Medical Learners Research Articles

Autonomy-Supportive Teaching in Medicine: From Motivational Theory to Educational Practice.

This article was migrated. The article was marked as recommended. Introduction: Promoting intrinsic motivation in medical learners is key for maximizing their engagement, performance, and well-being. Accordingly, methods of teaching and giving feedback focused on enhancing intrinsic motivation (i.e. autonomy-supportive approaches) are becoming increasingly recognized in medical education. However, these methods seem to be limited by a lack of understanding around what autonomy-support means and how to put it into practice. Approach: Grounded in Self-Determination Theory (SDT), this article defines autonomy-supportive versus controlling teaching, provides a rationale for its importance in medical education, addresses common misconceptions and potential challenges surrounding autonomy-supportive teaching in medicine, and outlines specific examples of ways to engage in it, in both clinical and non-clinical settings. Conclusion: Overall, this paper highlights how simple, flexible, and beneficial it can be to utilize an autonomy-supportive style in one's day-to-day interactions with medical learners, to stimulate their intrinsic motivation.These strategies can be applied in practically any setting and at all levels in medical education, through regular practice and reflection.

Are We Ready to Integrate Artificial Intelligence Literacy into Medical School Curriculum: Students and Faculty Survey.

Background:The effects of Artificial Intelligence (AI) technology applications are already felt in healthcare in general and in the practice of medicine in the disciplines of radiology, pathology, ophthalmology, and oncology. The expanding interface between digital data science, emerging AI technologies and healthcare is creating a demand for AI technology literacy in health professions.Objective:To assess medical student and faculty attitudes toward AI, in preparation for teaching AI foundations and data science applications in clinical practice in an integrated medical education curriculum.Methods:An online 15-question semi-structured survey was distributed among medical students and faculty. The questionnaire consisted of 3 parts: participant’s background, AI awareness, and attitudes toward AI applications in medicine.Results:A total of 121 medical students and 52 clinical faculty completed the survey. Only 30% of students and 50% of faculty responded that they were aware of AI topics in medicine. The majority of students (72%) and faculty (59%) learned about AI from the media. Faculty were more likely to report that they did not have a basic understanding of AI technologies (χ2, P = .031). Students were more interested in AI in patient care training, while faculty were more interested in AI in teaching training (χ2, P = .001). Additionally, students and faculty reported comparable attitudes toward AI, limited AI literacy and time constraints in the curriculum. There is interest in broad and deep AI topics. Our findings in medical learners and teaching faculty parallel other published professional groups’ AI survey results.Conclusions:The survey conclusively proved interest among medical students and faculty in AI technology in general, and in its applications in healthcare and medicine. The study was conducted at a single institution. This survey serves as a foundation for other medical schools interested in developing a collaborative programming approach to address AI literacy in medical education.

Zoom Burnout Amidst a Pandemic: Perspective from a Medical Student and Learner

Zoom Burnout Amidst a Pandemic: Perspective from a Medical Student and Learner

A Match Made in Heaven: Exploring Views of Medicine Students, Pharmacy Interns and Facilitators in an Interprofessional Medicines Pilot Study

Purpose: To date, few interprofessional education initiatives have included just medicine and pharmacy learners. This research sought to explore learners’ and facilitators’ views of an interprofessional education medicines pilot study involving medical students and pharmacy interns. Methods: Qualitative feedback was gathered from the participating learners and a facilitator focus group was undertaken. Results: Medical student and pharmacy intern learners reported enjoying taking part and found the simulation and overall initiative to be authentic. They described learning most about each other’s roles and responsibilities and about teamwork, collaborative management, and collaboration. Some logistical improvements were suggested. The facilitators judged that the topic of medicines, with medical and pharmacy learners taking part, to be a match made in heaven. Conclusions: Medical student and pharmacy intern learners found the medicines topic and discipline grouping facilitated their learning. Some topics and groups of disciplines are ideally matched for IPE and such a nexus should be capitalised upon.

