Medical Education Experience Research Articles

Interregional mapping of continuing medical education experiences during the covid phase and orientation towards future education: a multiphase study.

This study developed and validated three questionnaires addressed to the accrediting bodies of the CME system, the providers and the end-users to investigate facilitating factors, barriers and achieved results. Facilitating factors, barriers and achieved results were then described, and the predictors of the achieved result were identified. Multiphase and multi-method study. The developed questionnaires show evidence of validity and reliability. 8098 healthcare professionals, 10 accrediting bodies and 206 providers were enrolled to the study. The facilitating factors show the greater predictive capacity in explaining the variance of the perceptions of achieved results in all three groups. The common perspectives of the participants guided the creating of a framework aimed to provide guidance for strengthening facilitating factors regarding the activities of accrediting bodies, providers, and end-users of CME education.

Understanding reasons for electing gap years between undergraduate education and medical school and the impact of gap years on the student experience of medical education

Gap years have grown in popularity among students attempting to go to medical school in recent years. According to the Association of American Medical Colleges (AAMC), more than half of matriculated students now have taken time off between their undergraduate studies and medical school. Although many claim benefits to taking gap years, research on the impacts of these experiences on medical students is largely nonexistent. This study aimed to qualitatively analyze the gap year phenomenon and its impacts on medical students through semistructured interviews conducted at the University of Central Florida College of Medicine. Through these interviews, the research team collected in-depth responses that were thematically analyzed. Analysis revealed the following major themes regarding the impacts of gap years: 1) adaptability to change and failure, 2) professional identity formation and understanding of team role, 3) understanding the "real world," 4) refocusing of goals, 5) resilience and stress management, and 6) reinforcement of motivation.

Experiences of disabled students in undergraduate medical education

Purpose Since people with disabilities (PwD) are underrepresented in medical education, the authors of this article conducted a qualitative research in the form of an in-depth interview with students with disabilities from a medical school in Brazil, to characterize their experiences in medical education and identify barriers and facilitators to inclusion. Materials and Methods Participants were recruited by snowball sampling, signed an informed consent form, and completed a socioeconomic questionnaire. They were interviewed individually with open-ended questions so that they could develop narratives. Results The students identified some barriers to inclusion - teachers' lack of knowledge about students’ special needs, students' own lack of knowledge about their needs during the medical course, underestimation of the disability by teachers and classmates, difficult access to college buildings - and facilitators, such as acceptance of the disability by professors and colleagues, proactivity of professors and colleagues in adapting practical learning scenarios. Conclusion Students identified peer and teacher acceptance as an important determinant of inclusion, which is in line with the biopsychosocial view of disability. They also reported doubts about their ability to practice medicine, which dialogues with literature research that points to a medical culture that expects nothing less than perfection from students.

Learning to practice medicine during COVID-19 and mucormycosis epidemics: an intern perspective from India

The COVID-19 pandemic has greatly affected medical education and training experiences for interns and resident doctors. As medical schools shifted their teaching curriculum to virtual platforms, most senior medical students lacked sufficient clinical exposure as they missed out on in-hospital rotations before beginning their intern year. In this article, we share our experience in transitioning from medical school to our intern year while working in COVID and non-COVID facilities. We discuss our challenges while learning basic skills in a resource-limited setting during a period of high patient mortality because of COVID-19 and Mucormycosis.

A Multimethod Examination of Medical Students' Experiences With Bereavement and Complicated Grief.

Few studies have examined grief in medical students. This study used a multimethod approach to describe how bereavement and CG may impact medical students' educational experience and their perspectives on grief support and training. One hundred three medical students completed an online survey with quantitative and qualitative methods. Seventy-three (71%) students reported experiencing bereavement, of which 12 (18%) screened positive for CG. Medical students who screened positive for CG reported significantly more emotional and behavioral challenges (M = 3.58 [SD = 2.64]) compared to medical students without CG (M = 0.93 [SD = 1.58], p < .001). Qualitative analyses revealed that bereaved and nonbereaved students wanted more grief education and bereavement support from medical institutions. Therefore, it is crucial for medical institutions, to acknowledge that grief and bereavement may impact students' performance due to multifactorial causes.

