Twelve tips for integrating medical students into specialty clinics.

The specialty clinic is an excellent educational environment for medical students. However, preceptors face several challenges as they seek to balance treating complex system-specific conditions with effective teaching, including time constraints, clinical tasks, engaging multi-level learners, and perhaps a lack of guidelines for or training in outpatient medical education. We thus propose twelve tips for integrating medical students into specialty clinics in a feasible and mutually fulfilling way. The first three tips focus on planning the session and setting expectations, the next seven tips detail specific, actionable strategies for enhancing learning while maximizing efficiency, and the final two tips discuss how to optimally close the session with feedback and debriefing.

Comparing trends in medical education between the United Kingdom and Australia: A personal perspective.

Medical schools must create doctors who can address health workforce challenges. This article compares broad trends in medical education between the United Kingdom and Australia. Medical schools both help develop and are constrained by the health workforce. Innovations developed in Britain, like medical doctor degree apprenticeships, are unlikely to address workforce issues. Australia's medical curricula have more effectively adapted to its workforce needs.

Did the students' satisfaction rates at Avalon University School of Medicine correlate with the occurrence of accreditation site visits?

INTRODUCTION: Accreditation of medical education programs can be observed from different perspectives. Regulatory/accreditation agencies consider it vital to assure a certain level of quality. Other stakeholders may perceive the accreditation process as a negative experience, draining resources, and efforts. Although accreditation may improve the program's governance and administration, its direct or indirect impact on students must be further investigated. This study explores the relationship between the occurrence of accreditation site visits and student satisfaction rates at Avalon University School of Medicine. METHODS: A comparison study was conducted with retrospective satisfaction data from two accreditation cycles at AUSOM. We used the Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) student surveys for data collection, and data from 2017, 2019, and 2022 were used. The response rate was 70% (n = 71), 72% (n = 47), and 60% (n = 56) for basic science students and 80% (n = 111), 82% (n = 115), and 70% (n = 76) for clinical students in 2017, 2019, and 2022, respectively. The survey for basic sciences students included 37 questions/items, and the survey for clinical students included 39 questions/items. The responses for the questionnaire were on the five-point Likert scale. The retrospective data were evaluated using the unpaired Wilcoxon-rank sum test. RESULTS: The ratings for the basic science students' survey increased from 2017 to 2019 (first accreditation cycle) only for 11 items/questions and they were increased from 2019 to 2022 for all items/questions. The ratings for clinical science students' surveys increased from 2017 to 2019 (the first accreditation cycle) for all items/questions with a statistically significant p-value. They increased for 28 questions/items from 2019 to 2022, and two items (availability and adequacy of career counseling) showed statistically significant p-values. CONCLUSIONS: The pre-accreditation preparation and the self-evaluation process while correcting the program's deficiencies are essential triggers for the quality improvement process associated with accreditation.

Twelve tips for creating a longitudinal quality improvement and safety education for early health professions students.

Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.

Learning strategies for the advanced trainee in specialist training.

BACKGROUND: A significant factor of clinicians' learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. MATERIAL AND METHOD: We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. RESULTS: Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: 'Be ready to learn', "Take the 'take-home-messages' home', "Be ready to create your own opportunities', and "Face it, it's not entirely up to you'. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. CONCLUSION: Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.

Development of an integrated milestone assessment tool across multiple early-adopter programs for breaking bad news: a pilot project.

