Medical Education Review Research Articles

Sexual Harassment in the Medical Workplace: The Experience of Medical Students and Doctors

<p>本文回顧醫師職場的性騷擾議題，包含臺灣醫師勞動條件改革小組與臺北市醫師職業工會等團體於2018發布的「醫師職場性別友善問卷調查報告書」，分析其結果與後續回應，並綜論臺灣與國際文獻，從各國、各專科的研究數據、騷擾行為描述、帶來的負面影響與相應行動，可見#MeToo運動與#MeTooMedicine運動是遍地開花。自詡為亞洲性別平等領航者的臺灣，在當今的全球浪潮中，2023年5月台灣#MeToo運動從政治、學術、演藝界開始延燒，在社群媒體與報導中也陸續看到幾起醫療圈的騷擾事件。對於此議題的關注，臺灣醫界不應缺席，也應檢視醫學教育、醫療職場上的雇主責任、申訴管道與案件分析，並留意2024新版性平三法上路後的相關影響。此外，鑑於經歷疫情、#MeToo運動，帶來生活型態變化和法律變革，但國內對醫療勞動中性別議題的學術研究仍相當有限，今年臺北市醫師職業工會也已重啟「2024醫療職場性別友善調查」。</p> <p> </p><p>This study examines sexual harassment in the medical workplace through analyses of relevant literature, with a focus on the “Medical Workplace Gender-Friendliness Survey Report” published in 2018 jointly by the Taiwan Physician Labor Conditions Reform Group and Taipei Doctors Union. Results and subsequent responses of the report were analyzed, along with related Taiwanese and international literature spanning multiple countries and specialties, including research data, descriptions of harassment, as well as negative impacts of and reactions to harassment. The widespread global influence of the #MeToo movement and #MeTooMedicine movement is evident with Taiwan, generally recognized as a leader in Asian gender equality, experiencing its own #MeToo movement spreading from politics, academia, and the entertainment industry in May 2023. Concurrent with the movement, several harassment incidents in the medical field have been reported in social and news media. and in the news. Instead of remaining neutral or even absent, the Taiwanese medical community must address the issues through comprehensive review of medical education, employer responsibilities in the medical workplace, reporting mechanisms, and case analyses, while also paying attention to the impacts of the 2023 amendments to the three gender equality laws. To date, domestic academic research on gender issues in medical labor remains limited. In response to changes precipitated by the COVID-19 pandemic and the #MeToo movement, the Taipei Doctors Union has initiated a follow-up study, the “2024 Gender-Friendly Workplace Survey for Medical Professionals.”</p> <p> </p>

The Primacy of Professionalism: A Selective Review of Medical Education, Practice, and Research.

From the 12th Century, when the word referred to taking religious vows, to its present meaning as a constellation of organized practices requiring special training, legal liability, and covenants with individual patients and society, professionalism has played an important role in the practice of medicine. Until relatively recently, the concepts of professionalism and professional behavior were rooted in timeless ideals that individual physicians were expected to achieve in training and practice. As an ideal type, professionalism was seen as a quality or characteristic residing in the individual physician. By the same measure, the period of rapid technological and social change that marked the early to mid-20th Century made clear that timelessness, as it applied to professionalism, had its limitations. Where once sharing bad or sad news with patients was viewed as harmful, the right to know one's diagnosis is now enshrined in law and taken for granted in education and practice. Moreover, research shows that knowing one's diagnosis is often beneficial, not harmful, to individuals and families. In response to changing norms and technological advances, medical educators have introduced new models of professionalism that stress the role of social context and relationships in training and practice. One innovative approach is based on the concept of professional identity formation, the moment-by-moment process of becoming and being a physician. Identity formation occurs primarily through story-telling and other forms of self-expression in the context of a community of peers who learn to practice medicine with technical proficiency, kindness, and self-awareness together. [Pediatr Ann. 2024;53(12):e440-e445.].

The Relationship between Pediatric Medical Training and Neonatal Care in the Delivery Room and Beyond.

The modern neonate differs greatly from newborns cared for a half-century ago, when the neonatal-perinatal medicine certification examination was first offered by the American Board of Pediatrics. Delivery room resuscitation and neonatal care are constantly evolving, as is the neonatal workforce. Similarly, the Accreditation Council for Graduate Medical Education review committees revise the requirements for graduate medical education programs every 10 years, and the modern pediatric medical trainee is also constantly evolving. Delivery room resuscitation, neonatal care, and pediatric residency training are codependent; changes in one affect the other and subsequently influence neonatal outcomes. In this educational perspective, we explore this relationship and outline strategies to mitigate the impact of decreased residency training in neonatal-perinatal medicine.

