Clinical Faculty Research Articles

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Reliability of the Critical Thinking in Communication Science and Disorders: A Content-Specific Critical Thinking Assessment

Introduction: Students and professionals in communication sciences and disorders (CSD) need to exhibit good critical thinking (CT) skills when engaged in clinical tasks. CSD clinicians must make decisions that are free from biases and support their claim with facts. Thus, CSD clinicians need to be trained to question their clinical practices and to skeptically evaluate new practices that develop. A content-specific CT test can help determine if students are developing these skills. However, to date, no such content-specific CT assessment exists for CSD. The purpose of this study was to determine the reliability of the current version of a specific content CT assessment, the Critical Thinking in Communication Sciences and Disorders (CTCSD). Methods: A sample of 150 CSD graduate students enrolled in three programs participated. They completed an online Qualtrics survey that consisted of the CTCSD. They completed the Qualtrics survey twice, once at the beginning of a semester and once at the end. The participant responses were independently scored by two research associates. The data were analyzed for reliability in three ways. Intra-subject reliability was assessed by comparing scores across the two testing sessions. Internal consistency of the items to measure a common construct was assessed using Cronbach’s alpha and Guttman’s Lambda 6. Inter-rater reliability was assessed using Cohen’s Kappa coefficient. In addition, the time used to complete the survey was analyzed. Results: The students from the three programs scored similarly on the CTCSD. High reliability ratings occurred for the intra-subject, internal consistency, and inter-rater measures. Discussion/Conclusion: The results indicate the reliability of the CTCSD. In combination with previous results indicating the face, construct, and criterion validity of the CTCSD, it appears to have psychometric strength. The CTCSD may help academic and clinical faculty select learning activities and focus feedback to their graduate students in order to reinforce skills the students exhibit and to develop other skills.

Leading the Charge: Effectiveness of a Workshop to Enhance Faculty Education of Health Inequity.

Medical educators in residency programs have unique opportunities to teach health inequities, social determinants of health (SDOH), and implicit bias. However, faculty are not adequately trained to effectively teach these topics. The aim is to assess the effectiveness of a faculty-level workshop to teach health inequity. An interactive workshop was designed by an interprofessional faculty from a major urban teaching hospital, addressing SDOH, implicit bias, an "Enhanced Social History," and the benefits of interprofessional care. Before and after completion, workshop participants completed surveys regarding comfort in teaching these concepts. Survey results were analyzed to assess benefits of the intervention. Sixty-four percent of participants completed preworkshop and postworkshop surveys. Participants reported increased contemplation and improved comfort in teaching SDOH, barriers to medical care, and implicit bias. Faculty comfort in teaching health inequity increased after this workshop. This may help bridge the gap between the expectation of clinical faculty to evaluate trainee practice of patient-centered, culturally competent care, and faculty possession of and confidence in health inequity teaching skills in clinical settings. Future research should focus on learner- and patient-based outcomes, including teaching time and impact on delivery of care.

Dental hygiene educators' knowledge and implementation of objective structured clinical examination in United States dental hygiene programs.

In 2021, the American Dental Association (ADA) announced the intention to develop a standardized dental hygiene licensure objective structured clinical examination (DHLOSCE). The purpose of this study was to measure the United States (US) dental hygiene (DH) educators' foundational knowledge of OSCE development and delivery in light of the impending development of the DHLOSCE by the ADA's Testing Services. The study was determined to be exempt from Institutional Review Board oversight. A 21-question survey was developed, pilot tested, and electronically disseminated through Qualtrics. The survey recruitment was emailed to the directors of all entry-level DH education programs in the US (n = 328), asking them to participate in the survey and to forward it to the clinical faculty in their institutions. Descriptive and inferential statistics were utilized to analyze the data. There were 143 study participants, for a completion rate of 45%. Over two-thirds of respondents (64%) were unaware of the plans to develop the DHLOSCE, while 13% reported utilizing OSCEs to meet accreditation standards. Only 3% reported receiving a formal education in OSCE development compared to 29% who learned through a colleague or peer. Nearly half reported a lack of faculty experience as a barrier to OSCE implementation. Over three-quarters, 76% reported a lack of OCSE development committees within their program and only 14% had experience developing an OSCE station. The study results suggest an urgent need for the development of OSCE training resources specific to DH education, as programs across the US prepare for the impending DHLOSCE.