BACKGROUND: The transition of the Accreditation Council for Graduate Medical Education (ACGME) to milestone assessment creates opportunities for collaboration and shared assessments across graduate medical programs. Breaking bad news is an essential communication skill that is a common milestone across almost every medical specialty. The purpose of this study was to develop and pilot an integrated milestone assessment (IMA) tool for breaking bad news using ACGME milestone criteria and to compare the IMA tool with the existing SPIKES protocol. METHODS: The IMA tool was created using sub-anchors in professionalism and interpersonal communication skills that are applicable to every specialty and to the ability to break bad news. Two cases of breaking bad news, designed to be "easy" and "intermediate" in difficulty, were used to assess basic skills in breaking bad news in first-year medical residents from six residency specialties. Eight standardized patients were trained to portray the cases in sessions held in November 2013 and May 2014. Standardized patients completed an assessment checklist to evaluate each resident's performance in breaking bad news based on their use of the SPIKES protocol and IMA tool. Residents answered post-encounter questions about their training and comfort in breaking bad news. The association between SPIKES and IMA scores was investigated by simple linear regression models and Spearman rank correlations. RESULTS: There were 136 eligible medical residents: 108 (79.4%) participated in the first session and 97 (71.3%) participated in the second session, with 96 (70.6%) residents participating in both sessions. Overall, we were able to identify residents that performed at both extremes of the assessment criteria using the integrated milestone assessment (IMA) and the SPIKES protocol. Interestingly, residents rated themselves below "comfortable" on average. CONCLUSION: We developed an integrated milestone assessment (IMA) that was better than the SPIKES protocol at assessing the skill of breaking bad news. This collaborative assessment tool can be used as supplement tool in the era of milestone transformation. We aim assess our tool in other specialties and institutions, as well as assess other shared milestones across specialties.

Teaching compassion for social accountability: A parallaxic investigation.

BACKGROUND: In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement. AIM: This paper explores the co-evolution of compassion and SA. METHODS: The study used an arts integrated approach to investigate people's perceptions of SA in four medical schools across Australia, Canada, and the USA. Each school engaged approximately 25 participants who partook in workshops and in-depth interviews. RESULTS: We began with a study of SA and the topic of compassion emerged out of our qualitative data and biweekly meetings within the research team. Content analysis of the data and pedagogical discussion brought us to realize the importance of compassion in the practice of SA. CONCLUSIONS: The cultivation of compassion needs to play a significant role in a socially accountable medical educational system. Medical schools as educational institutions may operate themselves with compassion as a driving force in engaging partnership with students and communities. Social accountability without compassion is not SA; compassion humanizes institutional policy by engaging sympathy and care.

Twelve tips for excelling as an introvert in academic medicine (at all levels).

BACKGROUND: Introverted individuals comprise up to half of the population, but are often overlooked in a culture that privileges extraversion. This misunderstanding of introversion has downstream effects for introverts in academic medicine, including lower grades on clinical rotations, increased stress, and under-representation in leadership positions. AIMS: To increase support for and awareness of the unique strengths of introverted individuals at all stages of a career in academic medicine. DESCRIPTION: This article offers twelve tips, based in the educational, business, and personality literature, to empower introverted students, residents, and faculty members for success in academic medicine. While many of the tips apply broadly, certain tips may be more relevant to those in a particular career stage. CONCLUSION: Increased understanding of the natural tendencies and strengths of introversion will promote a more inclusive working environment for all personality types in medicine and allow introverts at all levels of training and practice to thrive.

Twelve tips for developing active bystander intervention training for medical students.

Healthcare experiences of mistreatment are long standing issues, with many not knowing how to recognise it and respond appropriately. Active bystander intervention (ABI) training prepares individuals with tools and strategies to challenge incidences of discrimination and harassment that they may witness. This type of training shares a philosophy that all members of the healthcare community have a role to play in tackling discrimination and healthcare inequalities. We developed an ABI training programme for undergraduate medical students, after recognising the need for this given the students' adverse experiences on clinical placements. From longitudinal feedback and robust observations of this programme, this paper intends to provide key learning lessons and guidance on how to develop, deliver and support faculty in facilitating these types of trainings. These tips are also accompanied by recommended resources and suggested examples.

Capacity for wonder among medical students: Assessment and educational implications.