GAAR: Gross Anatomy using Augmented Reality Mobile Application

Covid-19 pandemic has forced the teaching and learning activity into real time and real-world education meetings. The traditional physical and face-to-face meetings are avoided in accordance to reducing the close physical contacts among individuals. Thus, a new paradigm shift towards teaching and learning needs to be highly enforced. Teaching and learning on medical field especially require for real world anatomy against human or living things body. In response to providing the facility for medical teachers and learners, Gross Anatomy Augmented Reality (GAAR) is introduced. GAAR is an android mobile Augmented Reality (AR) learning tool to assist the educators and learners in internalizing 3D human anatomy with more fun and interactivity. The AR methodology is implied to attract the personal impacts and feelings towards operating of close to ‘real’ organ during anatomy practices. Traditional learning methods are changed with AR technology through small digital device. This application may be able to show the students the actual form of human gross anatomy and assist the teachers or educators’ in explaining the sciences behind human body in more interactive and interesting. Furthermore, this application uses a 3-dimensional object, video and interactive info so that students are interested in using this application. The AR for education and learning is vital in bridging the digital divide among all generations through the conversion of static pictures into real-like 3D animation. The implementation results show that, through the real visualization, small to adult learners can imitate the real truth on human organ and how this can motivate them to take care of their bodies that would lead to a healthier living styles as well as easy memorizing of the subject contents.

Developing Medical Learning Materials to Promote Learners’ Creativity: A Corpus-based Case Study

For a long time in Mainland China, there exists a need for authentic supplementary materials and an extensive native speaker environment in courses like English as a Foreign Language and English for Specific Purposes. Yet, how to promote learners’ creativity in the process of developing medical learning materials practice? This study aims to develop certain medical learning materials as an Enriched Corpus-Based English Supplement. Developing those proper medical learning materials for medical learners can help them to develop relevant strategies of corpus-based learning creatively. It had been conducted from December 2016 to November 2019 with four teachers and 180 third-year medical students at Xinxiang Medical University in the Medical English course. Mixed methods were chosen to observe and investigate the use of ECBES among third-year medical students. Both quantitative and qualitative data in the learning process and the outcome had been collected and analyzed. The practice showed that more than 60% of the learners thought they were language learners; their needs were the starting point of enriching creative supplementary materials. Quantitative data of learners’ production after the practice were displayed, which implied that the ECBES practice of four skills was practical and useful. Then it discussed several aspects of qualitative indexes for the learners’ creative production, such as their choosing autonomy opportunities, practice opportunities from the learners’ views. The findings suggested that certain corpus-based materials could be developed to promote learners’ creativity in ESP learning.

Development of a vocational and pedagogic position reflection of a doctor as part of continuing medical education program

The article considers vocational and pedagogic position reflection as an important component of medical vocational continuing education of doctors. According to the general hypothesis of the study, a special program for training vocational and pedagogic position reflection can contribute positively to medical caregivers’ vocational performance in treating patients, who experience troubles with medical compliance and adaptation to the disease. The key methods of the study include a literature survey and theoretical elaboration of the concept of the vocational and pedagogic position of a doctor reflection, meanwhile, the empirical research is based on formative pilot experiment, preceded and followed by testing medical learners’ personal reflexivity readinesses (by using Karpov’s questionnaire). The medical caregiver’s ‘reflective ability’ (Bogin) was considered as a source of doctors’ professionalization. Reflexivity was regarded as a key component of doctors’ preparedness to show empathy and to provide proper pedagogic support for hemodialysis patients, receiving audio-therapy. The results of the study show significant positive dynamics in learners’ cognitive sphere and critical thinking development, a high level of performance in role-played solving educational training healthcare cases, meanwhile personal reflexivity measurements have shown no statistically significant differences after training (according to Student’s t-test). The latter experimentation result testifies the personal nature of the reflexivity feature.

The Psychology of Shame: A Resilience Seminar for Medical Students.

IntroductionShame is a powerful emotion that can cause emotional distress, impaired empathy, social isolation, and unprofessional behavior in medical learners. However, interventions to help learners constructively engage with shame are rare. This module educated medical students about shame, guided them through an exploration of their shame experiences, and facilitated development of shame resilience.MethodsIn this 2-hour workshop, clinical-year medical students were guided through the psychology of shame through didactic slides. Next, a small panel of volunteer students, recruited and coached prior to the workshop, shared reflections on the content, including their shame experiences during medical school. This was followed by didactic slides outlining strategies to promote shame resilience. Participants then broke into faculty-led small groups to discuss session content. The module included a small-group facilitator guide for leading discussions on shame, didactic slides, discussion prompts, an evaluation tool, and a film entitled The Shame Conversation that was created after the initial workshop.ResultsA retrospective pre/postsurvey revealed statistically significant increases in: (1) importance ascribed to identifying shame in one's self or colleagues, (2) confidence in one's ability to recover from a shame reaction, and (3) comfort in reaching out to others when shame occurs. Analysis of open-ended questions showed that students felt the seminar would enhance future resilience by helping them identify and normalize shame, distinguish shame from guilt, and reach out to others for help.DiscussionThis workshop appears to prepare students to more constructively engage with shame when it occurs in medical training.