Promoting scholarship in improvement science: A model for academic clinical departments.

Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer-reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

Student and clinician perceptions of medical student mistreatment: a cross-sectional vignette survey

ObjectivesThe mistreatment of medical students remains pervasive in medical education. Understanding the extent to which clinicians and students recognise mistreatment can assist in creating targeted interventions that reduce mistreatment. The...

Socially Distanced Emergencies: Clinicians' Experience with Tele-behavioral Health Safety Planning.

Psychiatry has experienced a rapid expansion in providing behavioral health services using virtual means; however, little is known regarding clinicians’ experience in managing patient emergencies during virtual encounters. We present survey data from a large academic psychiatry department designed to better understand safety planning while delivering ambulatory tele-behavioral health services during the COVID-19 pandemic. Clinical faculty in the department were sent an anonymous electronic survey developed and distributed using the Qualtrics™ software. Departmental leadership provided a list of clinicians who performed ambulatory care. SAS 9.4 was used to conduct statistical analysis for associations between variables. Approximately one quarter (23.3%) of respondents engaged in proactive safety planning for most of their outpatient virtual visits, while a little over half (53.2%) of clinicians implemented emergent safety planning between just one to five visits. Clinicians who more frequently implemented emergency protocols were more likely to engage in proactive safety planning prior to emergencies (p = 0.0115). 10.8% of participants petitioned for civil commitment, though those that did identified numerous challenges. Our results reinforce the importance in appropriate training regarding best practices while providing tele-behavioral health care, with increased awareness for conducting safety planning and implementing emergent protocols. Furthermore, while petitioning for civil commitment is a relatively low base rate event in a large outpatient practice, these data and narrative feedback help to outline challenges and potential measures to improve this process for all parties. Increased attention to protocols and procedures are key as the utilization of virtual care within psychiatry continues.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11126-022-10000-z.

Knowledge and Readiness for Interprofessional Learning Among Pharmacy and Clinical Nutrition Students at King Saud University.

BackgroundInterprofessional education (IPE) in healthcare specialties is important to optimize patient outcomes and shape professional image toward teamwork and collaboration among healthcare professionals. The aim of this study is to assess the impact of IPE on pharmacy and clinical nutrition students’ knowledge in food–drug interactions and readiness for interprofessional learning.MethodsThis pre-post study was conducted at King Saud University between February and March 2020. We held an interprofessional workshop for pharmacy and clinical nutrition students. After we introduced the faculty members who would deliver the food–drug interactions session, the students took a seven-question quiz (total score = 7) to assess their knowledge about the basic concept of food–drug interactions before the session. After that, a 45-minute lecture was provided by a clinical pharmacy faculty member. Students from both disciplines worked on three clinical scenarios. After completing the assigned scenarios, the students retook the quiz to assess their knowledge after the workshop. In addition, student readiness was assessed using the 19-item Readiness for Interprofessional Learning Scale (RIPLS).ResultsA total of 48 students were included in this study. Overall, students’ mean scores in both colleges significantly increased after the workshop (p < 0.01). The mean RIPLS total scores (SD) for pharmacy students and clinical nutrition students were 80.6 (7.48) and 81.26 (6.96), respectively, out of a maximum possible score of 95. These scores indicated positive attitudes toward interprofessional learning in both groups.ConclusionPharmacy and clinical nutrition students’ knowledge regarding food–drug interaction improved after implementing the IPE session. Students also reported higher scores for interprofessional learning. This indicates their willingness to participate in future interprofessional learning activities. Roles and responsibilities domain scores were slightly lower among both groups. Simulation-based activities including profession role exchange can be added to traditional IPE sessions to improve this domain.