OBJECTIVE: The capacity for wonder (CfW) is a personal disposition related to lifelong learning and moral character development, two highly valued characteristics of health professionals. We previously developed and validated a CfW measure among college students. Here we describe how the scale performs among medical students. METHODS: We invited all students at a top-tier U.S. medical school (N = 477) to participate in an online survey including the CfW measure, year in medical school, and demographics. We performed confirmatory factor analysis on the CfW measure and reassessed its reliability. RESULTS: 276 students completed the survey for an overall response rate of 58%. Factor analysis resulted in a 10-item scale with an alpha of 0.79 and an eigen value of 3.57. Factor loadings ranged from 0.43 to 0.77. The mean total score was 39.3 (SD = 8.9) out of a possible high score of 60. Total scores varied by year in school with significantly lower scores among 2nd year students (32.9 vs. 41.5; p < 0.001). CONCLUSION: We confirmed the reliability of a 10-item CfW scale in 4 cohorts of medical students. Results suggest that the 2nd year of medical school poses the greatest risk to students' capacity for wonder. Efforts should be made to understand this phenomenon and develop interventions to mitigate it. Future research should explore the validity of the CfW scale, its utility in evaluating interventions designed to cultivate the capacity for wonder, its applicability to other groups of health professionals, and its association with ethical decision-making and practice.

The personal is political in the struggle for equity in global medical education research and scholarship.

Medical education research is rooted in a long tradition of objectivity, evidence-based methods, and clinical surety. However, the inexorable confidence, health professions research education, and scholarship have in the manifest supremacy of western science as the foundational epistemology is questionable. Is this bravado legitimate and if so by what authority? How does this dominance of western epistemic frames determine how we are seen and how we see ourselves as health professions educators scholars and researchers? In what ways does western epistemic dominance influence how and why we conduct research? What do we consider as important to research in health professions education (HPE)? The answers are different depending on where we position ourselves or are placed in a hierarchy of scholarly privilege. I pose that the supremacy of Western scientific epistemology in modern medical education, research, and practice blurs differently colored scientific lenses and silences marginalized voices from legitimate contribution to HPE.

Dental students' perception of their educational environment in relation to their satisfaction with dentistry major: a cross-sectional study.

BACKGROUND: Students' perception of their educational environment and satisfaction with their major can reveal the extent of their readiness to practice their profession after graduation. This study aimed to evaluate dental students' perception of their educational environment and satisfaction with their major in dentistry, as well as the relationship between these two factors. METHODS: An online survey was conducted in 2022 among first- to fourth-year students across 11 dental schools in Korea. The Dundee Ready Education Environment Measure (DREEM) and Academic Major Satisfaction Scale (AMSS) were used to measure the students' perception of the educational environment and satisfaction with their major in dentistry, respectively. RESULTS: A total of 539 students participated in the survey (response rate = 18.1%). The overall mean scores of the DREEM and AMSS were 125.03 (maximum score 200) and 22.01 (maximum score 30), respectively. Fourth-year students had the lowest scores in the overall DREEM, DREEM subscales (excluding students' perceptions of atmosphere), and AMSS. The overall DREEM scores and all DREEM subscales showed statistically significant positive and moderate correlations with AMSS (p < 0.001). CONCLUSION: Using the DREEM, we identified areas that need improvement and the academic year (fourth year) that require proactive support. Considering the positive correlation between all DREEM subscales and the AMSS, measures to comprehensively improve the educational environment are needed to improve dental students' satisfaction with their major.

Online medical education using a Facebook peer-to-peer learning platform during the COVID-19 pandemic: a qualitative study exploring learner and tutor acceptability of Facebook as a learning platform.

BACKGROUND: In recent years, higher education institutions have been moving teaching online, accelerated by the pandemic. The Remote Learning Project (RLP), based at the Norwich Medical School (NMS) in the United Kingdom (U.K.), was a peer-to-peer teaching program developed to supplement medical school teaching during the pandemic. The teaching was delivered through Facebook using peer-to-peer teaching. Tutors were final year medical students, teaching medical student learners in lower years. Tutors and learners perception of peer-to-peer online learning delivered through the Facebook Social Media (SoMe) platform was investigated. METHODS: This qualitative study recruited tutor and learner participants from NMS by email, participation in the study was voluntary. Online semi-structured interviews of both tutors and learners in the remote learning project were conducted. The data was analysed using thematic analysis. RESULTS: Seven participants were interviewed. Five themes were identified; education (learning/teaching), productivity, data security, professionalism, and usability of the platform. Learners enjoyed the asynchronous nature of the platform and both learners and tutors enjoyed the peer-to-peer nature of the RLP, including the ability to immediately and easily answer on Facebook comments. Some learners felt distracted on Facebook, whilst others enjoyed the reminders. The mix of social and professional on the platform was met with caution from tutors. Both learners and tutors enjoyed the familiarity of the platform. CONCLUSIONS: The study found that SoMe may be a credible platform to deliver online peer-to-peer teaching. Educators should consider the ergonomics of SoMe platforms when designing online curriculums. Guidelines for educators should be developed to better guide educators on the effective and safe use of SoMe as a learning tool.

