Health Medical Education Research Articles

From curriculum to clinic: a qualitative study of junior doctors’ perceptions of global health and sustainable development

IntroductionThe role of global health and sustainable development in medical education is often debated. However, research regarding medical doctors’ views on the application of their global health knowledge in the...

Disability health in medical education: development, implementation, and evaluation of a pilot curriculum at Stanford School of Medicine.

People with disabilities face significant healthcare disparities due to barriers to accessing care, negative attitudes of providers, and lack of education on disabilities for healthcare professionals. Physicians report discomfort when interacting with patients with disabilities, adding to the disparity, warranting research on medical school education. Two educational interventions were structured: (1) a brief 2-h intervention in the mandatory curriculum and (2) a 9-week elective course which included interactions with individuals with disabilities through workshops and partner programs. We predicted that both of these interventions would result in improvements in attitude and empathy toward individuals with disabilities and reduce student anxiety. During the 2018-2019 academic year, 54 students completed the surveys for the 2-h intervention and 8 students completed the 2-h intervention and elective course. Pre-, post-, and delayed post-intervention surveys (3 months after post survey) measured students' attitudes, using validated surveys on attitudes, empathy and anxiety toward individuals with disabilities. Both educational interventions resulted in improved attitudes toward individuals with disabilities. However, students reported only feeling prepared to care for patients with disabilities after the elective course. The elective course, but not the 2-h course, significantly decreased student anxiety levels, likely due to more individual time working with individuals with disabilities. Delayed analysis after 3 months showed that both interventions had a lasting impact on attitudes and behavior change when caring for individuals with disabilities. Medical education is effective at improving medical students' attitudes and behaviors toward individuals with disabilities. A 2-h session can lead to a modest improvement in attitudes. However, more dedicated time and exposure to persons with disabilities results in a greater improvement in students' attitudes, anxiety and preparedness.

One Health in Medical Education: A Proposed Framework.

The One Health concept focuses on the interconnections between human health, animal health, and the environment, stressing the need for interdisciplinary collaborations to address complex issues such as the health challenges posed by climate change and global pandemics. One Health is a central part of the curriculum of veterinary schools, however, it is rarely incorporated into medical school education. Nationally, there are limited examples of formal One Health education and training for medical students. To incorporate One Health into its curriculum, John A. Burns School of Medicine developed a Dean's Certificate of Distinction in One Health that consists of a One Health foundational course, a clinical One Health elective course, participation in the One Health Interest Group, engagement in One Health educational and outreach activities, and a One Health research or curriculum development project. To the authors' knowledge, this is the first One Health certificate program developed and implemented in any Association of American Medical Colleges accredited medical school. Although introducing similar programs into medical curricula will continue to be challenging, we hope it will serve as a framework for other academic institutions.

LGBTQIA health in medical education: a national survey of Australian medical students

PurposeLesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals experience poorer health outcomes than other individuals. Insufficient LGBTQIA health education of doctors in existing medical curricula contributes to these outcomes. We sought to explore medical students’ experiences of content coverage and mode of delivery, as well as their preparedness, attitudes and learning needs regarding LGBTQIA health education in Australia.MethodsUsing a conceptual framework specific to curricular development, we adapted a previous cross-sectional national survey. This included 28 questions (analysed statistically) and 5 free text responses (analysed deductively using Braun and Clarke’s thematic analysis framework). Data was compared between LGBTQIA and non-LGBTQIA respondents, and clinical and preclinical students.ResultsThere were 913 participants from 21 of 23 medical schools, with most preclinical (55%) and clinical (89%) students reporting no teaching specific to LGBTQIA health. Reported content coverage was highest for sexual history taking (30%), and especially low for transgender and intersex health (< 16%), and intersectional LGBTQIA health (< 7%). Participants had positive attitudes towards LGBTQIA health, with 89% agreeing LGBTQIA topics were important and need to be covered in detail. Students desired longitudinal integration of LGBTQIA content, and LGBTQIA community involvement and case-based teaching that allows for interaction and questions. Self-perceived competency was low in all LGBTQIA health topics, although LGBTQIA participants reported higher preparedness than non-LGBTQIA participants.ConclusionsMajority of survey participants reported limited teaching of LGBTQIA health-specific content, highlighting the limited coverage of LGBTQIA health in Australian medical schools. Participants expressed positive attitudes towards LGBTQIA content and broadly agreed with statements supporting increased integration of LGBTQIA health content within medical curricula.