244.10: Health System Barriers and Facilitators to Living Donor Kidney Transplantation: A Tale of Two States With the Highest and Lowest Rates

Purpose: Current efforts to increase living donor kidney transplantation (LDKT) entails identifying patient-level barriers and little is known about barriers that exist at the level of the health systems. The provision of transplantation in Canada is at the provincial level and there is wide variability in LDKT performance across different provinces. We aimed to learn and compare health systems with the best and the worst performance in LDKT, and to identify health system-level barriers to LDKT. Methods: This study took the form of a comparative case study analysis. Case study research is an in-depth and non-interventional examination of a single case over time using retrospective and contemporary data. Data collection entailed semi-structured interviews, document review, and participant observation. Data were analyzed thematically to generate themes surrounding the attributes and processes of a health system that facilitate the delivery of LDKT to patients, and those that create barriers. Results: In the best-performing province of Canada, five themes emerged as facilitators to the delivery of LDKT to patients. The relationship between two provincial organizations (a regional transplant and a regional nephrology order) was identified as key to enabling the mandate and processes for LDKT. On the other hand, in the worst-performing province, similar themes emerged as barriers to LDKT. Barriers were identified at the levels of organizational coordination, professional knowledge, resources, geography, and governance. Particularly, inconsistent coordination between regional clinics and transplant centers and poor role definition was seen to hinder and delay care processes. Conclusion: By comparing two health systems with variable rates of LDKT, we have identified several real-world health system-level barriers to the delivery of LDKT to patients. Many of these barriers are modifiable and have implications for practitioners, policymakers, administrators, and patients. This work is supported by a Gift of Life Institute Clinical Faculty Development Research Grant from the American Society of Transplantation and a Health Research Grant, Kidney Foundation of Canada.

Design, implementation and evaluation of a long-term educational faculty development program for clinical faculty

Design, implementation and evaluation of a long-term educational faculty development program for clinical faculty

Impact of Faculty Training in Health Systems Science on Scholarly Presentation of Resident Physician and Fellow Quality Improvement Projects.

The objective was to evaluate whether faculty participation in a Health Systems Science training program was associated with increased presentation and publication of quality improvement (QI) projects involving resident physicians and fellows at 1 institution. The authors evaluated annual, department-level counts of QI projects with resident physician or fellow involvement, presented locally or published, according to residency or fellowship program director and faculty participation in Teachers of Quality Academy. Ten clinical departments had 82 presentations and 2 publications. Each additional faculty member's participation in Teachers of Quality Academy increased the annual count of published or presented QI projects by 9% (P < 0.001). At this institution, participation in a Health Systems Science training program among clinical faculty improved engagement of resident physicians and fellows in local presentation of QI projects.

How to enhance students' learning in a patient-centered longitudinal integrated clerkship: factors associated with students' learning experiences.

PurposeLongitudinal integrated clerkships (LICs) have been introduced in medical schools, as learning relationships with clinical faculty or peers are important components of medical education. The purpose of this study was to investigate the characteristics of student-faculty and student-student interactions in the LIC and to identify other factors related to whether students understood and acquired the program’s main outcomes.MethodsThe study was conducted among the 149 third-year students who participated in the LIC in 2019. We divided the students into groups of eight. These groups were organized into corresponding discussion classes, during which students had discussions with clinical faculty members and peers and received feedback. Clinical faculty members and students were matched through an e-portfolio, where records were approved and feedback was given. A course evaluation questionnaire was completed and analysed.ResultsA total of 144 valid questionnaires were returned. Logistic regression analysis showed that relevant feedback in discussion classes (adjusted odds ratio [AOR], 5.071; p<0.001), frequency of e-portfolio feedback (AOR, 1.813; p=0.012), and motivation by e-portfolio feedback (AOR, 1.790; p=0.026) predicted a greater likelihood of understanding the continuity of the patient’s medical experience. Relevant feedback from faculty members in discussion classes (AOR, 3.455; p<0.001) and frequency of e-portfolio feedback (AOR, 2.232; p<0.001) also predicted a greater likelihood of understanding the concept of patient-centered care.ConclusionStudent-faculty interactions, including relevant feedback in discusstion classes, frequency of e-portfolio feedback, and motivation by e-portfolio feedback were found to be important factors in the LIC program.