‘Educator with a capital E’: Comparing medical education experiences of student-as-teacher elective participants and peers

Purpose Student-as-teacher electives are increasingly offered at medical schools, but little is known about how medical education experiences among enrolled students compare with those of their peers. The study’s aim was to characterize medical students’ education-related experiences, attitudes, knowledge, and skills based on their enrollment status in a student-as-teacher course. Materials/methods We conducted four focus groups at a medical school in the United States: two with graduating students in a student-as-teacher elective (n = 11) and two with unenrolled peers (n = 11). Transcripts were analyzed using the Framework Method to identify themes. Results Four themes emerged: interest in and attitudes towards medical education; medical education skills, knowledge, and frameworks; strategies for giving/receiving feedback; medical education training as part of medical school. Course participants demonstrated higher-level education-related knowledge and skills. Both groups endorsed teaching skills as important and identified opportunities to incorporate medical education training into medical school curricula. Conclusions Medical education knowledge and teaching skills are self-reported as important learning outcomes for medical students, independent of enrollment status in a student-as-teacher course. The structure of such courses, best understood through a deliberate practice-based model, supports students’ achievement of key learning outcomes. Certain course elements may warrant inclusion in standard medical school curricula.

Bridging The Gap: Demanding 1-1 Representation of Dark-Light Skin Tones Within Medical Lectures/Resources

Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions (e.g., acne, cancer), which present differently based on skin color and tone. Developing skin-tone-dependent diagnosing skills depends on the medical education (e.g., lectures, medical textbooks, and online board certification prep resources) and hands-on clinical experiences doctors receive. We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin. This lack of representation perpetuates race as a social determinant of health, leading to missed diagnoses and diagnosis at a later/worse stage in people of color. To combat this underrepresentation within medical education, we propose the Liaison Committee on Medical Education (LCME) amend Accreditation Standard 7: Curricular Content, Subsection 7.6: Cultural Competence and Health Care Disparities. The amendment is to include 1 of the 2 following policy changes, with preference for the top-down mandate: 1) Top-down Mandate: An objective measure and subsequent goal (1:1 representation) for the representation of skin of color within a school's medical lectures, which is evaluated by an LCME-approved curriculum committee and mandated for schools wishing to continue to be LCME accredited. 2) Bottom-up Individualized Institutional Goals: A requirement for schools to choose their own goal, create their committee, and evaluate their progress. These progress reports will be submitted to the LCME annually.

Teaching Telemedicine in the COVID-19 Era: a National Survey of Internal Medicine Clerkship Directors.

BackgroundPrior to the COVID-19 pandemic, telemedicine (TM) experiences in undergraduate medical education were uncommon. When students’ clinical experiences were interrupted due to the pandemic, TM education provided opportunities for students to participate in clinical care while adhering to social distancing guidelines.ObjectiveTo assess the prevalence of TM experiences in the internal medicine (IM) core clerkship experience prior to the COVID-19 pandemic, during interruption in clinical clerkships, and following the return to in-person activities at US medical schools.DesignThe Clerkship Directors in Internal Medicine (CDIM) survey is a national, annually recurring thematic survey of IM core clerkship directors. The 2020 survey focused on effects of the COVID-19 pandemic, including a section about TM. The survey was fielded online from August through October 2020.ParticipantsA total of 137 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited US/US territory–based medical schools.Main MeasuresA 10-item thematic survey section assessing student participation in TM and assessment of TM-related competencies.Key ResultsThe response rate was 73.7% (101/137 medical schools). No respondents reported TM curricular experiences prior to the pandemic. During clinical interruption, 39.3% of respondents reported TM experiences in the IM clerkship, whereas 24.7% reported such experiences occurring at the time they completed the survey. A higher percentage of clerkships with an ambulatory component reported TM to be an important competency compared to those without an ambulatory component.ConclusionsThe extent to which TM was used in the IM clinical clerkship, and across clinical clerkships, increased substantially when medical students were removed from in-person clinical duties as a response to COVID-19. When students returned to in-person clinical duties, experiences in TM continued, suggesting the continued value of TM as part of the formal education of students during the medicine clerkship. Curricula and faculty development will be needed to support TM education.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07061-4.

Editorial introductions

Editorial introductions

Collaborative governance of postgraduate medical education: Can it be achieved?

