Health Professions Education Research Articles

Care-educational game for men who have sex with men and live with HIV and Aids

Objective: To describe the construction of a board game-type care-educational technology for the health education of men who have sex with men and live with the Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome, within the scope of Primary Health Care. Methods: Methodological study, developed from a participatory perspective in four stages: development of a scoping review; theorization and construction of the technology; appraisal; and final design. Results: The game “HIVIVENDO E APRENDENDO” was constructed considering the integrative perspective of care for the target population, addressing in its content aspects about the infection and the disease, welcoming, treatment adherence, related stigmas and prejudices, citizenship, and quality of life. Conclusion: With the developed care-educational technology, it is intended that, after the validation phase, it can become a facilitating tool for promoting health education for both professionals and users in Primary Health Care.

The number needed to teach: A framework for health professions education

What is the educational challenge? Health professions education is continually limited by financial resources with increasing demands for accountability. Judicious resource allocation across competing demands rests on frameworks for analyzing and comparing costs and outcomes. What are the proposed solutions? We suggest health professions educators use the number needed to teach (NNTe) for reporting and communicating such analyses for teaching and learning. What are the potential benefits to a wider global audience? The NNTe has the potential to improve reporting and understanding of effectiveness of teaching and learning, similar to how the number needed to treat (NNTr) has improved communication of the effectiveness of clinical interventions. Prior widespread understanding of NNTr will likely allow NNTe to be easily grasped by most clinical educators and those responsible for resource allocation decisions. This article describes the origins of and parallels between NNTr and NNTe, which summarizes and presents in concrete terms to educators, learners, and institutional leadership the investment required to prevent or produce a specific outcome. The calculation and interpretation of NNTe is demonstrated using examples from published real-world data, and its potential benefits, limitations and applications are explored. What are the next steps? Next steps include explorations of the variety of contexts and comparisons that can be interpreted using NNTe and its corollary, the Number Need to Harm, and how recipients interpret and act upon NNTe.

Retention beyond representation: A call for structural inclusion in health professions education.

Retention beyond representation: A call for structural inclusion in health professions education.

A call to unify cost and economic impact research of health professions education.

Yaros argues that advancing evidence on the costs and economic impacts of student-led clinics requires joining forces to build towards conceptual and methodological unity across all health professions education economic research.

“Busting the hidden curriculum” a realist and innovative perspective to foster professional behaviors

Contemporary health professions education has long delineated the desired attributes of medical professionalism in the form of standard curricula and their role in forming professional behaviors (PBs) among aspiring doctors. However, existing research has shown the contradictory and powerful role of hidden curriculum (HC) in negatively influencing medical students’ PBs through unspoken or implicit academic, cultural, or social standards and practices. These contrasting messages of formal curricula and HC lead to discordance and incongruence in future healthcare professionals developing professional identity formation. There is little research on PB modifying educational strategies and their determinants that medical schools adopt to bust the impact of HC. Consequently, it is unclear how the right PBs can be influenced, entrenched, and inculcated in undergraduate medical students, especially in their early clinical placements. The lack of such insight highlights a critical gap in the literature, nudging educators to take a realist stance to deal with this problem. Behavior psychology stresses shaping medical students’ values and beliefs as salient mediators that influence intentions to pursue future PBs. Curiosity prevails about what would guide the educational interventions to target this behavior change. To help understand this concept, we present our design-based innovative perspective about PROfessionalism in Partnership for Education Research (PROPER) shaped by pluralistic theoretical models in the context of two European medical schools with diverse medical students, highlighting its non-parochial and transferable nature.

The experiences of trans (binary and non-binary) people accessing emergency department care in Australia: A grounded theory study

BackgroundThis study aimed to explore the experiences of trans (binary and non-binary) people accessing emergency department care in Australia. MethodThis qualitative descriptive study utilised a grounded theory approach. Seven people who identified as trans were recruited through social media and trans support groups. Individuals participated in an in-depth narrative interview. Interview transcriptions were analysed using a constant comparative approach. ResultsFollowing thematic analysis, four key themes were identified: 1. identity; 2. clinical care; 3. communication; and 4. perceptions of health professional education, beliefs and experience in caring for trans people. ConclusionThis study is the first in Australia to explore the experiences of trans people utilising emergency department services. The findings of this study are similar to international data whereby the delivery of gender affirming care in emergency departments is inconsistent, health professionals are perceived as poorly educated and gender identity is inadequately recognised.

Assessing Professional Behaviors of Physician Assistant Students in Objective Structured Clinical Examinations: A Scoping Review.

