Health Professions Education Research Articles

Dialogues across difference: Teaching for social justice and inclusion in health professions education.

Dialogues across difference: Teaching for social justice and inclusion in health professions education.

When words fail us: An integrative review of innovative elicitation techniques for qualitative interviews.

Interviews are central to many qualitative studies in health professions education (HPE). However, researchers often struggle to elicit rich data and engage diverse participants who may find this strategy exclusionary. Elicitation techniques are strategies tailored to address these challenges, enhancing oral conversations through other forms of interaction-for example, participant photography and neighbourhood walks. These strategies are tailored to elicit the rich data needed to address complex problems and meaningfully engage participants. Unfortunately, guidance on these techniques is scattered across literatures from diverse fields. In this synthesis, we offer an overview of the elicitation techniques available and advice about how to choose between them. We conducted an integrative review, drawing on methodological literature from across the health and social sciences. Our interdisciplinary searches yielded 3056 citations. We included 293 citations that were methodologically focused and discussed elicitation techniques used in interviews with adults. We then extracted specific elicitation techniques, summarising each technique to capture key features, as well as strengths and weaknesses. From this, we developed a framework to help researchers identify challenges in their interview-based research and to select elicitation techniques that address their challenges. To enrich data, researchers might seek to shift conversations away from participants' entrenched narratives, to externalise conversations on sensitive topics, or to elicit affect, tacit knowledge or contextual details. When empowering participants, researchers might seek to increase equity between the researcher and participant or foster interview accessibility across diverse participant populations. When chosen with study goals in mind, elicitation techniques can enrich interview data. To harness this potential, we need to re-conceptualise interviews as co-production of knowledge by researcher(s) and participant(s). To make interviews more equitable and accessible, we need to consider flexibility so that each participant can engage in ways that best suit their needs and preferences.

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.

DEVELOPMENT OF A COMPETENCY MATRIX IN A FRAMEWORK FOR THE PRACTICE OF RATIONAL MEDICINE USE IN THE TREATMENT OF SYSTEMIC ARTERIAL HYPERTENSION

Background: The use of medicines plays an important therapeutic role in the care of hypertension. Nonetheless, the inadequacies related to pharmacotherapy are still a major challenge to health, and the lack of systematisation of the competencies to be acquired during the training of health professionals undermines practices involving rational medicine use in the treatment of hypertension. This study was intended to develop and validate a competency matrix that can be used in the education and training of health professionals, contributing to the practice of rational medicine use (RMU) in the treatment of systemic arterial hypertension (SAH). Methods: This is applied research containing an integrative review and exploratory research with the presence of a systematic search, following guidelines proposed by the Cochrane Database of Systematic Reviews and the PRISMA group, and the building of the competency matrix was carried out through a focus group with researchers who work in the area registered in two research groups certified by an agency linked to the Brazilian Ministry of Education. The matrix was validated using the Delphi method by expert judges selected using Fehring’s technique and scoring criteria. Results: The panel of experts reached a consensus on the relevance of four intrinsic dimensions containing seven competencies and 31 knowledge, skills and attitudes of the RMU in SAH and three extrinsic dimensions that encompassed nine competencies and 22 knowledge, skills and attitudes of the RMU in SAH, with a frequency of agreement greater than 80%.

Instilling social accountability into the health professions education curriculum with international case studies: AMEE Guide No. 175

This AMEE guide focuses on instilling social accountability (SA) concept and values into health professions education (HPE) curricula with the goal of producing competent, compassionate healthcare professionals who can act as change agents within the healthcare system. By incorporating SA, HPE schools will instil in their students a strong sense of accountability for addressing the health needs of the communities they serve. This AMEE guide presents a comprehensive framework for embedding SA into the HPE curriculum, covering various aspects in curriculum design, implementation, and evaluation. It also includes case studies of exemplary socially accountable curricula, highlighting the experiences of schools aspiring for SA. Acknowledging how curriculum is embedded in a larger institutional structure, and that SA requires institutional commitment in its governance structure and policies is also a critical component for consideration.

