Learners In Medical Education Research Articles

Effectively supporting widening participation learners in medical education through a capability approach lens

Effectively supporting widening participation learners in medical education through a capability approach lens

Strategies to recognize and mitigate mistreatment of medical students

Mistreatment of learners in medical education is a significant problem affecting more than half of all trainees worldwide. This mistreatment can lead to severe consequences, including burnout, posttraumatic stress disorder symptoms, substance misuse, and decreased self-esteem, impacting not only future physicians but also the broader educational community. Despite increased awareness of such harms associated with mistreating medical learners, these behaviors have continued to persist over the years. We aim to equip medical educators and learners with practical strategies to recognize and mitigate mistreatment in the educational setting. We offer examples and concrete advice to help educators and institutional leaders classify mistreatment, navigate various scenarios, and create optimal reporting structures. Additionally, we provide recommendations for dismantling toxic environments and enhancing reporting transparency to build learner trust. Addressing mistreatment will require multifaceted collaboration between learners, educators, and institutions. This advice will help foster a shared commitment to establishing a culture of respect and support among all in the medical learning environment.

EXPRESS: Decoding Medical Educators' Perceptions on Generative Artificial Intelligence in Medical Education.

Generative AI (GenAI) is a disruptive technology likely to generate a major impact on faculty and learners in medical education. This work aims to measure the perception of GenAI among medical educators and to gain insights on its major advantages and concerns.A survey invitation was distributed to medical education faculty of colleges of allopathic and osteopathic medicine. The survey comprised twelve items assessing the role of GenAI for students and educators.Responses showed a positive attitude towards GenAI and disagreed on GenAI having a very negative effect on either the students' or faculty's educational experience. Eighty-five percent responded to have heard about GenAI, while 42% have not used it at all. Generating text (33%), automating repetitive tasks (19%), and creating multimedia content (17%) were some of the common utilizations of GenAI by school faculty. The majority agreed that GenAI is likely to change their role as educator. The greatest perceived strengths of GenAI were the ability to conduct more efficient research, task automation, and increased content accessibility. The faculty's major concerns were with cheating in home assignment (97%), tendency for blunder and false information (95%), lack of context (86%), the removal of human interaction in important feedback processes (83%), and the lack of guidelines for safe use of GenAI.Consensus-based guidelines at the institutional and/or national level need to start to be implemented to govern the appropriate use of GenAI while maintaining ethics and transparency. Faculty responses reflect an optimistic and favorable outlook on GenAI's impact on learning.

Assessment of learning levels of students using ‘Dennis Congo study skill inventory’ & evaluation of protocol for slow, average & advanced learners in medical education

: Students starting their medical education congregate from diverse educational environments and varied learning experiences. Hence, they would have developed individual preferences in learning styles for obtaining and refining information. Some students need accelerated approach so that they can learn things in the syllabus at their own speed. While some lack focus and understand topics at a slower pace compared to their peers. The process of assessment of the learning levels of students and conduction of activities for them can open up a new window for the teachers in adopting different teaching learning methods and result in more dynamic classroom interaction. This also paves way for adoption of appropriate strategies to address the concerns of all learners. The study was done with the aim to explore the study skills and determine any correlation between study skills of the students and their academic performance. This is a cross-sectional observational, questionnaire - based descriptive study involving undergraduate students enrolled in medical college. A predesigned, pretested structured and validated questionnaire, the Denis Congo Study Skills Inventory was administered on the sample. Study Skills Efficacy Scores were determined using the same. Learners were categorized as slow, average and advanced based on their scores in the first internal examination. These scores were aligned with the study skills used by the learner and the data was analysed using Microsoft Excel 2010 & IBM SPSS Statistics 28.0.1.1 Windows software to find out any correlation.: It was found that all the six skills included in the Dennis Congo study skill inventory may need to be developed in slow learners with equal emphasis so as to facilitate them in becoming average learners. All the six skills also require improvement in average learners to become advanced learners, however our study shows that more emphasis needs to be laid on the development of skills of note-taking, memory enhancement, test preparation and concentration. Out of these, note-taking and test preparation are skills which might be easier to work on as compared to memory and concentration, as a part of these skills are inherent to the individual. Teachers can play a significant role in helping the students in acquiring the skills. : Factors affecting student academic performances is a multidimensional issue which has to be identified at individual level. Deficient study skills appear to be a statistically significant cause for poor academic performance. With the objective to change the learner’s behaviour, it can be conveyed to learners what exactly is to be accomplished by providing a direction in the planning of a learning activity.This study assesses student learning levels in medical education using the 'Dennis Congo Study Skill Inventory'. It further evaluates a tailored protocol designed for slow, average, and advanced learners, aiming to enhance learning outcomes across diverse proficiency levels."