Professionalism in physician assistant (PA) students is an essential behavior to assess during formative medical education. Objective structured clinical examinations (OSCEs) provide an opportunity to evaluate PA students performing professional behaviors within simulated clinical settings. This scoping review aims to explore insights the existing literature offers regarding evaluating the professional behaviors of PA students using an OSCE. A secondary objective is to identify gaps in the literature to clarify future research. This scoping review was conducted in March 2024. From January 2018 until March 2024, CINAHL, MEDLINE Ultimate, Health Source-Nursing/Education, and PubMed online databases were searched for publications in English. Records included research studying PA or medical students evaluated on professional behaviors using an OSCE or performance-based assessment instrument. Allied health profession students were excluded from the primary search because of their heterogeneous curriculum models outside the population of interest. This review includes 5 papers. All papers reported communication as a professional behavior measured in an OSCE or performance-based assessment. A consensus or formal definition of professional behavior is a notable absence in this scoping review. More definitive homogenous evidence is needed to assess the professional behaviors of PA students using an OSCE. This limits the guidance and educational standards for future health profession educators. Comprehensive research into professional behaviors among PA students is essential. Scholars must publish their findings on professionalism curriculum design and outcomes to facilitate a broader understanding and improvement in educating future PA professionals.

International Delphi study on developing entrustable professional activities (EPAs) for master’s learners in health professions education

BackgroundCompetencies-based education has gained global recognition, emphasizing the need for educators to align educational outcomes with healthcare system requirements. However, limited literature exists on competency frameworks and Entrustable Professional Activities (EPAs) specific to health professions educationists, hindering the development of tailored Master’s programs.AimThis study aimed to develop a competency framework outlining the roles and functions for Master’s learners in Health Professions Education (MHPE) and identify the key EPAs that form the foundation of a task-based MHPE curriculum, along with the expected levels of entrustment.MethodsAn international Delphi study was conducted involving three rounds of surveys and qualitative discussions with an expert panel of health professions educationists from diverse contexts (n = 29). The Delphi technique, including open-ended and quantitative rating scales, was employed to reach consensus on the EPAs and their levels of entrustment. The final list of EPAs was validated using the EQual rubric.ResultsA total of 16 EPAs were identified and validated, mapped to core and potential roles and functions of health professions educationists. There is less agreement on the level of entrustment that should be attained at the master level, resulting in EPAs that must be fully entrusted before graduation and others which need further development afterwards.ConclusionThe study presents a comprehensive competency framework and a set of EPAs tailored for MHPE programs, providing a structured approach to curriculum design and learner assessment. The findings underscore the importance of incorporating context-specific considerations and aligning educational objectives with the evolving roles and responsibilities of health professions educationists.

The interpretation-use argument- the essential ingredient for high quality assessment design and validation.

There is increasing interest in health professions education (HPE) in applying argument-based validity approaches, such as Kane's, to assessment design. The critical first step in employing Kane's approach is to specify the interpretation-use argument (IUA). However, in the HPE literature, this step is often poorly articulated. This article provides guidance on developing the IUA using a worked example involving a workplace performance assessment tool. In developing the IUA, we have drawn inspiration from approaches used in the discipline of language assessment to situate the inferences, warrants and assumptions in the context of the assessment tool. The worked example makes use of Toulmin's model of informal logic/argumentation as a framework to structure the IUA and presents Toulmin diagrams for each inference such that the reader can connect the argument chain together. We also present several lessons learned so the reader can understand the issues we grappled with in developing the IUA. A well laid out IUA allows the argument to be critiqued by others and provides a framework to guide collection of validity evidence, and therefore is an essential ingredient in the work of assessment design and validation.

Using freedom of information requests to access novel data sources in health professions education research.

Educators and researchers are reliant upon access to data to drive teaching methods, curricular improvements, and progress in medical education research. However, data are not always accessible, due to resource constraints, institutional policies, and privacy concerns. Researchers have attempted to access novel data sources through surveys, semistructured interviews, and databases; however, these methodologies are limited. To improve access to data, Freedom of Information (FOI) Acts grant researchers the ability to formally request data that any public institute holds. Researchers have been reluctant to use this tool due to negative perceptions, despite its unique benefits. To increase awareness of this underutilized methodology, we summarize the process of FOI Act requests, its strengths and weaknesses, and the ways in which health professions education can leverage FOI requests within research. We provide examples of the use of FOI requests as a research method within adjacent fields and nascent use within the field of health professions research. In doing so, we hope to highlight how FOI requests can be a useful tool in health professions education researchers and its potential to increase access to unique data sources.

Transfusions, disease-modifying treatments, and curative therapies for sickle cell anemia in Africa: where are we now?