Team-based learning in health professions education: an umbrella review

BackgroundTeam-Based Learning (TBL) has garnered considerable attention in education research. To consolidate the existing evidence, we conducted an umbrella review with four objectives: (a) to identify TBL review characteristics, (b) to synthesize findings from previous reviews regarding TBL effectiveness and outcomes, (c) to determine which student groups benefit most, and (d) to identify the most and least researched elements.MethodsThe Joanna Briggs Institute (JBI) methodology was followed: [1] Search strategy and literature search [2] Screening and Study Selection [3] Assessment of methodological quality [4] Data collection, and [5] Data summary. We utilized Endnote, Excel, and MAXQDA for efficient project management and analyzing data.ResultsAnalyzing twenty-three reviews spanning from 2013 to 2024, we found a peak in TBL research in 2022 including more than 312 unique primary studies involving more than 63,987 participants. Notably, the United States and China accounted for over 61% of the total primary articles focused on students from medicine, nursing, pharmacy, and dentistry. Evidence supports the superiority of TBL in enhancing cognitive outcomes. However, findings related to retention are mixed. Insufficient evidence exists to draw robust conclusions when comparing TBL with other active learning methods. TBL demonstrates favorable outcomes in terms of clinical performance and engagement. Non-technical skills show mixed results. Notably, TBL positively impacts self-study, learning ability, decision-making, and emotional intelligence. Faculty experiences reveal an initial increase in workload, but generally hold positive attitude. Faculty development remain limited in duration and scope. Freshmen, academically weaker students, undergraduates, Chinese female students, and nursing students appear to benefit most from TBL. Team formation and size are the most frequently studied elements.ConclusionTBL holds promise for improving learning outcomes, but ongoing investigation is essential to maximize its impact in diverse educational contexts. This umbrella review underscores the need for further research in specific areas i.e. effective pre-class learning methods and faculty workload.

Communicating with Deaf Patients in the Clinical Environment: Lessons Learned from a Virtual Patient Panel

Background Communication and cultural differences predispose Deaf patients to suboptimal healthcare. Despite this disparity, health professionals have historically received little to no training in caring for Deaf patients. Patient panels are an effective tool in medical education to model communication strategies. Objective In this paper, we describe the design, implementation, and results of a virtual patient panel focused on communicating with Deaf patients in clinical contexts. We offer practical suggestions for incorporating similar educational interventions in health professions education to prepare trainees to effectively navigate these conversations with their patients. Methods The panel consisted of a one-hour question and answer discussion facilitated by the authors with Deaf patients and Certified Deaf Interpreters (CDI). The panel was presented to 271 second-year medical students at our institution in November of 2023. Following this discussion, students were encouraged to share one or two key takeaways from the session through a survey link. These results were analyzed using pile-sorting qualitative analysis to identify main themes. Results There were 73 respondents, with a response rate of 27%. After the panel, the most popular takeaway points from student reflections included communication (n=56, 77%) and access to care (n=47, 64%), followed by autonomy (n=17, 23%), the doctor-patient relationship (n=15, 21%), and culture (n=11, 15%). Based on this initiative, we identified and offer twelve tips for developing similar exercises. These tips are thematically presented under three groupings: Planning Considerations, Patient Panelist Considerations, In-Session Considerations, and Post-Session Considerations. Conclusion This patient panel was the first of its kind in our medical school curriculum. Important considerations in panel design and implementation should focus on delivery time constraints with live-interpreting and further exploring the role of trust and communication in the physician-patient relationship.

Effect of the community of simulated participant model on the identity formation of simulated participants: A qualitative study

Health professional education is rooted in patient interaction. The utilization of the simulated participant method is a widely accepted approach in this regard, as it enables students to engage in experiences that closely resemble real patient interactions. So, the simulated participants need to be well-prepared and well-engaged in the concept of their roles. The purpose of the study is to evaluate a new model for identity formation of simulated participants based on communities of practice theory. An 8-month follow-up study with pre- and post-interviews, observations, and reflective diaries designed with a qualitative approach. The results were categorized together under the five themes: “motivation of simulated participants”, “background of simulated participants”, “interaction between simulated participants as a part of a community of practice”, “limitations from simulated participants’ perspectives”, and “roles of simulated participants in simulation”. Our model based on communities of practice theory is an effective method for the formation of identities of simulated participants. Educators have the responsibility to improve the quality of simulated participant–based simulation. Our model can be thought of as an effective tool to use in this regard.

Dental education amid armed conflict in Sudan: Unveiling the impact on training.