A thematic content analysis of the structure and effects of good doctor abilities in China

BackgroundThe efforts to explore and build the structure of good doctor abilities are important because they help improve the quality of education for medical students and better standardize the working performance of doctors. However, at present, no worldwide standards for such a structure have been established. In this study, we endeavoured to map the structure of good doctor abilities and identify their effects.MethodsWith a focus on China, a thematic content analysis was adopted in this study to analyse the personal profiles of 50 widely recognized good doctors. NVivo11 software was used.ResultsThe Structure and Effects of Good Doctor Abilities in China model was proposed, and interpretations were made based on AMO theory. Good doctor abilities fall within six categories: rigorous clinical thinking, skilled in diagnosis and therapy, clinical empathy, continuous learning and innovation, enhancing and sharing experiences, and communication and coordination. These abilities have positive impacts on doctors’ work performances and social benefits by encouraging good behaviours, ultimately promoting the sustainable development of the hospitals where they serve.ConclusionsIn this study, we established a model of the structure and effects of good-doctor abilities in China and interpreted its mechanism, innovation and theory diversification in “good-doctor” research. Moreover, this study has practical significance because it provides systematic and well-targeted criteria for improving the professionalism of doctors, promoting more good doctor behaviours, providing guidance for regulating doctors’ conduct and providing a reference for medical education and working performance reviews worldwide.

A Message from the New Editor-in-Chief of the Korean Medical Education Review

A Message from the New Editor-in-Chief of the Korean Medical Education Review

The current landscape of emergency medicine resident scheduling.

The Accreditation Council for Graduate Medical Education (ACGME) and Residency Review Committee oversee resident physician work hours with additional specifics for U.S. emergency medicine (EM) residency programs. While there are maximum work hours, the regulatory bodies do not describe minimum work hours to achieve competency, leading to variable scheduling practices. This study aimed to understand the current landscape of U.S. EM residency scheduling given the expansion of programs, evolution of policies, and increased emphasis on wellness. We conducted a cross-sectional study to assess current strategies of U.S. EM residency scheduling. The RedCap survey was sent to all ACGME-accredited EM residency programs across the United States via individualized emails between January 10, 2023, and March 15, 2023. Data were combined using Microsoft Excel. A total of 138 of 278 (50%) programs responded to the survey. A total of 73.2% of programs were using thirteen 28-day blocks with the remainder using twelve 1-month blocks or reported "other" block scheduling. The number of blocks in the ED increases with each postgraduate year (PGY). For PGY-1 through PGY-3, the most commonly used shift duration was 9 h. The mean total shifts per ED block and hours worked per ED block are as follows: 19 shifts and 185.1 h (PGY-1), 18.2 shifts and 173.9 h (PGY-2), 17.3 shifts and 163.6 h (PGY-3), and 14.8 shifts and 157.2 h (PGY-4). Programs provide a median for 4 weeks of vacation per year of residency. Given the expansion of U.S. EM residency programs, we reevaluated the landscape of resident scheduling. We described scheduling patterns related to night shifts, vacations, requested time off, conference coverage, charting time, and circadian rhythms. Programs should utilize these data as a starting point for setting a clinical experience for their residents.

GP specialty trainees' knowledge and values towards physical activity: a national survey of Scottish trainees.

Despite the known benefits of physical activity (PA), one-third of adults in the UK fail to meet recommended levels of PA. PA promotion in primary care has been shown to be effective at improving PA in patients but implementation of PA promotion by GPs remains poor. Research has shown a need to improve PA education in undergraduate medical education, but, to the authors' knowledge, no review of postgraduate medical education has been performed. To assess the knowledge and values of general practice specialist trainees (GPSTs) towards PA promotion in Scotland. Cross-sectional survey distributed to GPSTs in Scotland. A mixed-methods cross-sectional survey, informed by previous research, was developed and distributed to all (n = 1205) GPSTs in Scotland in December 2022. Descriptive statistics were used to analyse quantitative data. A content analysis of free-text responses was also performed. A total of 168 GPSTs responded, representing 13.9% of all GPSTs in Scotland. Of responders, 93.5% reported no previous experience in the subject of sports and exercise science and medicine. Overall, 38.9% of responders stated they were unaware of the current UK PA guidelines, with 33.9% unable to correctly identify the UK PA guidelines when presented with multiple choice options. In addition, 83.3% felt they had been inadequately trained to deliver PA advice during their medical training. This study highlights a lack of knowledge, confidence, and education in PA promotion in GPSTs in Scotland. Given the importance of primary prevention, this urgently needs to be addressed.