Developing Medical Learning Materials to Promote Learners’ Creativity: A Corpus-based Case Study

For a long time in Mainland China, there exists a need for authentic supplementary materials and an extensive native speaker environment in courses like English as a Foreign Language and English for Specific Purposes. Yet, how to promote learners’ creativity in the process of developing medical learning materials practice? This study aims to develop certain medical learning materials as an Enriched Corpus-Based English Supplement. Developing those proper medical learning materials for medical learners can help them to develop relevant strategies of corpus-based learning creatively. It had been conducted from December 2016 to November 2019 with four teachers and 180 third-year medical students at Xinxiang Medical University in the Medical English course. Mixed methods were chosen to observe and investigate the use of ECBES among third-year medical students. Both quantitative and qualitative data in the learning process and the outcome had been collected and analyzed. The practice showed that more than 60% of the learners thought they were language learners; their needs were the starting point of enriching creative supplementary materials. Quantitative data of learners’ production after the practice were displayed, which implied that the ECBES practice of four skills was practical and useful. Then it discussed several aspects of qualitative indexes for the learners’ creative production, such as their choosing autonomy opportunities, practice opportunities from the learners’ views. The findings suggested that certain corpus-based materials could be developed to promote learners’ creativity in ESP learning.

Medical student learner neglect in the clinical learning environment: Applying Glaser's theoretical model.

Learner neglect is a relatively new concept in education, and no suitable framework for its exploration has been devised. The aim of this study was to determine whether an existing framework, Glaser's framework of child neglect, could be applied to learner neglect in clinical learning environments. This was a retrospective analysis of data obtained as part of a related study. Six focus groups were conducted with medical students in their early clinical years to explore their views of what experiences in medical education were challenging and why they presented a challenge. The transcript data were analysed using inductive content analysis, within an interpretivist approach in the development of categories. The identified categories were cross referenced with Glaser's framework categories replacing the carer with the teacher and the child with the learner. Glaser's classifications of teacher (parent) behaviours were all identified in the negative aspects of medical learner clinical education including emotional unavailability/unresponsiveness, acting in a hostile manner, inappropriate inconsistent developmental interaction, failure to recognise individuality and failure to promote social adaption. Physical unavailability was identified as an additional category and is included in our proposed framework of learner neglect. Adapting Glaser's framework was useful in considering learner neglect. Medical schools have a role in ensuring learning experiences are positive across contexts and to make explicit to teachers any behaviours that may appear as learner neglect. Applying this framework has the potential to make more explicit any subtle undermining teacher behaviours. Once explicit, there is a greater likelihood that behaviours may be reappraised both by the teacher and learner and modified to promote a more effective clinical learning experience.

269: Educational Adaptation for the COVID-19 Pandemic: A Virtual Model Enables Ongoing Training

Jordan, Mary1; Evans, Susan2; Spangler, Lacey1; Miles, William3; Brintzenhoff, Rita3 Author Information

Teaching mindfulness-based stress management techniques to medical learners through simulation.

Implication StatementAcutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers. The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.

The Silent Epidemic: Causes and Consequences of Medical Learner Burnout.

Purpose of ReviewClinician burnout has significant socioeconomic, health, and quality of life implications. However, there has been little attention directed at medical students and house officers (i.e., medical learners). This review provides pertinent evidence regarding burnout as it relates to medical learners including risk factors and potential interventions. We conclude with recommendations on future research directions and potential approaches to address this epidemic of medical learner burnout.Recent FindingsBurnout is a significant issue among medical learners that is impacted both by interpersonal and environmental factors. There are points of heightened vulnerability for medical learners throughout their training. However, studies are unable to reach consensus regarding effective interventions to mitigate the impact of burnout. Furthermore, some elements of burnout are not readily reversible even after removing risk factors.SummaryBurnout is a significant concern for medical learners with wide-ranging physical, emotional, and psychosocial consequences. However, the current body of literature is sparse and does not provide consistent guidance on how to address burnout in medical learners. It is clear additional attention is needed in understanding burnout among learners and establishing proactive approaches to minimize its negative impact.