Storylines of Trauma in Health Professions Education: A Critical Metanarrative Review

Phenomenon Learners in medical education are often exposed to content and situations that might be experienced as traumatic, which in turn has both professional and personal implications. The purpose of this study was to synthesize the literature on how trauma has been conceptualized and approached within medical education, and the implications thereof. Approach A metanarrative approach was adopted following the RAMESES guidelines. Searches of 7 databases conducted in January 2022 with no date limitations yielded 7,280 articles, of which 50 were identified for inclusion through purposive and theoretical sampling. An additional 5 articles were added from manual searches of reference lists. Iterative readings, interpretive and reflexive analysis, and research team discussions were performed to identify and refine metanarratives. Findings Five metanarratives were identified, including the concept of trauma, the trauma event, the person with trauma, the impact of trauma, and addressing trauma, with each metanarrative encompassing multiple dimensions. A biomedical concept of trauma predominated, with lack of conceptual clarity. Theory was not integrated or developed in the majority of articles reviewed, and context was often ambiguous. Trauma was described in myriad ways among studies. Why certain events were experienced as trauma and the context in which they took place were not well characterized. The impact of trauma was largely concentrated on harmful effects, and manifestations beyond symptoms of post-traumatic stress were often not considered. Furthermore, the dominant focus was on the individual, yet often in a circumscribed way that did not seek to understand the individual experience. In addressing trauma, recommendations were often generic, and earlier research emphasized individually-focused interventions while more recent studies have considered systemic issues. Insights Multiple dimensions of trauma have been discussed in the medical education literature and from many conceptual standpoints, with biomedical, epidemiologic, and individualized perspectives predominating. Greater precision and clarity in defining and understanding trauma is needed to advance research and theory around trauma in medical education and the associated implications for practice. Exploring trauma from intersectional and collective experiences and impacts of trauma and adapting responses to individual needs offers ways to deepen our understanding of how to better support learners impacted by trauma.

'Oh yes, that is also reflection'-Using discursive psychology to describe how GP registrars construct reflection.

Learners in medical education generally perceive that reflection is important, but they also find that reflection is not always valuable or practically applicable. We address the gap between the potential benefits of reflection and its practical implementation in medical education. We examined the perspective of Dutch GP registrars who (must) reflect for their GP specialty training to understand their participant perspective on reflection. Our aim is stimulating alignment between reflective activities that occur in a medical curriculum and the ideals of reflection as a valuable educational activity. We conducted, video-recorded and transcribed seven focus group sessions with GP registrars in 2021 across two Dutch GP educational programmes. We used discursive psychology to analyse the focus group data by focusing on 'assessments of reflection'. We analysed their discursive features (how something was said) and content features (what was said) and related these to each other to understand how GP registrars construct reflection. Participants constructed reflection with nuance; they combined negative and positive assessments that displayed varied orientations to reflection. First, their combined assessments showed complex orientations to norms and experiences with reflecting in practice and that these are not simply negative or positive. Second, GP registrars constructed reflection as a negotiable topic and showed how reflection and its value can be variably understood. Third, through combined assessments, they displayed an orientation to the integration of reflection with other educational tasks, which impacts its value. Generally, GP registrars speak positively about reflection, but the value of reflection partly depends on its proper integration with other educational tasks. When meaningful integration fails, activities to stimulate reflection can overshoot their own goal and hamper learner motivation to reflect. Developing a healthy 'reflection culture' could mitigate some challenges. Therein, reflection is treated as important while learners also have adequate autonomy.