The Development and Characteristics of Planetary Health in Medical Education: A Scoping Review.

Climate change, biodiversity loss, and other ecological crises threaten human health globally. The interrelation between human health and ecosystems is addressed in the emerging field of planetary health. Ecological crises have created an urgency to integrate planetary health, including sustainable health care, into medical education. To facilitate integration and guide future research, this review aims to provide an overview of the existing literature about planetary health in medical education. The authors conducted a scoping review using the conventional methodological framework for scoping studies. They performed a comprehensive search in 7 databases without language restrictions in March 2022. Two researchers independently extracted data. The team analyzed the data using data-driven thematic analysis, content analysis, and qualitative summarizing. Data were structured according to the Curriculum Development for Medical Education: A Six-Step Approach. The authors identified 3,703 unique publications, of which 127 were included. Articles predominantly (71%, n = 90) covered the call to integrate planetary health in medical education (step 1: general needs assessment). Many publications (24%, n = 31) proposed learning objectives (step 3); these mainly concerned raising awareness while few concerned action perspectives. Publications limitedly reported on the final steps of curriculum development. Only 2 covered a full cycle of curriculum development. Most were published recently, with first authors mainly from Europe and North America. Planetary health in medical education is an urgent and hot topic. Literature focused predominantly on why planetary health should be integrated in medical education and what should be covered. The authors recommend future research and education development to shift to how to do so, especially in evaluation and feedback. Research and education development needs to be conducted and reported on systematically and underpinned by educational principles. Lastly, it would benefit from perspectives beyond 'Western-based' ones.

INSIGHT: Integrating Social Determinants of Health in Medical Education During Psychiatry Prison Placements

INSIGHT: Integrating Social Determinants of Health in Medical Education During Psychiatry Prison Placements

A qualitative study of mentors’ perceptions and experiences of a near-peer mentoring program for medical students

IntroductionDuring their academic studies, medical students may encounter a variety of challenging situations. It is no wonder that they have a higher prevalence of poor mental health than the general population. Mentoring programs have proven useful in promoting mental health in medical education. The study aimed to explore the perceptions and experiences of medical students as mentors in a near-peer mentoring program.MethodsA qualitative study was carried out between March and April 2022 at Semmelweis University in Budapest, Hungary. Five focus group discussions (FGDs) included 26 medical students who were enrolled as mentors in the mentoring program. The recordings were transcribed verbatim and anonymized. An deductive and semantic approach was adopted, and the data were analyzed with thematic analysis.ResultsThree major themes were identified: professional and personal growth and reflections on the mentoring experience. Mentors reported growth in social and practical problem-solving skills, self-confidence, psychosocial benefits, and both personal and professional development. The program had a great impact on students’ sense of self-efficacy, self-awareness, perception of their competencies, and adherence to their boundaries.DiscussionIn conclusion, the mentors strongly emphasized the professional and psychosocial benefits they perceived while participating in the mentoring program. Therefore, the experiences obtained during the mentoring are important milestones. Mentoring programs could greatly improve students both personally and professionally so that later, they will be the best possible professionals in the field of health care.

Mediverse Beyond Boundaries: A Comprehensive Analysis of AR and VR Integration in Medical Education for Diverse Abilities

This research paper explores the pioneering role of augmented reality (AR) and virtual reality (VR) in reshaping medical education within the metaverse, focusing particularly on their remarkable benefits for individuals with disabilities. This research examines how these immersive technologies can be customized to meet the unique needs of those with disabilities, including those with mobility. It demonstrates how AR and VR enable these individuals to actively participate in medical simulations, offering them a deeper understanding of intricate medical procedures. This article highlights the critical importance of ethical considerations, privacy measures, and adherence to accessibility standards in the deployment of AR and VR in medical training and a robust framework for harnessing the transformative capabilities of AR and VR in medical health education. It delves into the various ways in which AR and VR facilitate experiential learning, providing an immersive, hands-on approach to medical education. This research highlights the role of AR and VR in supporting remote diagnostics and mental health services, showcasing their capability to enhance doctor–patient interactions and support. This article represents that AR and VR in the metaverse have the potential to empower individuals with disabilities, leading to more inclusive and effective medical training.