Faced with the need to modernize and improve the postgraduate medical education experience and to maintain the high quality of physicians that Canadians expect, in 2010, four organizations –Association of Faculties of Medicine of Canada (AFMC); Collège des Médecins du Québec (CMQ); College of Family Physicians of Canada (CFPC); and Royal College of Physicians and Surgeons of Canada (RCPSC) formed a consortium to conduct a review of Postgraduate Medical Education (PGME) in Canada. In 2012, the Consortium published the Future of Medical Education in Canada Postgraduate (FMEC PG) project’s 10 recommendations for change in PGME. One of these recommendations was to ‘Establish Effective Collaborative Governance in PGME’. The recommendation stated- ‘Recognizing the complexity of PGME and the health delivery system within which it operates, integrate the multiple bodies (regulatory and certifying colleges, educational and healthcare institutions) that play a role in PGME into a collaborative governance structure in order to achieve efficiency, reduce redundancy, and provide clarity on strategic directions and decisions’ The purpose of this paper is to describe the creation, function and dissolution of a collaborative governance structure within the complex system of PGME and the challenges that were faced in its sustainability. The lessons learned are applicable internationally where integration of multiple organizations is being attempted. A fundamental question remains as to whether a consensus-based decision-making process can ever be achieved among organizations with overlapping mandates and in some cases, hierarchical structures?

Stigma towards psychiatry: correlating personal experience with existing literature

AimsStigma towards psychiatry feels rife within medical school and this extends from university life into clinical placements. Mental health remains an unattractive area of medicine and is frequently regarded as subpar by other specialists. Against existing literature, this study compares the authors first hand experiences over the last five years within medical school to evaluate how representative their experiences of stigma in psychiatry are for the wider community and published literature. The study aims to inform the wider discussion on this topic and offer areas where intervention may yield a better perception and hence uptake of this specialism.MethodLiterature review relating to the topic was completed. Studies pertaining to medical students and/or educators views and experiences of psychiatric medical education and clinical placement were included for discussion. A reflection on the first author's specific experiences to date of psychiatry and his intent to pursue psychiatric career was conducted, with careful reference to existing literature. This allowed validating personal experiences in light of shared experience within the medical community in various national and international settings.ResultArguably, some non-psychiatric clinicians do inadvertently set the scene early in medical school for the stigma that is to be thrust upon students. This builds upon prospective students ranking psychiatry low for satisfaction, prestige and stating it to be a ‘pseudoscience’ or words to that effect. The lack of understanding from junior medical students of the role of the psychiatrist sees them associating psychosocial education as equivalent to psychiatry. This reinforces the idea of psychiatry being grounded in sciences other than anatomy, biochemistry, physiology and pharmacology. On clinical placement, there is little cross-speciality support for those students who want to be psychiatrists and sometimes even lost opportunities for those publically aspiring towards psychiatry. Placements in psychiatry give students a better understanding of psychiatry but this does not seem to significantly change their career aspirations and this is rather defined from the admission stages.ConclusionAfter comparing experience with literature, stigma towards psychiatry appears to be universal. It may be important to consider the types of students who are being attracted to medical school as currently students seem to have an intrinsic disinterest in psychiatry despite later becoming better informed through psychiatric placement. Culture is notoriously hard to change, particularly within medicine. This stigma exists both in the lay and medical communities with early potentially inaccurate lay views of psychiatry being validated and reinforced throughout medical school.

Longitudinal qualitative research in medical education: Time to conceptualise time.

ContextLongitudinal qualitative research is an approach to research that entails generating qualitative data with the same participants over extended periods of time to understand their lived experiences as those experiences unfold. Knowing about dynamic lived experiences in medical education, that is, learning journeys with stops and starts, detours, transitions and reversals, enriches understanding of events and accomplishments along the way. The purpose of this paper is to create access points to longitudinal qualitative research in support of increasing its use in medical education.MethodsThe authors explore and argue for different conceptualisations of time: analysing lived experiences through time versus analysing lived experiences cross‐sectional or via 2‐point follow‐up studies and considering time as subjective and fluid as well as objective and fixed. They introduce applications of longitudinal qualitative research from several academic domains: investigating development and formal education; building longitudinal research relationship; and exploring interconnections between individual journeys and social structures. They provide an illustrative overview of longitudinal qualitative research in medical education, and end with practical advice, or pearls, for medical education investigators interested in using this research approach: collecting data recursively; analysing longitudinal data in three strands; addressing mutual reflexivity; using theory to illuminate time; and making a long‐term commitment to longitudinal qualitative research.ConclusionsLongitudinal qualitative research stretches investigators to think differently about time and undertake more complex analyses to understand dynamic lived experiences. Research in medical education will likely be impoverished if the focus remains on time as fixed. Seeing things qualitatively through time, where time is fluid and the past, present and future interpenetrate, produces a rich understanding that can move the field forward.