Measuring the Learning Orientation Fostered by Pediatric Residency Programs With the Graduate Medical Education Learning Environment Inventory Instrument.

Mastery learning orientation, conceptualized as a growth mindset, can be beneficial to learners in medical education and is supported by a program's learning environment. Currently, there are no instruments which reliably assess the learning orientation of a graduate medical education program's learning environment. To explore the reliability and validity of the Graduate Medical Education Learning Environment Inventory (GME-LEI). Leaders of the Education in Pediatrics Across the Continuum (EPAC) project revised Krupat's Educational Climate Inventory to create the GME-LEI. We investigated the GME-LEI's reliability and validity through confirmatory factor and parallel factor analyses and calculated Cronbach's alpha for each subscale. We compared mean subscale scores between residents in traditional programs and the EPAC project. As EPAC is known to foster a mastery-focused learning orientation, we hypothesized differences detected between resident groups would strengthen the instrument's validity. One hundred and twenty-seven pediatric residents completed the GME-LEI. The final 3-factor model was an acceptable fit to the data, and Cronbach's alpha for each subscale was acceptable (Centrality: 0.87; Stress: 0.73; Support: 0.77). Mean scores on each subscale varied by program type (EPAC vs traditional) with EPAC residents reporting statistically significant higher scores in the Centrality of Learning subscale (2.03, SD 0.30, vs 1.79, SD 0.42; P=.023; scale of 1-4). The GME-LEI reliably measures 3 distinct aspects of the GME learning environment with respect to learning orientation. The GME-LEI may be used to help programs better monitor the learning environment and make changes to support mastery-oriented learning.

"My Assessments Are Biased!" Measurement and Sociocultural Approaches to Achieve Fairness in Assessment in Medical Education.

Assessing learners is foundational to their training and developmental growth throughout the medical education continuum. However, growing evidence shows the prevalence and impact of harmful bias in assessments in medical education, accelerating the urgency to identify solutions. Assessment bias presents a critical problem for all stages of learning and the broader educational system. Bias poses significant challenges to learners, disrupts the learning environment, and threatens the pathway and transition of learners into health professionals. While the topic of assessment bias has been examined within the context of measurement literature, limited guidance and solutions exist for learners in medical education, particularly in the clinical environment. This article presents an overview of assessment bias, focusing on clinical learners. A definition of bias and its manifestations in assessments are presented. Consequences of assessment bias are discussed within the contexts of validity and fairness and their impact on learners, patients/caregivers, and the broader field of medicine. Messick's unified validity framework is used to contextualize assessment bias; in addition, perspectives from sociocultural contexts are incorporated into the discussion to elaborate the nuanced implications in the clinical training environment. Discussions of these topics are conceptualized within the literature and the interventions used to date. The article concludes with practical recommendations to overcome bias and to develop an ideal assessment system. Recommendations address articulating values to guide assessment, designing assessment to foster learning and outcomes, attending to assessment procedures, promoting continuous quality improvement of assessment, and fostering equitable learning and assessment environments.

Twelve tips for providing academic remediation to widening access learners in medical education

As medical schools expand access and diversity through widening access initiatives, there is an increasing need to provide academic remediation for learners during their first year in medical school. The previous educational experiences of widening access learners are often mismatched for continuing success in medical school. This article offers 12 tips for providing academic remediation to widening access learners and draws on insights from the learning sciences and research in psychosocial education to support academic development within a holistic framework.