Please don't gayify!: an autoethnographic account of medicalised relationality for LGBTQI+ safe affirming medical health education and clinical practice.

In this article, the authors, a cis-gender gay man and an Indigenous non-binary, two-spirit person, narrate their past encounters with health professionals and their experiences pursuing allied health care training as students. Taking an autoethnographic approach, the first author re-narrates how medical practitioners and students engage (or fail to engage) with the LGBTQIA+ community. They draw on gray documentation derived from an interaction with a consulting physician that highlighted a telling lack of knowledge about the LGBTQ+ community, including those with diverse sex characteristics and sexualities/manifesting as unconscious bias. This interaction provided the impetus to speak back to the experience of being reduced to a medical prognosis. The second author questions the hegemonic practices underpinning encounters with the medical model of response in tertiary education. Our remit in this paper is to question how adequately the specific needs of the LGBTQI+ population are being addressed by the medical model and to what extent aspiring clinicians understand how their actions can contribute to gender- and sexuality-based discrimination and stigmatization.

Embracing Global Health in medical education: innovative ideas to achieve equity transnationally.

Embracing Global Health in medical education: innovative ideas to achieve equity transnationally.

Planetary health as a main topic for the qualification in digital teaching - a project report.

To do justice to the need for planetary health in medical education, these are the aims of the online elective course "Planetary Health in Medical Education" (ME elective):1. Enable students to plan and realize their own course sessions on planetary health;2. Encourage communication among university medical faculties regarding planetary health in medical education;3. Reinforce competency in digital teaching and amplify the expert role as multiplicator among students pursuing a Master's degree in Medicinal Education (MME). The development of the ME elective followed Kern's six-step approach to curriculum development by means of cooperation between the German Medical Students' Association (Bundesvertretung der Medizinstudierenden in Deutschland, abbreviated as bvmd), and the MME study program. Based on general and specific needs analyses, core learning objectives regarding planetary health, medical education and digital education were identified in the National Catalogue of Learning Objectives in Undergraduate Medical Education (NKLM) and the MME study program and relevant teaching methods were selected. The ME elective, consisting of two contact hours per week per semester, was established at 13 medical schools as a four-phase course:1. Introduction to medical education using examples from planetary health;2. Lesson planning on a topic in planetary health under the supervision of MME students;3. Course sessions held by the undergraduate students; and4. Networking with the MME study program through participation in digital courses on planetary health and the pilot OSCE on planetary health.A total of 24 students attended the pilot in the 2022 summer semester. The topic of planetary health combines interests that span many subjects and semester levels. As a collaborative, interdisciplinary and interprofessional subject, it lends itself to training students in a trans-institutional elective course to become multiplicators.

The Medical Education Planetary Health Journey: Advancing the Agenda in the Health Professions Requires Eco-Ethical Leadership and Inclusive Collaboration

Climate change and the declining state of the planet’s ecosystems, due mainly to a global resource-driven economy and the consumptive lifestyles of the wealthy, are impacting the health and well-being of all Earth’s inhabitants. Although ‘planetary health’ was coined in 1980, it was only in the early 2000s that a call came for a paradigm shift in medical education to include the impact of ecosystem destabilization and the increasing prevalence of vector-borne diseases. The medical education response was, however, slow, with the sustainable healthcare and climate change educational agenda driven by passionate academics and clinicians. In response, from about 2016, medical students have taken action, developing much-needed learning outcomes, resources, policies, frameworks, and an institutional audit tool. While the initial medical education focus was climate change and sustainable healthcare, more recently, with wider collaboration and engagement (Indigenous voices, students, other health professions, community), there is now planetary health momentum. This chronological account of the evolution of planetary health in medical education draws on the extant literature and our (an academic, students, and recent graduates) personal experiences and interactions. Advancing this urgent educational agenda, however, requires universities to support inclusive transdisciplinary collaboration among academics, students and communities, many of whom are already champions and eco-ethical leaders, to ensure a just and sustainable future for all of Earth’s inhabitants.