Medical Education's Wicked Problem: Achieving Equity in Assessment for Medical Learners.

Despite a lack of intent to discriminate, physicians educated in U.S. medical schools and residency programs often take actions that systematically disadvantage minority patients. The approach to assessment of learner performance in medical education can similarly disadvantage minority learners. The adoption of holistic admissions strategies to increase the diversity of medical training programs has not been accompanied by increases in diversity in honor societies, selective residency programs, medical specialties, and medical school faculty. These observations prompt justified concerns about structural and interpersonal bias in assessment. This manuscript characterizes equity in assessment as a "wicked problem" with inherent conflicts, uncertainty, dynamic tensions, and susceptibility to contextual influences. The authors review the underlying individual and structural causes of inequity in assessment. Using an organizational model, they propose strategies to achieve equity in assessment and drive institutional and systemic improvement based on clearly articulated principles. This model addresses the culture, systems, and assessment tools necessary to achieve equitable results that reflect stated principles. Three components of equity in assessment that can be measured and evaluated to confirm success include intrinsic equity (selection and design of assessment tools), contextual equity (the learning environment in which assessment occurs), and instrumental equity (uses of assessment data for learner advancement and selection and program evaluation). A research agenda to address these challenges and controversies and demonstrate reduction in bias and discrimination in medical education is presented.

A Telesimulation Elective to Provide Medical Students With Pediatric Patient Care Experiences During the COVID Pandemic.

Objectives/IntroductionThe Association of American Medical Colleges suggested that medical students not be involved in direct patient care activities in the United States because of the COVID pandemic. Our objectives are to (1) describe the rapid creation and implementation of a fully online simulation-based pediatric emergency medicine training intervention for medical student learners using existing simulation center staff (faculty, technicians, actors) and resources (simulation technology, scenario files) and (2) report student and faculty feedback on the intervention.MethodsThe sessions involved the use of our existing simulation center faculty, staff, and resources. Feedbacks on the sessions were collected via a survey from faculty and students at the end of each session.ResultsSixteen simulation sessions were conducted (8 febrile infant, 8 anaphylactic toddler). Forty-eight students, 2 technicians, 2 actors, and 10 faculty participated. Ninety percent of the students agreed with the statements, “I am more comfortable with pediatrics after this session,” “participating improved my pediatric knowledge/skills,” “this session was more useful than other learning activities I am involved in at this time.” Seventy percent of the students agreed with the statement, “I learned as much from observing as when I was actively involved.” All faculty agreed with the statement, “this was an effective educational strategy compared to other distance learning.” Most faculty (60%) disagreed with the statement, “virtual simulation was equal to or superior to in-person simulation.” All students and faculty strongly agreed with the statement, “I would highly recommend this to others.”ConclusionsA telesimulation intervention involving all medical students, staff, and facilitators interacting remotely for pediatric emergency training during COVID was associated with high levels of satisfaction by the majority of learners and faculty.

Mock Trial as a Learning Tool in a Family Medicine Residency.

Mock trials have been used to teach medical learners about malpractice litigation, ethics, legal concepts, and evidence-based practice. Although 5.2% of family physicians are sued for malpractice annually, there is no formal requirement nor curriculum for educating our residents about malpractice, and mock trial has not been reported as an education modality in a family medicine residency. We developed a mock trial experience to educate family medicine residents about malpractice litigation and evaluated the resident experience over 3 years. This is a retrospective, single-site study evaluating resident experience in our mock trials. We assessed perceived value using a 5-point Likert scale; and we assessed knowledge with free-text answers to both open and closed questions. We used descriptive statistics to describe data. Residents found the mock trial effective and engaging, giving the experience an overall evaluation of 4.9/5±0.3; 86.4% identified the importance of documentation as a learning outcome; 72.7% of residents identified negligence as necessary to justify a lawsuit, but they demonstrated limited mastery of the four elements of negligence, with 45.5% correctly listing harm, 40.9% causation, 13.6% breach of duty, and 0% duty owed. Mock trial is an enjoyable and effective tool to engage residents and provide a general understanding of malpractice litigation. It is less effective in conveying nuanced details of negligence. It may also be effective in teaching practice management techniques.