Twelve tips for clinical teaching with telemedicine visits

Telemedicine is now an established mode of clinical care for most medical specialties, and clinical teachers must teach and precept learners in this modality. However, faculty need training on how best to teach students when caring for patients via telemedicine. Effectively incorporating learners into telemedicine visits to optimize their education is a critical skill for clinical teachers. In this article, we review 12 practical tips unique to telemedicine to engage and educate undergraduate medical education learners in building their clinical skills. We outline synchronous and asynchronous elements before, during, and after the patient encounter to facilitate teaching while improving patient care. These principles can also be adapted for teaching in other health professions as well as postgraduate medical education.

What Does It Mean for Medical School Admissions to Be Socially Accountable?

Health care workforce diversity is a critical determinant of health equity and the social mission of medical education. Medical schools have a social contract with the public, which provides significant financial support to academic medical centers. Although a focus on diversity is critical in the admissions process for health professions schools, most US medical schools have failed to achieve racial-ethnic or economic diversity representative of the general US population. This article discusses limitations of holistic admissions, structural challenges for diverse learners in medical education, and how to implement socially accountable admissions.

COVID-19: Strategies for Engaging Remote Learners in Medical Education.

This document is the Version 2 of: Zayapragassarazan Z. COVID-19: Strategies for Online Engagement of Remote Learners [version 1; not peer reviewed]. F1000Research 2020, 9:246 (document) ( https://doi.org/10.7490/f1000research.1117835.1 ) This document discusses about the different strategies for ensuring higher levels of online student engagement in medical education in the wake of COVID-19.

The Hidden Curriculum: A Good Thing?

IntroductionThe hidden curriculum is defined as a set of influences that function at the level of the organizational structure and culture to impact learning. Literature supports the significant impact of the hidden curriculum on all levels of learners in medical education. Our project aims to capture the messages being delivered to healthcare providers at our local facility.MethodsMultiple one-time educational sessions on the hidden curriculum were provided over a five-year period to healthcare professionals. Participants were asked to share personal examples of their lived experiences with the hidden curriculum. A thematic analysis of the responses was completed and coded by two independent reviewers. ResultsParticipants consisted of medical students, residents, faculty physicians, and allied health professionals. Their experience of the hidden curriculum emerged in six main themes: Vulnerability, Hierarchy, Privilege, Navigation & Negotiation, Positivity, and Dehumanizing.ConclusionA minority of responses demonstrated the positive impact that the hidden curriculum can have on professional development. This project highlights the importance of formally addressing the hidden curriculum to capitalize on its impact on medical trainees. The results have inspired a project focusing on residents as the population of interest in their unique role as learners and preceptors.

Academic coaching for learners in medical education: Twelve tips for the learning specialist

As medical education moves toward a competency-based model of teaching and learning, the need for individual academic coaching has increased. However, coaching for improving academic performance is underexplored relative to coaching for the improvement of technical skills. This manuscript introduces 12 tips for developing academic coaching skills (in the context of one-on-one coaching encounters as well as that of the broader learning and teaching environment) that promote lifelong learning habits. These tips were developed by drawing upon relevant literature from coaching (across disciplines), educational linguistics, the learning sciences, and my experiences as a medical education learning specialist. Key considerations for impactful academic coaching include critical self-reflection (for both the learner and learning specialist), dialogic interpersonal communication, collaborating with student leaders and faculty, and facilitating the development of self-regulated, lifelong learning skills.