Assessing the effects of a mentoring program on professional identity formation.

BACKGROUND: Medical education has enjoyed mixed fortunes nurturing professional identity formation (PIF), or how medical students think, feel and act as physicians. New data suggests that structured mentoring programs like the Palliative Medicine Initiative (PMI) may offer a means of developing PIF in a consistent manner. To better understand how a well-established structured research mentoring program shapes PIF, a study of the experiences of PMI mentees is proposed. METHODOLOGY: Acknowledging PIF as a sociocultural construct, a Constructivist approach and Relativist lens were adopted for this study. In the absence of an effective tool, the Ring Theory of Personhood (RToP) and Krishna-Pisupati Model (KPM) model were used to direct this dual Systematic Evidence-Based Approach (Dual-SEBA) study in designing, employing and analysing semi-structured interviews with PMI mentees and mentoring diaries. These served to capture changes in PIF over the course of the PMI's mentoring stages. Transcripts of the interviews and mentoring diaries were concurrently analysed using content and thematic analysis. Complementary themes and categories identified from the Split Approach were combined using the Jigsaw Approach and subsequently compared with mentoring diaries in the Funnelling Process. The domains created framed the discussion. RESULTS: A total of 12 mentee interviews and 17 mentoring diaries were analysed, revealing two domains-PMI as a Community of Practice (CoP) and Identity Formation. The domains confirmed the centrality of a structured CoP capable of facilitating longitudinal mentoring support and supporting the Socialisation Process along the mentoring trajectory whilst cultivating personalised and enduring mentoring relationships. CONCLUSION: The provision of a consistent mentoring approach and personalised, longitudinal mentoring support guided along the mentoring trajectory by structured mentoring assessments lay the foundations for more effective mentoring programs. The onus must now be on developing assessment tools, such as a KPM-based tool, to guide support and oversight of mentoring relationships.

Promising score for teaching and learning environment: an experience of a fledgling medical college in Saudi Arabia.

BACKGROUND: Professional competency of graduates of an institute reflects its teaching and learning environment (TLE). This study aimed to provide a preliminary assessment of the TLE at the College of Medicine at Majmaah University. METHODS: A cross-sectional survey was conducted during the 2019-20 academic year among students at the College. A validated scoring tool "the Experience of Teaching and Learning Questionnaire" (available at https://bit.ly/3sVBuEw ) was used. The mean score of each section and statement, the difference between the mean scores of different demographic groups, and correlations between sections were analysed. RESULTS: A total of 234 (72.2%) enrolled students participated in this survey, with a male-to-female ratio and a ratio of participants from basic to clinical years being 2:1 and 1:1, respectively. Most participants reported a GPA of above 3/5. The overall mean score was 3.52/5 points. Section one "approaches to learning and studying" has the highest mean score (3.68), and no section scored a mean below three, though section three "demands made by the course" scored a borderline mean of 3.08. Students in clinical years had a significantly higher overall mean score compared to their counterparts (3.66 vs. 3.39, p < 0.001). CONCLUSIONS: Students at the College had a positive perception of the TLE, but face challenges in coping with the demands of acquiring knowledge and subject-based skills, and in appreciating the TLE especially during basic science years, highlighting the need for an atmosphere that allows them to meet demands and develop greater appreciation.

Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure.

BACKGROUND: The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students' perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM). METHODS: 76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion. RESULTS: 38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥ 4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤ 3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1-3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥ 4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p = 0.008), preparedness for student entry (p = 0.003), and overarching dimension of social participation (p = 0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p = 0.000 and p = 0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p = 0.000). DISCUSSION: The students' CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.