Impact of the COVID-19 pandemic on emergency medicine education: Insights from faculty and residents.

ObjectivesThe COVID‐19 pandemic continues to impact health systems across the United States and worldwide in an unprecedented way; however, its influence on frontline medical trainees’ educational experiences is unknown. Our objective was to determine the effects of COVID‐19 on emergency medicine (EM) training programs and residents.MethodsWe performed a mixed‐methods cross‐sectional survey study of faculty and residents at programs registered with Foundations of Emergency Medicine. Participants completed an online survey consisting of closed and open‐ended response items. We reported descriptive statistics for discrete and continuous data. Free‐response data were analyzed qualitatively using a thematic approach.ResultsNinety‐two percent of faculty (119/129) and 47% (1,965/4,154) of residents responded to our survey. We identified three major themes related to effects on learning: 1) impact on clinical training, 2) impact on didactic education, and 3) impact on the trainee. Nearly all residencies (96%, 111/116) allowed residents to work with patients suspected of having COVID‐19, although fewer (83%, 96/115) allowed residents to intubate them. We found that 99% (1918/1928) of residents experienced virtual didactics. Faculty and trainees noted multiple educational challenges and strategies for adaptation. Trainees also expressed concerns about stress and safety.ConclusionCOVID‐19 has impacted EM education in many ways including clinical training, didactic education, and trainee emotional state and concentration. Challenges and suggested solutions for learning in the virtual environment were also identified. While the pandemic continues to evolve and impact EM residents in various ways, our results may inform strategies to support medical educators and trainees during pandemics or other periods of significant disruption or crisis.

Twelve tips for engaging learners in online discussions

Educators play a critical role in designing, facilitating and delivering an online medical education experience. Their teaching decisions and practices shape learners’ experiences and affect their achievements. This is true even in large-scale, open educational contexts such as Massive Open Online Courses (MOOCs), which are designed based on self-regulated and collaborative learning. Thus, it is particularly important to explore the ways in which educators can effectively support online or blended learning through their interactions with learners. The 12 tips in this article aim to provide medical educators with guidelines for creating engaging online discussions that both support and challenge learners’ understanding. The advice draws on a recent study examining the experiences and activities of 24 educators in MOOC discussion areas, and how their learners engaged with them. It provides practical recommendations on facilitating online discussions, producing engaging discussion tasks, and creating a balanced educator presence.

Virtual Emergency Medicine Clerkship Curriculum during the COVID-19 Pandemic: Development, Application, and Outcomes.

The COVID-19 pandemic has been a significant catalyst for change in medical education and clinical care. The traditional model of bedside clinical teaching in required advanced clerkships was upended on March 17, 2020, when the Association of American Medical Colleges recommended removing medical students from direct patient care to prevent further spread of the disease and also to help conserve scarce personal protective equipment (PPE). This created unique challenges for delivering a robust, advanced emergency medicine (EM) clerkship since the emergency department is ground zero for the undifferentiated and potentially infected patient and has high demand for PPE. Here, we describe the development, application, and program evaluation of an online-based, virtual advanced EM curriculum developed rapidly in response to the COVID-19 pandemic.Starting March 23, 2020, we began rotating fourth-year medical students through a four-week rotation. We completed a total of four virtual clerkship experiences comprised of 56 students through July 27, 2020. Through analysis of the students’ performance on a national standardized EM shelf exam, students participating in this virtual clerkship demonstrated a fund of knowledge that was not significantly different from that of their peers who completed a traditional clerkship in the specialty prior to the pandemic interruptions. Additionally, the critical review of the traditional course created the opportunity to make improvements and enrich the medical student educational experience in a virtual environment and upon resumption of the traditional course when students returned to the in-person environment. The resources provided for those interested in adopting our pedagogical approach include a course syllabus, calendar, and learner summative assessment.