The ongoing conflict in Sudan has severely disrupted the health professions education, notably in dentistry. This study aims to explore the impact of the armed conflict on dental education and training. A mixed-method cross-sectional study encompassed 29 dental schools in Khartoum, Darfur, Kordofan States, and Merowe City. Five key informants from the Sudanese Medical Specialization Board, the Human Resource Development Administration, and a university offering clinical dental master's programs were interviewed. Quantitative data on attacks against dental schools were collected through a structured Google form, and qualitative data on postgraduate training were obtained through semi-structured key informant interviews. Findings reveal that 79.3% of dental schools faced military assaults, with 73.9% experiencing looting and 60.9% repurposed as military bases. Notably, 44.8% of schools shifted to online education,3.4% collaborated with other universities, and 27.6% adopted a combined approach. Key informants' interviews unveiled disruptions in specialty training and housemanship, limiting access to crucial training facilities. The primary proposed solution was overseas training. Recurrently emphasized strategies to enhance the resilience of the training system included establishing dental centers in all states, collaborating with external training bodies, and anticipating and preparing for potential disasters. The adverse effects of the conflict on both undergraduate and postgraduate dental education are discernible, manifested through resource limitations, a shortage of dental materials and supplies within training facilities, and direct disruptions to clinical training due to attacks on healthcare institutions. The imperative need for urgent interventions is underscored to alleviate these consequences and safeguard the continuity of educational and training efforts.

The constituents, ideas, and trends in team-based learning: a bibliometric analysis

Team-based learning (TBL) has gained significant popularity in higher education. Despite its widespread adoption, there is a lack of comprehensive understanding of the current state of TBL research. Hence, we conducted a bibliometric analysis to address this gap, reviewing 692 papers from the Web of Science database. The study revealed a notable increase in TBL research, with a peak of 87 publications in 2021. The United States emerged as the leading contributor, with medical and nursing education being the most prominent research areas. Specialized journals played a significant role in disseminating TBL research. Key themes, including TBL outcomes, non-technical competencies, and implementation principles, were identified. Moreover, it highlighted a growing interest in applying TBL in interprofessional education and formative assessment. The findings suggest the need to establish priorities and expand TBL research beyond health professions education to other fields. This study provides valuable insights into the current landscape of TBL research and offers directions for future investigations.

Twelve tips for creating a works in progress conference that builds capacity for educational scholarship and creates a scholarly community

Educators have implemented various strategies to build capacity for education scholarship, and often, these strategies focus on a specific set of interested individuals. We perceived a need for a strategy to engage a health professions education community with peer support. The purpose of these 12 tips is to describe an approach in place for nearly two decades that concurrently advances education scholarship and fosters a community that welcomes novices to experts. The approach is based on principles that not only build capacity and community but also stress the importance of alignment with the institution’s missions. The tips guide setting up, conducting, and sustaining such an approach.

Interculturality in the Development of Technology-Mediated Courses for Massive Health Education: A Systematic Review.

Virtual Learning Environments have become innovative tools in health professionals education. Through Massive Open Online Courses, they enable different ways of connecting with knowledge, facilitating study autonomy, interaction, and closer alignment with professional practices and the context of course participants. MOOCs comprise an educational strategy for many fields, including health. As they educate health professionals about a variety of practices, MOOCs play a crucial role in interculturality by enabling professionals to approach cultural diversity in work settings. This study provides a review of the literature investigating the element of interculturality in the production of healthcare-related MOOCs intended for a variety of audiences, including practicing healthcare professionals, healthcare professional trainees, and the general public. Based on a systematic review protocol, we searched for peer-reviewed studies published between 2016 and 2023 in Science Direct, PubMed, ERIC, and Scopus. Fifteen studies were selected for final analysis, which highlighted MOOC development, its underlying processes, and its importance in promoting health and social well-being. MOOCs have (1) provided new approaches to technology-mediated learning in distance health education, (2) aided training, (3) disseminated knowledge, and (4) promoted interculturality. Continuous collaboration and innovation in MOOC development are essential to ensure their effectiveness and relevance in the contemporary educational scenario.

Evaluating Pre-travel Health Consultations for Business and Occupational Travelers: A Systematic Review.