Your Goals, My Goals, Our Goals: The Complexity of Coconstructing Goals with Learners in Medical Education

Phenomenon: Despite a long-standing recognition of the importance of learning goals in feedback, there has been relatively little research on how to address mismatches between learner goals and preceptor goals in medical education. Our study addresses this gap by reporting on challenges and strategies around goal coconstruction as identified by clinical educators who were learning and attempting to implement a goal-oriented feedback approach in their own teaching contexts. Approach: We employed a qualitative, design-based research methodology to study how 5 clinician educators incorporated goal-oriented feedback into their teaching practice. Participants attended workshops on goal-oriented feedback and reflective writing. They then narratively reflected over a 6-month period on their attempts with goal-oriented feedback and shared these reflections in periodic facilitated group discussions. Themes were developed using iterative thematic analysis of group discussions and individual exit interviews. Findings: Participants identified several benefits of goal setting in all environments. They perceived improved rapport with learners and developed empathy for the vastness of learner goals. However, they experienced several struggles especially when learner and preceptor goals did not match. These included (a) how to address learner goals that were not easily amenable to a coconstruction, (b) how to coconstruct goals while actively running a clinical practice, and (c) how to remain learner centered while raising preceptor goals based on perceived gaps. Insights: Mismatches between learner and preceptor goals are inevitable and frequent. Preceptors must find ways to coconstruct goals with learners in various learning environments. That said, in enacting goal-oriented feedback, preceptors are effectively using feedback throughout the teaching and learning interaction to coconstruct the learning environment, resulting in improved rapport with learners and emphasizing why it is important to focus feedback around goals.

Characterizing the literature on validity and assessment in medical education: abibliometric study.

IntroductionAssessment in Medical Education fills many roles and is under constant scrutiny. Assessments must be of good quality, and supported by validity evidence. Given the high-stakes consequences of assessment, and the many audiences within medical education (e. g., training level, specialty-specific), we set out to document the breadth, scope, and characteristics of the literature reporting on validation of assessments within medical education.MethodSearches in Medline (Ovid), Web of Science, ERIC, EMBASE (Ovid), and PsycINFO (Ovid) identified articles reporting on assessment of learners in medical education published since 1999. Included articles were coded for geographic origin, journal, journal category, targeted assessment, and authors. A map of collaborations between prolific authors was generated.ResultsA total of 2,863 articles were included. The majority of articles were from the United States, with Canada producing the most articles per medical school. Most articles were published in journals with medical categorizations (73.1% of articles), but Medical Education was the most represented journal (7.4% of articles). Articles reported on a variety of assessment tools and approaches, and 89 prolific authors were identified, with a total of 228 collaborative links.DiscussionLiterature reporting on validation of assessments in medical education is heterogeneous. Literature is produced by a broad array of authors and collaborative networks, reported to a broad audience, and is primarily generated in North American and European contexts. Our findings speak to the heterogeneity of the medical education literature on assessment validation, and suggest that this heterogeneity may stem, at least in part, from differences in constructs measured, assessment purposes, or conceptualizations of validity.Electronic supplementary materialThe online version of this article (10.1007/s40037-018-0433-x) contains supplementary material, which is available to authorized users.

The Feedback Tango: An Integrative Review and Analysis of the Content of the Teacher–Learner Feedback Exchange

To conduct an integrative review and analysis of the literature on the content of feedback to learners in medical education. Following completion of a scoping review in 2016, the authors analyzed a subset of articles published through 2015 describing the analysis of feedback exchange content in various contexts: audiotapes, clinical examination, feedback cards, multisource feedback, videotapes, and written feedback. Two reviewers extracted data from these articles and identified common themes. Of the 51 included articles, about half (49%) were published since 2011. Most involved medical students (43%) or residents (43%). A leniency bias was noted in many (37%), as there was frequently reluctance to provide constructive feedback. More than one-quarter (29%) indicated the feedback was low in quality (e.g., too general, limited amount, no action plans). Some (16%) indicated faculty dominated conversations, did not use feedback forms appropriately, or provided inadequate feedback, even after training. Multiple feedback tools were used, with some articles (14%) describing varying degrees of use, completion, or legibility. Some articles (14%) noted the impact of the gender of the feedback provider or learner. The findings reveal that the exchange of feedback is troubled by low-quality feedback, leniency bias, faculty deficient in feedback competencies, challenges with multiple feedback tools, and gender impacts. Using the tango dance form as a metaphor for this dynamic partnership, the authors recommend ways to improve feedback for teachers and learners willing to partner with each other and engage in the complexities of the feedback exchange.