The mortality burden of sickle cell anemia (SCA) is centered in sub-Saharan Africa. In addition to a lack of systematic programs for early diagnosis, access to disease-modifying treatments is limited to only a few urban centers. Providing a safe and adequate blood supply is a major challenge, heightening mortality from SCA-associated complications that require urgent blood transfusion and making the delivery of regular transfusion therapy for stroke prevention nonfeasible. Hydroxyurea therapy with proven clinical benefits for pain episodes, acute chest syndrome, malaria, transfusions, hospitalizations, and stroke prevention is the most feasible treatment for SCA in Africa. Access barriers to hydroxyurea treatment include poor availability, unaffordable costs, health professionals' reluctance to prescribe, a lack of national guidelines, and exaggerated fears about drug toxicities. Strategies for the local manufacture of hydroxyurea combined with the systematic education and training of health professionals using guidelines supported by the World Health Organization can help surmount the access barriers. Hematopoietic stem cell transplantation as a curative therapy is available in only 7 countries in Africa. The few patients who have suitable sibling donors and can afford a transplant must usually travel out of the country for treatment, returning to their home countries where expertise and resources for posttransplant follow-up are lacking. The recently developed ex-vivo gene therapies are heavily dependent on technical infrastructure to deliver, a daunting challenge for Africa. Future in-vivo gene therapies that bypass myeloablation and ex-vivo processing would be more suitable. However, enthusiasm for pursuing these gene therapies should not overlook strategies to make hydroxyurea universally accessible in Africa.

Beyond the classroom: enhancing graduate health professions education programs for non-clinicians

Beyond the classroom: enhancing graduate health professions education programs for non-clinicians

Response to: "Ethical use of Artificial Intelligence in Health Professions Education: AMEE Guide No. 158"

Response to: "Ethical use of Artificial Intelligence in Health Professions Education: AMEE Guide No. 158"

Using Lesson Study to Enhance the Quality of Teaching and Learning in Health Professions Education

Lesson study (LS) offers a systematic, but flexible, approach for enhancing the quality of teaching and learning in Health Professions Education (HPE). During LS, teachers collaboratively increase their understanding of their own practice with a variety of stakeholders, including students, subject specialists and education experts. There is increasing global use of LS in primary, secondary and higher education, with studies highlighting its impact on enhancing the quality of both teaching and learning through the professional development of teachers. Despite these benefits of LS, there have been few studies of how LS have been implemented in HPE. The article describes how LS can be practically adapted and implemented in a variety of both academic and clinical settings across the continuum of HPE, from basic to postgraduate and continuing professional education. There is great potential of LS as a method for faculty development in HPE, with both integration into current faculty development programmes and as a continuing professional development activity for teachers across the continuum of HPE.

Factors associated with retakes in health Professions Courses: A case study of Five selected Universities in Sub-Saharan Africa.

Background Academic examination retakes are significant challenges in health professions education. With rigorous clinical assessments, limited training resources and high-stakes examinations, students struggle to meet academic requirements which cab result in retakes. This study aimed to assess the proportion of medical and nursing students with retakes across five Sub-Saharan African universities and to explore factors contributing to the retakes. Methods This was a cross-sectional quantitative study. The study involved 764 medical and nursing clinical students from five universities across Sub Saharan Africa: Busitema University (Uganda), Mzuzu University (Malawi), University of Ibadan (Nigeria), Kwame Nkrumah University of Science and Technology (Ghana), and the University of Zambia. Data was analyzed using descriptive statistics and logistic regression to identify factors associated with retakes. Results Overall, the proportion of students who had ever had a retake in clinical assessments was 12.6%. Factors associated with retakes are age with students aged 25 and above showed a higher likelihood of failing compared to their younger counterparts (OR: 2.45, 95% CI: 1.06-5.64, P = 0.036) and gender with Male students more likely to get retakes compared to their female counterparts (OR: 1.91, 95% CI: 1.21-3.00, P = 0.005) at univariate, although this association was not statistically significant in multivariate analysis. OSCE was the most frequent examination format associated with retakes, accounting for 47.7% ( P < 0.001). Conclusions The present study brings to light the proportion of students who experienced retakes and the factors associated with retakes among health professions students in Sub-Saharan Africa. This highlights the need for institutional interventions targeting at-risk populations: older and male students, and those with assessment problems related to the different modes of assessing clinical skills. Amelioration of these factors through appropriate support systems could minimize the proportion of students having to retake modules and create a more supportive academic environment. Further research might focus on exploring the proportion of students experiencing retakes in each country and thus determine factors that could contribute to high stakes towards retakes for each country so as to develop country specific solution and improved clinical skills assessment.

Curriculum Definition Revisited

The definition of "curriculum" has been the subject of scholarly debate for decades. This commentary revisits one of the most widely accepted definitions of curriculum in health profession education and offers a revised definition. The authors aim to emphasize the importance of planned and unplanned learning experiences in the definition of curriculum. Also, the key role of students’ support to help students make the most of their learning from the un-planned experiences is highlighted. In cases where the holistic learning experiences are neglected, the school is unlikely to achieve its ultimate goals.