"A whole other competence story": exploring faculty perspectives on the process of workplace-based assessment of entrustable professional activities.

The centrality of entrustable professional activities (EPAs) in competency-based medical education (CBME) is predicated on the assumption that low-stakes, high-frequency workplace-based assessments used in a programmatic approach will result in accurate and defensible judgments of competence. While there have been conversations in the literature regarding the potential of this approach, only recently has the conversation begun to explore the actual experiences of clinical faculty in this process. The purpose of this qualitative study was to explore the process of EPA assessment for faculty in everyday practice.We conducted 18 semi-structured interviews with Anesthesia faculty at a Canadian academic center. Participants were asked to describe how they engage in EPA assessment in daily practice and the factors they considered. Interviews were audio-recorded, transcribed, and analysed using the constant comparative method of grounded theory. Participants in this study perceived two sources of tension in the EPA assessment process that influenced their scoring on official forms: the potential constraints of the assessment forms and the potential consequences of their assessment outcome. This was particularly salient in circumstances of uncertainty regarding the learner's level of competence. Ultimately, EPA assessment in CBME may be experienced as higher-stakes by faculty than officially recognized due to these tensions, suggesting a layer of discomfort and burden in the process that may potentially interfere with the goal of assessment for learning. Acknowledging and understanding the nature of this burden and identifying strategies to mitigate it are critical to achieving the assessment goals of CBME.

Health sciences students' and instructors' perceptions of the emergency switch to virtual internship amid the COVID-19 pandemic: A case from Qatar.

In efforts to contain the COVID-19 pandemic, health colleges at Qatar University shifted their clinical training to virtual internships (VI) and project-based learning (PBL). The shift was new to students and faculty alike, and a major change that posed many challenges. This study aimed to explore the experience of changing to VIs during the pandemic from both the clinical instructors' and health sciences students' perspectives. A qualitative study was conducted based on the framework of readiness to change. It involved focus group discussions with students from the departments of Public Health and Human Nutrition and in-depth interviews with clinical instructors using appropriate online platforms. A total of 4 focus groups with 20 students and 4 interviews with instructors were conducted. Transcripts were analyzed following the inductive-deductive approach. The major themes that emerged from the analysis described students' and clinical instructors' perceptions of the necessity and efficiency of the switch to VI; the design of the VI and the extent of the clinical/field experience and skills that it offered; confidence in the ability to succeed in this type of internship and confidence about reaching expected goals; academic and moral support from clinical faculty and coordinators and the communication process with faculty and preceptors; and finally, the benefits gained and how employers would view this type of internship. Health sciences students' readiness for VI was generally low. Several student and faculty needs have to be addressed, specifically regarding the design of the program and the level of preceptors' communication with students. The findings would direct health programs, clinical instructors, and preceptors to better understand students' needs and efficiently plan for virtual internships during not only emergencies but also whenever there is a need to deliver online experiential learning courses.

Racial/Ethnic Disparities in Clerkship Grading: Perspectives of Students and Teachers.

Racial/ethnic disparities exist in clinical clerkship grading, yet little is known about medical student and faculty perspectives on why these disparities occur. This study explored what happens during clerkships that might explain grading disparities. Medical students and clerkship teachers at 3 U.S. medical schools completed a demographic survey and semistructured interview. The constant comparative method was used to analyze transcripts by inductively developing codes; grouping codes in categories; and refining codes, descriptions, and group assignments to identify themes. Interpretations of and relationships among themes were iteratively discussed to develop a grounded theory. Fifty-nine participants (29 medical students, 30 teachers [28 clinical faculty, 2 residents]) were interviewed in 2020. The Social Milieu of Medical Education (relationships, fit, opportunities, and judgments in the clinical-learning setting) was the organizing theme, influenced by 5 additional themes: Societal Influence (experiences in society), Students' Characteristics and Background (personal characteristics and experiences outside medical school), Assessment Processes (collection of student performance data and how data inform grades), Learning Environment (resources available and messaging within the clinical setting), and Students' Interactions and Reactions (interactions with and reactions to peers and teachers). The grounded theory highlights complex, multilayered aspects of how the social milieu of medical education is shaped by and shapes students' experiences, relationships, and clerkship assessments and promotes clerkship-grading disparities. Mitigating clerkship-grading disparities will require intervening on interrelated, contextual factors to provide equitable opportunities for students from diverse backgrounds and with varying styles of engagement in clinical-learning settings, along with attending to modifying assessment processes.