Identifying stressor criteria that hinder or challenge junior clinical medical student learning.

INTRODUCTION: What makes something a stressor within clinical students' education is unclear. Medical students moving from a predominantly protected classroom environment to a situated-work environment provided an ideal transition point to explore the criteria that might make a learning experience a stressor and whether these stressors hinder or challenge learning. METHOD: Data on the stressors associated with learning experiences in clinical education were collected from New Zealand undergraduate medical students. Free text comments, in a survey-based questionnaire were supplemented by focus group data. Using inductive thematic analysis with grounded theory, themes were generated about the characteristics of stressors; referred to here as stressor criteria. These stressor criteria were then classified according to their impact on perceived learning. RESULTS: Under the broad headings of the nature of the learning task, external factors, internal factors, and social interaction; 12 stressor criteria groupings were defined. Some of these criteria were a positive challenge to learning (e.g. legitimacy of the task, novelty of the learning, social interactions) and others a hindrance. DISCUSSION: Not all stressors hinder learning. Instead, and depending on their nature, many result in perceived assistance to learning. Stressors hindering learning need to be recognised by the teacher, especially those that can be converted from a hindrance to an assistance.

Twelve tips for creating an escape room activity for medical education.

Communication, teamwork, and resilience all require active practice by healthcare teams. Games such as escape rooms can add variety, interactivity, and value to teaching sessions. Escape room activities typically include a variety of sequential puzzles that lead participants to break free of a room, or can be adapted into an 'escape box' challenge where participants work to successfully unlock a box. Escape room or escape box exercises can help healthcare teams develop and enhance team skills, as well as reinforce medical knowledge. We developed an escape box session to teach and reinforce organizational Safety II principles and the resilience potentials: monitor, respond, learn, and anticipate. We report 12 tips to effectively organize and develop an escape room or escape box activity for multidisciplinary healthcare teams.

Twelve tips for mindful teaching.

Medical educators' stressors continue to increase, and they increasingly find themselves removed from their learners. This distance is thought to contribute to the disenchantment many educators feel. The challenge for educators is to reengage with their learners and restore their satisfaction in teaching. Mindful teaching can help educators meet this challenge. Mindful teaching is not an instructional technique; rather, it is a way of being that the teacher embodies. Mindful teachers practice awareness, acceptance and curiosity. They recognize the needs of their learners, engaging with learners who are 'at the ready'; encouraging those who might not be engaged; and advocating for those who need support. These educators are less susceptible to burnout and help learners develop their own mindfulness. The Tips noted in this article can help educators make deeper connections with their learners, garner greater sense of personal accomplishment and become invigorated by their learners' achievements.

R.E.A.C.T: A framework for role modeling anti-racism in the clinical learning environment.

PURPOSE: In 2020, medical schools across the U.S. were called to task by students who demanded a response to structural racism in medicine. Many medical schools made anti-racism declarations and pledged to promote more inclusive learning environments. Much of the focus was on changing the pre-clinical curriculum and less on the everyday interactions that occur in clinical settings. As medical educators, we have an obligation to reinforce statements of solidarity by role modeling behaviors that demonstrate anti-racism in clinical practice. METHODS: This article proposes a framework that provides practical steps for role modeling anti-racism in the clinical learning environment. These steps are drawn from a review of the literature on role modeling, constructs from Social Cognitive Learning Theory, and anti-racism praxis. RESULTS: The resulting framework uses the acronym R.E.A.C.T to describe practical steps that include Reflecting on implicit biases, Educating ourselves on historical and current forms of structural racism, Assessing the use of race in clinical practice and asking how racism is impacting a clinical interaction, Calling out behaviors that perpetuate racism, and Treating everyone with dignity and respect. CONCLUSIONS: The R.E.A.C.T framework is of value to medical educators because it provides practical steps on role modeling anti-racism in the clinical learning environment. The framework calls medical educators not to merely passively 'react,' but to be introspective, proactive, and intentional in their response to racism. Examples are provided on how each step can be actualized and adapted for different learning environments.