Twelve tips for integrating Virtual Reality Simulation into Health Professions Curricula

Virtual reality simulation (VRS) has the potential to disrupt and transform current understandings and practices in simulation-based education in health professions curricula. Recent technological developments, including AI applications, give the learner high levels of immersion into a virtual environment that even more closely mimic the real world than heretofore. At the same time, there are significant obstacles facing educators who strive to integrate VRS into their simulation curricula. We have written a VRS handbook for nurse educators, developed VR scenarios and delivered VRS workshops to undergraduate nursing students. Our twelve tips are aimed at undergraduate curriculum developers and simulation leaders, guiding them on how to support educators in integrating VRS into their curricula. The tips describe key considerations to be addressed in the development and integration of VRS into curricula. The tips are timely, as health professions education is on the cusp of entering technology-enhanced simulation, of which VRS will be a key player.

An Outdoor Educational Experience in Health Professions Education: Beyond a Focus Group Study

Outdoor learning can relate students with environment, community, society and themselves. It can benefit students of all ages and successful in a variety of settings. Furthermore, it can enrich the curriculum and improve educational attainment. So, the present study has tried to explore experience of PhD candidates in Medical Education through a focus group. Data were collected from PhD students in medical education after participating in an outdoor session through a focus group which is frequently used as a qualitative approach to gain an in-depth understanding of social issues. Data were analyzed through conventional content analysis approach. Fifteen PhD candidates participated in focus group. Most of them aged above 35. The majority of them were working at Education Development Center (EDC), the rest were clinical practitioner, faculty member and people involved with educational activities. As to conventional content analysis of data, two main categories of instructional and inspirational sides of outdoor learning had emerged with three (Different physical space, Environmental distractors, and Innovative teaching method) and four subcategories (Informal communication, Attractive learning environment, inducing reflection, and making a new viewpoint) respectively. It is recommended to include the outdoor learning experience to provide situations for research and practice. It should be noted that curriculum reform might be necessary for planning the Outdoor learning environments and associated teaching learning methods.

An Educational Framework for Healthcare Ethics Consultation to Approach Structural Stigma in Mental Health and Substance Use Health.

This paper addresses the need for, and ultimately proposes, an educational framework to develop competencies in attending to ethical issues in mental health and substance use health (MHSUH) in healthcare ethics consultation (HCEC). Given the prevalence and stigma associated with MHSUH, it is crucial for healthcare ethicists to approach such matters skillfully. A literature review was conducted in the areas of bioethics, health professions education, and stigma studies, followed by quality improvement interviews with content experts to gather feedback on the framework's strengths, limitations, and anticipated utility. The proposed framework describes three key concepts: first, integrating self-reflexive practices into formal, informal, and hidden curricula; second, embedding structural humility into teaching methods and contexts of learning; and third, striking a balance between critical consciousness and compassion in dialogue. The proposed educational framework has the potential to help HCEC learners enhance their understanding and awareness of ethical issues related to structural stigma and MHSUH. Moreover, context-specific learning, particularly in MHSUH, can play a significant role in promoting competency-building among healthcare ethicists, allowing them to address issues of social justice effectively in their practice. Further dialogue is encouraged within the healthcare ethics community to further develop the concepts described in this framework.

Enhancing Temporomandibular Disorders Education for Initial Care Clinicians Through Interprofessional Education.

Temporomandibular disorders (TMDs) are common musculoskeletal pain conditions that can significantly impact daily activities such as eating, talking, breathing, intimacy, and expressing emotion. TMDs are often complex and multifactorial, and many patients experience overlapping pain conditions, sleep difficulties, and mental health challenges. The National Academies of Sciences, Engineering and Medicine (NASEM) has called for improved TMD education and training for health professionals, as current training opportunities are limited. To prepare health professionals to care for patients who have a TMD, we designed a 5-hour, interactive, module-based curriculum aligned with the 2020 NASEM recommendations. The four-part module set addresses TMD physiology and pathophysiology, assessment, diagnosis, and management. Instructional methods are founded on the Cognitive Theory of Multimedia Learning and include engaging videos, clinical evaluation and education tools, and interactive digital simulation scenarios. Thirty learners from diverse health professional backgrounds (medicine, dentistry, physician assistant, nursing, physical therapy) participated. Multiple-choice question assessments and pre/post retrospective survey scores demonstrated enhanced knowledge (M = 2.9 vs. M = 4.2, p < .001) and perceived competence (M = 1.9 vs. M = 3.4, p < .001), respectively. Encouragingly, all participants indicated applicability to their clinical practice. Our modules offer educators and clinicians a valuable resource to improve TMD knowledge and facilitate best practices. Supplementary resources included in the curriculum are conducive to clinical implementation, fostering improved clinician assessment and patient education.