Physician Assistant Program Policies to Assess and Address Student Reports of Mistreatment During Clinical Training.

Many physician assistant (PA) students experience mistreatment in clinical learning environments, and accredited PA programs are required to define, publish, and make readily available policies and procedures for student reports of mistreatment. The purpose of this study is to describe the prevalence, content, and dissemination of program policies to address students' reports of mistreatment involving preceptors during supervised clinical experiences. To conduct a national policy analysis, the investigators included 10 new survey items in the 2019 Physician Assistant Education Association annual program survey. Deidentified data were analyzed by using descriptive statistics. The program response rate to the survey items was 99% (232). Approximately 76% of PA programs reported having a learner mistreatment policy. Policy content across programs varied widely, and several student reporting mechanisms were available. Program directors, clinical faculty, and institutional leadership were most likely to be involved in the management of reports. A majority programs actively assessed for mistreatment and most did so through clinical course evaluations and at the end of each clinical phase course. Most programs disseminated information about policy to faculty, students, and preceptors at least once a year. The descriptions of policy content, procedures, and dissemination increase educators' understanding of current policies across PA programs in the context of renewed efforts to write or revise policy that is specific to mistreatment. The authors discuss key policy priorities to define mistreatment, offer a range of confidential reporting mechanisms, review the management of reports, and consider how to optimize dissemination strategies.

Interdisciplinary simulation for nursing and medical students about final conversations: Catalyzing relationships at the end of life (CAREol)

Final conversations (FCs) go beyond how patients want to be cared for at the end of life (EOL) and focus on messages of love, identity specific, and unique to an individual and relationship that requires self-examination, everyday talk that normalizes a difficult situation, religious/spiritual messages, and if needed, difficult relationship talk to heal broken relationships. The purpose of the Catalyzing Relationships at the End of Life (CAREol) program was to provide interdisciplinary education to nursing and medical students and clinical faculty about facilitating FCs among patients and families. This two-part, quasi-experimental program consisted of a cognitive (online) and experiential (live simulation) curriculum experience. Program curriculum, including video vignettes, readings, and live simulation (utilizing actors), was developed by the study team. Reflective journaling and researcher designed pre- and post-tests were used to assess comfort, confidence, importance, and distress regarding FCs and collaboration with other disciplines. The pre-/post-test questions demonstrate statistical significance based on a paired t-test with effect sizes supporting the practical importance of the findings for effect size. Preliminary content and thematic analysis of qualitative responses describe categories of the mock team meeting experience and interaction with the actors to change patient and family outcomes. Early intervention with the CAREol program provides a framework to help students and clinical faculty facilitate FCs that may result in peace and comfort for patients and families during a difficult time.

Shifting Culture by Creating Synergy and Equity Through the Unification of Tenure Criteria.

Tenure requirements within universities vary; however, most focus on excellence in teaching, service, and scholarship. Within our university, faculty with either research or clinical doctorates were on both tenure and clinical tracks, with reported marginalization from clinical track faculty. A task force was convened in 2018 to develop a unified single track that included a single set of criteria for all College of Health Professions faculty to obtain tenure. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) Roadmap was used to guide the work of the task force. The implementation of a single track has influenced discourse around previous notions regarding what is considered "tenure worthy" and has opened the door to contractual equity among faculty. Internal structures, such as implementation of a single track, can support cohesion and productivity that facilitates collaborations among faculty of all ranks and degree backgrounds, promoting a culture that continues to embrace intellectual discourse and unity. [J Nurs Educ. 2022;61(8):455-459.].