What Matters Most? The Power of Kafka's Metamorphosis to Advance Understandings of HIV Stigma and Inform Empathy in Medical Health Education.

HIV stigma, a social-medical problem, continues to confound researchers and health professionals, while undermining outcomes. Empathy may reduce stigma; its absence may predict stigma. This research investigates: How does Kafka’s Metamorphosis advance understandings of HIV stigma in medical health education? Metamorphosis amplifies the sociological-relational mechanisms fostering HIV stigma. It offers a multi-disciplinary, responsive space for ethical, humanistic and clinical inquiry to meet: enabling students to consider how social structures shape health inequities, moral, social experience, and their professional identity within. Metamorphosis may ultimately promote medical health humanities’ social mission—allowing literature to unfold such revelations towards greater equity in health.

The Sum is Greater Than the Parts: Aligning Graduate Allied and Medical Health Education at a Training Institution.

Analysis of military Graduate Medical Education (GME) remains in the discussion forefront as resources continue to face scrutiny along with military-specific obligation challenges. The Military Health System Quadruple Aim of Better Care, Better Health, Lower Cost, and Increased Readiness continues to drive debate of the right approach to both GME and Graduate Allied Health education. In this paper, we expand the discussion beyond traditional physician-focused GME and include the military's highly trained allied health specialists. Graduate Allied Health medical providers provide quality and effective medical care to the military's service members and dependents. These specialists also carry a significant deployment and operational medicine footprint complimenting core physician medical specialties delivering cost-efficient, optimal patient care and providing a ready force. This paper addresses GME and GAH interprofessionalism, institutional culture endorsement, patient safety, increasing demand, research productivity, and encouraging physician retention altogether benefiting the Military Health System. This institution's support for the interprofessional GME model works well, expanding physician and GAH specialists' professional application and knowledge while garnering mutual respect across all medical disciplines ultimately benefiting all.

25014 Interactive didactic session for residents and medical students on dermatologic care for lesbian, gay, bisexual, and transgender patients

Introduction: Despite increasing emphasis on lesbian, gay, bisexual, and transgender (LGBT) health in medical education across specialties, evidence-based training on LGBT patient care in dermatology is lacking. Our study assessed the effectiveness of an interactive didactic session on dermatologic care of LGBT patients in improving participants’ clinical preparedness, attitudinal awareness, and basic knowledge of LGBT patients in a dermatologic setting.

Perspectives on climate change in medical school curricula—A survey of U.S. medical students

IntroductionAlthough climate change has been identified as one of the greatest threats to health, medical school curricula have very little coverage of its health consequences. While students are key stakeholders in medical school curricula, their perspectives on the inclusion of this content are largely unknown. This study sought to evaluate medical student perceptions on the intersection of climate change and health in medical education. Materials and methodsAuthors surveyed students at select U.S. medical schools from April–July 2020 using Likert-scale items, multiple choice questions, and free text responses. Data was analyzed using descriptive statistics, and a regression analysis was performed to assess student characteristics predictive of stronger beliefs in climate health education. ResultsOf 600 student respondents at 12 medical schools, 83.9% (n=503) believed that climate change and its health effects should be included in the core medical school curriculum, but just 13.0% (n=78) believed that their school currently provides adequate education. Only 6.3% of students (n=38) felt they would be “very prepared” to discuss the question, “How can climate change affect my health?” with a patient. There was no significant association between student beliefs regarding climate change in medical education and age, medical school region or rank, or stage of training, though students with no or low past or present engagement with climate change had significantly lower scores in a composite score assessing belief in climate change's health effects and place in medical education. DiscussionThe majority of medical students believe that climate change should be a core topic in medical school curricula and current coverage is inadequate. By demonstrating student demand to fill this educational gap, this study functions as a needs assessment in the development of climate health curricula moving forward.

Interactive Session for Residents and Medical Students on Dermatologic Care for Lesbian, Gay, Bisexual, Transgender, and Queer Patients.

