Improvement priorities encompass low learner engagement and "content mismatch" in didactic education, balancing education and service at a time of growing clinical volumes, and improving the utility of assessment systems. Common opportunities encompass collaborations that improve education, involving alumni and harnessing technology to enrich education, while threats include an unsustainable effort for many program leaders, clinical pressures on faculty, and loss of external sites important for education. Linked dimensions of the environmental assessment suggest benefit in a growing focus on learners, and approaches to ensure a humanistic learning environment that allows for growth, self-determination, and inclusion. Conclusions: The findings highlight actionable themes for the environmental assessment. We discuss implications for programs, institutions, and the ACGME.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Melhoria de Qualidade , Meio Social , Acreditação , Competência Clínica , Retroalimentação , Teoria Fundamentada , Humanos , Objetivos Organizacionais , Pesquisa Qualitativa , Estados Unidos
14.
Acad Med ; 92(7): 976-983, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28514230

RESUMO

PURPOSE: To systematically study the number of U.S. resident deaths from all causes, including suicide. METHOD: The more than 9,900 programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) annually report the status of residents. The authors aggregated ACGME data on 381,614 residents in training during years 2000 through 2014. Names of residents reported as deceased were submitted to the National Death Index to learn causes of death. Person-year calculations were used to establish resident death rates and compare them with those in the general population. RESULTS: Between 2000 and 2014, 324 individuals (220 men, 104 women) died while in residency. The leading cause of death was neoplastic disease, followed by suicide, accidents, and other diseases. For male residents the leading cause was suicide, and for female residents, malignancies. Resident death rates were lower than in the age- and gender-matched general population. Temporal patterns showed higher rates of death early in residency. Deaths by suicide were higher early in training, and during the first and third quarters of the academic year. There was no upward or downward trend in resident deaths over the 15 years of this study. CONCLUSIONS: Neoplastic disease and suicide were the leading causes of death in residents. Data for death by suicide suggest added risk early in residency and during certain months of the academic year. Providing trainees with a supportive environment and with medical and mental health services is integral to reducing preventable deaths and fostering a healthy physician workforce.


Assuntos
Causas de Morte/tendências , Internato e Residência/estatística & dados numéricos , Neoplasias/mortalidade , Médicos/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Estados Unidos/epidemiologia
15.
J Grad Med Educ ; 8(5): 795-805, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28018556

RESUMO

BACKGROUND : Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. OBJECTIVE : A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours-including patient safety, learning, and resident well-being. METHODS : Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. RESULTS : Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. CONCLUSIONS : The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.


Assuntos
Internato e Residência , Tolerância ao Trabalho Programado , Carga de Trabalho , Educação de Pós-Graduação em Medicina , Fadiga , Humanos , Segurança do Paciente , Privação do Sono
17.
J Grad Med Educ ; 8(2): 291-6, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27168915

RESUMO

Background Resident and faculty views of program strengths and opportunities for improvement (OFIs) offer insight into how stakeholders assess key elements of the learning environment. Objective This study sought (1) to assess the degree to which residents and faculty in 359 programs in 5 surgical specialties (obstetrics and gynecology, orthopaedic surgery, otolaryngology, plastic surgery, and surgery) were aligned or divergent in their respective views of program strengths and OFIs; and (2) to evaluate whether responses to selected questions on the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey correlated with strengths or OFIs identified by the residents during the site visit. Methods Faculty and resident lists of program strengths and OFIs in site visit reports for 2012 and 2013 were aggregated, analyzed, and compared to responses on the Resident Survey. Results While there was considerable alignment in resident and faculty perceptions of program strengths and OFIs, some attributes were more important to one or the other group. Collegiality was valued highly by both stakeholder groups. Responses to 2 questions on the ACGME Resident Survey were associated with resident-identified OFIs in site visit reports pertaining to aspects of the didactic program and responsiveness to resident suggestions for improvement. Conclusions The findings offer program leadership additional insight into how 2 key stakeholder groups view elements of the learning environment as program strengths or OFIs and may serve as useful focal areas for ongoing improvement activities.


Assuntos
Cirurgia Geral , Internato e Residência/métodos , Internato e Residência/organização & administração , Acreditação/métodos , Adulto , Educação de Pós-Graduação em Medicina , Docentes , Humanos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
18.
Acad Med ; 91(6): 858-64, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26910897

RESUMO

PURPOSE: Recent reports have identified concerning patterns of unprofessional and dishonest behavior by physician trainees. Despite this publicity, the prevalence and impact of these behaviors is not well described; thus, the authors aimed to review and analyze the various studies on unprofessional behavior among U.S. medical trainees. METHOD: The authors performed a literature review. They sought all reports on unprofessional and dishonest behavior among U.S. medical school students or resident physicians published in English and indexed in PubMed between January 1980 and May 2014. RESULTS: A total of 51 publications met criteria for inclusion in the study. The data in these reports suggest that plagiarism, cheating on examinations, and listing fraudulent publications on residency/fellowship applications were reported in 5% to 15% of the student and resident populations that were studied. Other behaviors, such as inaccurately reporting that a medical examination was performed on a patient or falsifying duty hours, appear to be even more common (reportedly occurring among 40% to 50% of students and residents). CONCLUSIONS: "Unprofessional behavior" lacks a unified definition. The data on the prevalence of unprofessional behavior in medical students and residents are limited. Unprofessional behaviors are common and appear to be occurring in various demographic groups within the medical trainee population. The relationship between unprofessional behaviors in training and future disciplinary action is poorly understood. Going forward, defining "unprofessional behavior"; developing validated instruments to evaluate such behaviors scientifically; and studying their incidence, motivations, and consequences are critical.


Assuntos
Educação de Graduação em Medicina , Internato e Residência , Má Conduta Profissional , Estudantes de Medicina/psicologia , Humanos , Má Conduta Profissional/psicologia , Má Conduta Profissional/estatística & dados numéricos , Má Conduta Profissional/tendências , Fatores de Risco , Estados Unidos
19.
J Grad Med Educ ; 7(2): 300, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26221467
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