Adaptations of Clinical Teaching During the COVID-19 Pandemic: Perspectives of Medical Students and Faculty Members.

BackgroundThe COVID-19 pandemic had serious implications on medical schools’ programs that necessitated lots of adaptations of teaching, learning, and assessment to guarantee continuity of education in medical schools. Our study aimed to evaluate perspectives of clerkship students and faculty members regarding clinical teaching adaptations implemented during the COVID-19 pandemic.MethodsA descriptive, cross-sectional, survey-based study was conducted and targeted 5th and 6th year clerkship students and full- and part-time clinical faculty. The survey explored (1) perception of the degree of contribution of implemented adaptations to student achievement of expected clinical competencies, (2) degree of confidence regarding students’ achievement of expected clinical competencies through such adaptations, and (3) perception of the effect of implemented educational adaptations on students’ learning. Descriptive statistics were used, and statistical significance level was set at p < 0.05.ResultsThe survey exhibited high internal consistency. Both students and faculty members felt that most of the adaptations had moderate to high contribution to student achievement of expected clinical competencies. On a 5-point scale, the highest score was given by faculty members to “Interpretation of investigations” (3.93±0.84) while the lowest scores were given by faculty members (3.10±1.21) and students (2.57±1.36) to “Performing clinical procedures”. Students and faculty members agreed that the adaptations had positive effect on students’ learning except for the statement “Students were able to easily monitor their academic progress” where students gave less scores than faculty members, with a statistically significance difference (p=0.029).ConclusionStudents and faculty members had similar perspectives regarding the implemented adaptations and their impact and contribution to student learning and achievement of the basic clinical competencies. Both of them agreed on the need for and importance of the implemented adaptations. Our findings recommend such adaptations during the times of crises, which can be conducted through integrating online teaching with face-to-face teaching.

Faculty Experiences Related to Career Advancement and Success in Academic Medicine

Phenomenon : Faculty career success in academic medicine is complex. Dynamic interactions among faculty and between faculty and their socio-cultural working environments contribute to the mystique of academic advancement. There are few empirical studies that analyze the social practice of faculty career advancement in academic medicine, especially those that focus on relations between individual and environmental contexts. This study aimed to investigate various faculty members’ experiences around career advancement in a medical school. Through the analytical lens of Bourdieu’s theory of practice, we focused on the relationship among individuals, positions, and environmental contexts. Approach : Following a general process of interpretive grounded theory, we collected faculty members’ perceptions and experiences related to their career development and advancement via in-depth semi structured-interviews of 23 faculty at a medical school in the United States. We analyzed the interview transcripts using thematic and constant-comparison analyses, informed by Bourdieu’s theory of practice emphasizing the concepts of habitus, field, doxa, illusio, and capital. Findings: While there was a general perception of collaborative success in the school, access to resources seemed to be unequally distributed and linked to faculty positions. Career opportunities, such as leadership and promotion, were mostly granted by leaders based on interpersonal relationships (social capital). Clinical faculty’s limited access to professional development activities (cultural capital), including research, limited their likelihood for promotion (symbolic capital) at the school. An institutional emphasis on clinical productivity reinforced clinical faculty’s constraints on academic scholarship, which led to perceived inequities by clinical faculty. Participants also perceived subtle gender bias and an unequal distribution of power among the specialties, which contradicted a culture of collaboration and support in the school. Insights : Complex power structures influence faculty career success. Unequal access and differential power among faculty positions resulted in disparities in career advancement. Greater transparency, equity, and inclusivity are obvious suggestions for change to allow all faculty to benefit from essential resources and career building opportunities. Furthermore, building high-quality relationships between leaders and faculty and mutual respect between specialties are essential to sustaining an organizational culture conducive to career success for all faculty. Faculty will benefit from a greater awareness of the structural and normative aspects of a medical school that are less obvious and more difficult to change. This is the value of applying Bourdieu’s theory of practice to the socio-cultural dynamics of the medical school.