IntroductionDespite increasing emphasis on LGBTQ health in medical education, evidence-based training on LGBTQ patient care in dermatology is lacking. We designed an interactive online didactic session on dermatologic care of LGBTQ patients for medical students and dermatology residents.MethodsSession content was based on continuing medical education articles and incorporated preexisting LGBTQ-inclusive policies, environments, and videos. We implemented the session via a web-based videoconferencing platform as part of a preexisting resident lecture series. We began with a 90-minute lecture on LGBTQ health care disparities and dermatologists’ roles, best practices for providing inclusive care, and dermatologic health concerns and screening recommendations in LGBTQ populations. To solidify knowledge and promote practice of learned skills, a 30-minute interactive role-playing session followed where participants acted as observer, patient, or provider in three distinct clinical scenarios pertaining to dermatologic care of LGBTQ patients. Participants completed baseline and follow-up surveys, which included a psychometrically validated clinical skills scale and an ad hoc knowledge assessment.ResultsBaseline and follow-up scores from the clinical skills scale increased overall (0.7; 95% CI, 0.5–0.9; p < .001), in self-reported clinical preparedness (1.1; 95% CI, 0.5–1.6; p = .001), and in basic knowledge (0.8; 95% CI, 0.3–1.4; p = .003).DiscussionAn online interactive didactive session on dermatological care of LGBTQ patients increased participants’ clinical preparedness and basic knowledge. Implementation of similar sessions at other institutions can improve gaps in preparing residents and medical students in dermatological care of LGBTQ patients.

Transgender health in medical education.

Transgender health in medical education.

How Do We Decolonize Global Health in Medical Education?

Medical schools are increasing global health training opportunities, but these have been marketed to medical students as an exotic vocation. The challenges of global health education in high income country (HIC) medical schools are rooted within broader inequities in global health partnerships. More meaningful engagement during medical training is hindered by students’ inability to take extended absences, difficulty securing funding, a paucity of mentors with demonstrated commitment to equitable global health practice, and inadequate preparation. Calls for decolonizing global health have recently amplified, and medical schools must seize the opportunity to train decolonizers. We outline steps medical schools can adopt to shift their global health education approach to develop practitioners better prepared to contribute equitably. First, students should be exposed to more global health courses, including the history of colonial medicine and its effects on specific local contexts. Medical schools should deemphasize short-term unidirectional engagement, and encourage extended experiences. International experiences must have clearly defined roles, clarified with pre-visit contracts and supervision of the experience to ensure students do not engage in medicine above their level of training. For any exchange, medical schools must provide pre-visit training that includes site-specific orientation and strategies for effective collaboration. Finally, medical schools must recruit faculty committed to developing equitable, long-term collaborations, and institutional promotion criteria must be aligned to encourage this work. An understanding and commitment to this lifelong practice can be fostered through medical school curricula that expose students to global health work that prioritizes equity in clinical work and research.

A Call for One Health in Medical Education: How the COVID-19 Pandemic Underscores the Need to Integrate Human, Animal, and Environmental Health.

During the early stages of the COVID-19 pandemic in 2020, the first author, then a fourth-year student at Harvard Medical School, was enrolled in a One Health clinical experience at Zoo New England where he was introduced to a transdisciplinary approach to integrate human, animal, and ecosystem health. Seeing the vast impact of the pandemic and knowing its roots as a zoonotic disease, he realized this approach was critical to his medical education and for preparation against future novel infectious diseases. Zoonotic diseases have been emerging into human populations with increasing frequency, leading to public health emergencies such as Ebola, avian influenza, and SARS. The SARS-CoV-2 narrative, starting in bats and then mutating through an intermediate host into humans, is another striking example of the interconnectedness between human, animal, and ecosystem health that underlies these infections. Preventing future pandemics will require a transdisciplinary One Health approach, and physicians should be prepared to participate in these discussions while advocating for One Health initiatives for the benefit of their current and future patients. Integration of One Health education into medical school curricula will also prepare future physicians for other complex and urgently important health issues such as climate change, antimicrobial resistance, and the impact of biodiversity loss. As the consequences of the COVID-19 pandemic persist, education in One Health must become a priority; it is essential to break down the conventional disciplinary silos of human medicine, veterinary medicine, environmental health, public health, and the social sciences, so that future health crises can be prevented and mitigated collaboratively.