Understanding Reasons for Electing Gap Years Between Undergraduate Education and Medical School and the Perceived Impact of Gap Years on the Student Experience of Medical Education: An Interview Study

Gap years have grown in popularity among many students attempting to go to medical school in recent years. According to the Association of American Medical Colleges (AAMC), more than half of matriculated students have taken time off between their undergraduate studies and medical school. While many anecdotally claim benefits to taking gap years, research surrounding the impacts of these gap year experiences on medical students is largely nonexistent. The objective of this study was to qualitatively analyze the gap year phenomenon and its impacts on medical students’ subsequent experience of medical school. Semi-structured interviews were conducted at the University of Central Florida College of Medicine, which were recorded and transcribed verbatim for thematic analysis. An Interpretive Phenomenological Approach was taken, and the primary analysis was performed by Haroon Rashid, who is a pre-medical student aiming to take a gap year prior to medical school. Nine medical students gave informed consent and participated in interviews conducted online via Zoom. Students from each of the four years in the MD program were represented in the sample. Six students had previously applied to medical school, four of whom took gap year(s) to improve their applications. Six students engaged in clinical activity during their gap year(s), four of whom worked as medical scribes; four students engaged in non-clinical jobs. Emergent themes on the perceived benefits of gap years were: 1) Increased adaptability and resilience that lead to better management of stress and burnout, 2) Professional identity formation and “real world” experiences that lead to increased recognition of a patient-centered approach to medicine, 3) Reinforcement of motivation and increased reflective capacity. A perceived disadvantage compared to traditional students was a short-lived challenge in returning to the study routines of full-time academic life. We conclude that gap year experiences, in general, provide significant benefits to students and their medical schools in terms of increased maturity and professionalism from the first day of training.

The Effect of Pandemıc on Medical Education and Distance Learning Experience

Uygulama ve beceri eğitimlerinin yoğun olması nedeniyle tıp eğitiminin tamamen uzaktan yapılması günümüze kadar hiç tartışma konusu yapılmadı. Modern tıp eğitimi böyle bir küresel salgınla ilk kez karşılaştı. Bu sebeple uzaktan tıp eğitimi yapmaya kimse hazırlıklı değildi. E-öğrenme uygulamaları tıp eğitimi içinde yaygınlığını giderek artıracağı görülmektedir. Örgün eğitim için geliştirilen ve öğrenme yönetim sistemi olarak tanımlanan yazılımlar, asenkron uzaktan eğitimlerin yapılabildiği ve senkron eğitim uygulamalarının entegre edilebildiği bir platform sağladığı için uzaktan eğitimde kullanıma uygundur. Böyle bir öğretim yönetim sistemini eğitim öğretim hayatımızın başından beri yaklaşık dört yıldır kullandığımız için bu süreçte tıp eğitimimizi kesintiye uğratmadan sürdürebildik. Ancak tıp eğitiminin temel hekimlik uygulama ve becerilerinin uzaktan eğitimle verilmeyeceği, elektronik ortamlarda yapılan sınavlarda güvenlik sorununun en önemli kısıtlılık olduğu yaşanarak görülmüştür.

Akdeniz Üniversitesi Tıp Fakültesi’nin COVID-19 Pandemisi Dönemindeki Tıp Eğitimi Deneyimi

Yeni koronavirus hastalığı (COVID-19) pandemisi (küresel salgını) dünya çapında tıp eğitimini etkiledi. COVID-19 küresel salgınını kontrol altına almak için uygulanan sosyal mesafenin korunması önlemi, tüm eğitim kurumlarında derslik eğitiminin askıya alınmasına neden oldu. Yükseköğretim Kurulu’nun 2019-2020 eğitim öğretim yılı bahar döneminde tüm yükseköğretim kurumlarında eğitimin uzaktan eğitim yolu ile yapılması kararı sonrası geleneksel yüz yüze yürütülen Mezuniyet Öncesi Tıp Eğitimi de askıya alındı. Bu makalede, COVID-19 küresel salgını döneminde Akdeniz Üniversitesi Tıp Fakültesi’nde tıp eğitim programında ve ölçme-değerlendirmede yapılan değişiklikleri özetlemeyi amaçladık.

The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review

Introduction: Most widening participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both ‘traditional’ and WP students. Methods: This qualitative systematic review used the Joanna Briggs Institute (JBI) meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and four synthesised findings. Results: The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with ‘traditional’ medical student peers, WP students form strong relationships with students from similar backgrounds. Conclusions: Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution.

Particularising 'experiences': Naming whiteness in the academy.

In 'Attaining full professor: Women's and men's experiences in medical education', Varpio and colleagues parse the gendered nature of faculty members' experiences of the pathway to full professor status. Analysing narratives of male and female full professors in five white-dominant high-income countries around the world, the authors describe how "ideological practices and principles … saturated with patriarchal power" suffuse academic institutions where medical education occurs1 .