Feedback for Learners in Medical Education: What Is Known? A Scoping Review.

To conduct a scoping review of the literature on feedback for learners in medical education. In 2015-2016, the authors searched the Ovid MEDLINE, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Web of Science, and Scopus databases and seven medical education journals (via OvidSP) for articles published January 1980-December 2015. Two reviewers screened articles for eligibility with inclusion criteria. All authors extracted key data and analyzed data descriptively. The authors included 650 articles in the review. More than half (n = 341) were published during 2010-2015. Many centered on medical students (n = 274) or residents (n = 192); some included learners from other disciplines (n = 57). Most (n = 633) described methods used for giving feedback; some (n = 95) described opinions and recommendations regarding feedback. Few studies assessed approaches to feedback with randomized, educational trials (n = 49) or described changes in learner behavior after feedback (n = 49). Even fewer assessed the impact of feedback on patient outcomes (n = 28). Feedback is considered an important means of improving learner performance, as evidenced by the number of articles outlining recommendations for feedback approaches. The literature on feedback for learners in medical education is broad, fairly recent, and generally describes new or altered curricular approaches that involve feedback for learners. High-quality, evidence-based recommendations for feedback are lacking. In addition to highlighting calls to reassess the concepts and complex nature of feedback interactions, the authors identify several areas that require further investigation.

Incorporating Lifelong Learning From Residency to Practice: A Qualitative Study Exploring Psychiatry Learners' Needs and Motivations.

There has been an increased focus on lifelong learning (LLL) as a core competency to develop master learners in medical education across the learner continuum. The purpose of this study was to explore the perceptions of psychiatry residents and faculty about LLL implementation, motivation, and training needs. This qualitative study was conducted in a large, urban, multisite psychiatry training program as part of a larger mixed methods study of LLL in psychiatry education. Using a purposive sampling approach, psychiatry residents were recruited to participate in focus groups; early career psychiatrists and psychiatry educators were recruited to participate in semistructured interviews. Content analysis of interviews and focus groups was done using the iterative, inductive method of constant comparative analysis. Of the 34 individuals participating in the study, 23 were residents, six were psychiatry educators, and five were early career psychiatrists. Three predominant themes were identified in participants' transcripts related to (1) the need for LLL training in residency training; (2) the implementation of LLL in residency training and practice; and (3) the spectrum of motivation for LLL from residency training into practice. This study identified the lack of preparation for LLL in residency training and the impact of this gap for psychiatrists transitioning into practice. All participants described the importance of integrating LLL training within clinical rotations and the importance of grounding LLL within the clinical workplace early in residency training to support the delivery of effective, high-quality patient care.

A Developmental Approach to Evaluating Competence in Clinical Reasoning

In the past two decades there has been tremendous worldwide interest in assessing the clinical competence of learners in medical education. This interest marks a philosophical shift toward greater objectivity, accountability, and predictive power in the evaluation of trainees. One of the core competencies in medical education is clinical reasoning. Because veterinary and human medical training share several similarities and differences, a review of the current state of clinical reasoning competency assessment in medical education may be useful for veterinary educators. This article covers the core competency of clinical reasoning (not other important competencies, such as physical examination or communication) and reviews research from medical education on the development of clinical reasoning and its implications for the transition from novice to expert. Four common stage-related learner difficulties are described: reduced knowledge, dispersed knowledge, tunnel vision, and the outsider. Specific approaches to measuring competence in clinical reasoning for each developmental level are recommended. Finally, two specific examples of evaluation based on a developmental approach to clinical expertise, the RIME (reporter, interpreter, manager, expert) system and the Script Concordance Test (SCT) methods, are discussed.