Business and occupational travelers' health is at risk due to the specific itineraries and activities, prolonged stays, work-related stressors, short preparation time, more chances of disease importation, underutilization of vaccination, and chemoprophylaxis. The objective of the review is to assess theeffectiveness of pre-travel health consultation and how it will help travelers prevent health risks. The question is to evaluate how can prolonged stays and underutilization of chemoprophylaxis and vaccination be better managed with pre-travel health consultation. The literature was searched on databases such as PubMed, Google Scholar, Cochrane Library, and Semantic Scholar using Boolean operators with keywords and Medical Subheading (MeSH) terms such as "occupational travelers," "business travelers," "pre-travel health consultation," "effectiveness of consultation," "health risk assessment," "travel illness prevention," "risk management," and "risk assessment" to retrieve relevant published studies. The Cochrane Risk of Bias (ROB) 2.0 tool and Newcastle Ottawa scale (NOS) were utilized to measure the risk of bias. The Grading, Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assign evidence strength. In total, a preliminary search yielded 334 articles. One high-quality study and seven studies of moderate quality were included. In conclusion, pre-travel health consultations are a vital tool to prevent travel-related health problems in business and occupational travelers. The current approach needs to be more specific and proactive to address health-specific risks experienced by travelers. However, early comprehensive consultations focusing on preventive measures, region-specific health risks, and timely immunizations are crucial to improving health outcomes. Moreover, enhanced guidance, awareness, and education of health professionals are also necessary to treat the complex medical needs of business and occupational travelers effectively.

Refracting the concept of physician advocacy using the prism of professional resistance

Background Advocacy is a well-established term in the context of medicine and medical education. However, what constitutes advocacy is unclear and at times contested as it can range from relatively anodyne acts of facilitating patient journeys to more substantial acts of non-compliance. As a result, guiding medical learners in establishing advocacy as part of their future practice is a somewhat subjective and variant undertaking. Analyzing advocacy using the emerging concept of professional resistance as an analytic prism can afford better understanding of what advocacy means in a health professions context. Methods The authors employed a concept analysis methodology to explore discourses of advocacy using the concept of ‘resistance’ as a prism. The findings of the study are presented as a series of dyadic tensions that elicit different meanings of advocacy, including the rhetorical uses of the term ‘advocacy’ and ‘resistance’. Results Physician advocacy can be defined in terms of six dyads: scope and scale, goals and intentions, effort and risk, disobedience and confrontation, responsibility and commitment, and consequences and outcomes. Moreover, describing acts or positions as ‘advocacy’ confers legitimacy and authority, whereas describing acts or positions as ‘resistance’ confers doubt as to their ethical and professional credibility even when they refer to the same things. Conclusions By utilizing resistance as an analytic prism to deconstruct advocacy in health professions education, the authors seek to resolve some of the tensions and areas of uncertainty associated with the use of the term ‘advocacy’ in medical education, and to advance new ways of thinking about these two concepts. This is achieved through developing an understanding of advocacy and resistance, not as discrete categories, but as discursive positions, such that there are factors common to both that need to be interrogated to properly understand the advocacy-resistance landscape in medical education.

COVID Just-in-Time Extension for Community Health Outcomes: A Collaborative Information-Sharing Platform for a School Health Community.

The COVID-19 pandemic challenged school health professionals to navigate a dynamic public health emergency and to stay aware of changing recommendations. This study aimed to determine the value of the COVID Just-in-Time ECHO (Extension for Community Health Outcomes) Learning Series for Schools among participating school health personnel and to describe their ongoing information needs during the pandemic. School health, public health, and education professionals across Colorado participated in this ECHO series. Participants attended 1-hour sessions every 2 to 4 weeks from March 2020 through December 2021 for a total of 34 sessions. Data collection included postsession and postseries surveys assessing what participants found most valuable and what additional information they needed. School nurses represented 113 of 224 participants (50%). ECHO content noted as being the most valuable included epidemiology updates and special topics as chosen by participant input. Postseries surveys identified the value of experiencing shared knowledge among Just-in-Time ECHO participants. Participants identified ongoing needs for information about COVID-19 guidance and risk mitigation in schools throughout the sessions. In postseries surveys, participants reported additional ongoing information needs related to COVID-19 outside schools. This ECHO series delivered reliable and time-sensitive information for school health personnel and school leaders and may provide a useful model for information sharing among education and public health professionals.

Transitioning to rural practice together: a rural fellowship model (in 6 Ps).

Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Maximising potential in health professions education

Maximising potential in health professions education

Enablers of and Barriers to Self-Regulated and Self-Directed Aptitudes of Learning (SELF-ReDiAL) in Health Professional Education: A Systematic Review and Meta-analysis.

Recently, accrediting organizations have focused on developing lifelong learners who possess self-regulated and self-directed aptitudes of learning (hereinafter SELF-ReDiAL or in short, SR). This meta-analysis aimed to identify factors which promote or deter SR in health professionals. Original studies which, by using self-reports, evaluated enablers of and barriers to SR in health professionals (dentistry, medicine, nursing, and pharmacology), and were indexed in Scopus® and PubMed® databases from 1 January 2000 to 31 August 2022, were retrieved. Major themes suggested to affect SR were determined, and enablers or barriers related to those themes, were considered eligible for inclusion. Studies were excluded if they were not in English, and if the full text could not be retrieved. From 149 identified papers, 43 studies were subsequently included in the meta-analysis. The strongest effect was generated by wellbeing (d = 0.806; 95% confidence of interval [CI]: 0.296, 1.316). In respect of teaching method, problem-based learning (d = 0.590; 95%CI: 0.375, 0.806), team-based learning (d = 0.382; 95%CI: 0.232, 0.531), and flipped classroom (d = 0.095; 95%CI: -0.088, 0.279) showed positive effects on SR, whereas lectures were negatively associated with SR (d = -0.079; 95%CI: - 0.389, 0.230). Further, the analysis showed that SR generally decreases during the first year of enrolment (d = -0.144; 95%CI: - 0.284, -0.004), while no major change in SR is observed in the second year (d = 0.027; 95%CI: -0.044, 0.099). Considering that student wellbeing had the strongest observed effect on SR, policy-setting and governing bodies should incorporate methods which improve wellbeing to develop health professionals with high levels of SR. The online version contains supplementary material available at 10.1007/s40670-024-02068-y.

Utilizing the Delphi Method to Develop Undergraduate Medical Education Learning Objectives to Address Medical Care of Gender and Sexually Diverse Individuals.

Introduction Gender and sexually diverse (GSD) individuals disproportionately experience worse outcomes, bias, discrimination, and inequities in their care. Many avoid seeking healthcare due to fear of discrimination and mistreatment. One method for improvement focuses on specific GSD medical care training for undergraduate medical education (UME) learners. Efforts to standardize GSD care in UME are present, as displayed by the competencies put forth by the Association of American Medical Colleges (AAMC); however, these attempts resulted in broad themes that can be challenging to implement. The need for specific and easily implementable learning objectives exists. Methods We aimed to create a set of learning objectives specific to GSD care by utilizing the Delphi Method to develop consensus. Three hundred and seventy-nine individuals were invited to participate in this study, which involved four iterative rounds of expert participation. In round one, the expert panel received an initial questionnaire comprising published learning competencies and items.The panel was requested to review and propose additional items.The research team then consolidated and structured these items into learning objectives.In round two, the expert panel was asked to review these objectives and edit language to reflect appropriate, inclusive language.In round three, the expert panel was asked to rate the importance of each learning objective using a 5-point Likert scale (1 =not at all important; 5 =extremely important).In round four, experts were given the overall panel's mean and mode rating for each objective, reminded of their rating, and asked to make a final rating. Learning objectives rated 4 or 5 ("very important" or "extremely important") by at least 80% of experts were determined to be at consensus. The researchers then further examined objectives that had 100% respondent rating of either 4 or 5, thus achieving universal consensus by our expert panel. Results Although 59 individuals agreed to participate in the study, 31 individuals engaged in at least one round of the iterative process as part of the expert panel.The initial questionnaire comprised 30 competencies published by the AAMC and 32 published overlapping learning items.After round two, 79 learning objectives were created.This process eliminated 28 objectives, resulting in 51 succinct objectives that used inclusive and patient-centered language. Conclusion These learning objectives can easily be integrated into existing curricular structures in UME. They can be utilized to improve curricular education for future health professionals, with the final goal of improving health equity for GSD individuals.

Does the Journal of Health Professions Education and Innovation allow the use of artificial intelligence for peer-reviewing submitted manuscripts?

Does the Journal of Health Professions Education and Innovation allow the use of artificial intelligence for peer-reviewing submitted manuscripts?