Why do few medical students report their experiences of mistreatment to administration?

Over 50% of medical students worldwide report experiencing mistreatment and abuse during their clinical education, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide whether to formally report these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. Using Constructivist Grounded Theory, we interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Data were analysed in an iterative fashion, using focused and theoretical forms of coding. The decision of whether to report mistreatment is only one phase in the process that students report experiencing when encountering mistreatment. This process can be understood as a journey consisting of five phases: Situating, Experiencing and Appraising, Reacting, Deciding and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Student perceptions of trust or mistrust in their educational institution are highly influential when it comes to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organisational trust between students and the medical school.

The Role of Empathy in Full-Scale Battle of Medical and Paramedical Learners Against COVID-19.

The Role of Empathy in Full-Scale Battle of Medical and Paramedical Learners Against COVID-19.

Qualitative exploration of the medical learner\u2019s journey into correctional health care at an academic medical center and its implications for medical education

Correctional systems in several U.S. states have entered into partnerships with academic medical centers (AMCs) to provide healthcare for persons who are incarcerated. One AMC specializing in the care of incarcerated patients is the University of Texas Medical Branch at Galveston (UTMB), which hosts the only dedicated prison hospital in the U.S. and supplies 80% of the medical care for the entire Texas Department of Criminal Justice (TDCJ). Nearly all medical students and residents at UTMB take part in the care of the incarcerated. This research, through qualitative exploration using focus group discussions, sets out to characterize the correctional care learning environment medical trainees enter. Participants outlined an institutional culture of low prioritization and neglect that dominated the learning environment in the prison hospital, resulting in treatment of the incarcerated as second-class patients. Medical learners pointed to delays in care, both within the prison hospital and within the TDCJ system, where diagnostic, laboratory, and medical procedures were delivered to incarcerated patients at a lower priority compared to free-world patients. Medical learners elaborated further on ethical issues that included the moral judgment of those who are incarcerated, bias in clinical decision making, and concerns for patient autonomy. Medical learners were left to grapple with complex challenges like the problem of dual loyalties without opportunities to critically reflect upon what they experienced. This study finds that, without specific vulnerable populations training for both trainees and correctional care faculty to address these institutional dynamics, AMCs risk replicating a system of exploitation and neglect of incarcerated patients and thereby exacerbating health inequities.

Professionalism and inter-communication skills (ICS): a multi-site validity study assessing proficiency in core competencies and milestones in medical learners

BackgroundInterpersonal and Communication Skills (ICS) and Professionalism milestones are challenging to evaluate during medical training. Paucity in proficiency, direction and validity evidence of assessment tools of these milestones warrants further research. We validated the reliability of the previously-piloted Instrument for Communication skills and Professionalism Assessment (InCoPrA) in medical learners.MethodsThis validity approach was guided by the rigorous Kane’s Framework. Faculty-raters and standardized patients (SPs) used their respective InCoPrA sub-component to assess distinctive domains pertinent to ICS and Professionalism through multiple expert-built simulated-scenarios comparable to usual care. Evaluations included; inter-rater reliability of the faculty total score; the correlation between the total score by the SPs; and the average of the total score by two-faculty members. Participants were surveyed regarding acceptability, realism, and applicability of this experience.ResultsEighty trainees and 25 faculty-raters from five medical residency training sites participated. ICC of the total score between faculty-raters was generally moderate (ICC range 0.44–0.58). There was on average a moderate linear relationship between the SPs and faculty total scores (Pearson correlations range 0.23–0.44). Majority of participants ascertained receiving a meaningful, immediate, and comprehensive patient-faculty feedback.ConclusionsThis work substantiated that InCoPrA was a reliable, standardized, evidence-based, and user-friendly assessment tool for ICS and Professionalism milestones. Validating InCoPrA showed generally-moderate agreeability and high acceptability. Using InCoPrA also promoted engaging all stakeholders in medical education and training–faculty, learners, and SPs—using simulation-media as pathway for comprehensive feedback of milestones growth.