Reviews in Medical Education: Advances in Simulation to Address New Challenges in Neurology

Simulation is an engaging modality of medical education that leverages adult learning theory. Since its inception, educators have used simulation to train clinicians in bedside procedures and neurologic emergencies, as well as in communication, teamwork, and leadership skills. Many applications of simulation in neurology are yet to be fully adopted or explored. However, challenges to traditional educational paradigms, such as the shift to competency-based assessments and the need for remote or hybrid platforms, have created an impetus for neurologists to embrace simulation. In this article, we explore how simulation might be adapted to meet these current challenges in neurologic education by reviewing the existing literature in simulation from the field of neurology and beyond. We discuss how simulation can engage neurology trainees who seek interactive, contextualized, on-demand education. We consider how educators can incorporate simulation for competency-based evaluations and procedural training. We foresee a growing role of simulation initiatives that assess bias and promote equity. We also provide tangible solutions that make simulation an educational tool that is within reach for any educator in both high-resource and low-resource settings.

Graduate Medical Education Training and the Health of Indigenous Peoples.

Graduate Medical Education Training and the Health of Indigenous Peoples.

The Undergraduate to Graduate Medical Education Transition as a Systems Problem: A Root Cause Analysis.

The transition from undergraduate medical education (UME) to graduate medical education (GME) constitutes a complex system with important implications for learner progression and patient safety. The transition is currently dysfunctional, requiring students and residency programs to spend significant time, money, and energy on the process. Applications and interviews continue to increase despite stable match rates. Although many in the medical community acknowledge the problems with the UME-GME transition and learners have called for prompt action to address these concerns, the underlying causes are complex and have defied easy fixes. This article describes the work of the Coalition for Physician Accountability's Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) to apply a quality improvement approach and systems thinking to explore the underlying causes of dysfunction in the UME-GME transition. The UGRC performed a root cause analysis using the 5 whys and an Ishikawa (or fishbone) diagram to deeply explore problems in the UME-GME transition. The root causes of problems identified include culture, costs and limited resources, bias, systems, lack of standards, and lack of alignment. Using the principles of systems thinking (components, connections, and purpose), the UGRC considered interactions among the root causes and developed recommendations to improve the UME-GME transition. Several of the UGRC's recommendations stemming from this work are explained. Sustained monitoring will be necessary to ensure interventions move the process forward to better serve applicants, programs, and the public good.

Easing the Transition From Medical School to Residency: Using Deliberate Practice to Improve Senior Medical Students' Performance Responding to Urgent Pages From Registered Nurses.

Purpose: New interns are expected to perform initial evaluation and management of medical emergencies for hospitalized patients, 1 yet many are unprepared to care for such patients. 2 To address this gap, we designed a specialty-specific simulated paging curriculum based on Ericsson’s model of deliberate practice 3 for senior medical students. The purpose was to assess whether this curriculum leads to improved performance handling specialty-specific medical emergencies. Approach: Graduating senior medical students enrolled in 1 of 6 required specialty-specific residency preparation courses (emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, and procedures) in 2020 and 2021 participated. Students received an electronic handover with information about simulated patients. Throughout the course, students received 4–6 urgent pages about these patients that were specific for each specialty (e.g., atrial fibrillation case in internal medicine course, postoperative pain case in procedures course). Upon receiving each page, students called a standardized registered nurse (SRN) who used a script to answer questions about the patient. Students explained next steps in evaluation and management. Immediately after the page was complete, the SRNs delivered verbal feedback about performance. Students also received written feedback by the SRNs within the week. Additionally, the gold standard approach to the case was reviewed with the class by course instructors. Clinical performance was graded by SRNs using a predefined weighted rubric for each case. The rubric consists of “must do” (+2 points), “should do” (+1 point), “could do” (0 points), “should not do” (−1 point), or “must not do” (−2 points) diagnostic, therapeutic, and communication items. 4 “Must do” items represented the most critical actions for new interns to take. Each rubric was based on clinical guidelines and was reviewed by at least 2 faculty members. All variables were analyzed using descriptive statistics including medians and proportions overall and by specialty. Continuous variables were expressed using median and interquartile range. The relationship between clinical performance scores and case number was evaluated with the Jonckheere–Terpstra test. Outcomes: There were 1,403 pages sent to 265 students (84.1%) during the study period. Clinical performance improved over time from median (interquartile range) of 59.4% (46.9%, 75.0%) on case 1 to 80.0% (68.0%, 86.7%) on case 6 (P < .001). The proportion of “must do” items improved significantly from 69.2% (53.8%, 81.8%) to 80.0% (66.7%, 88.9%) (P < .001). Discussion: This novel simulated paging curriculum allowed senior medical students to practice and improve handling medical emergencies in a safe setting before entering the clinical setting as a resident. The highly realistic scripts and guideline-based scoring rubrics cover common intern-level patient care scenarios, representing content validity. Limitations include that this was a single-institution study and thus may not be generalizable to courses at other institutions. Additionally, the cases were different throughout the RPCs with varied case order and difficulty which limits analysis. Significance: The Coalition for Physician Accountability’s Undergraduate Medical Education-Graduate Medical Education Review Committee recently advised that specialty-specific just-in-time training is necessary for all incoming first-year residents and that meaningful assessment data be collected about each graduate to help serve as a baseline and inform tailored learning plans. 5 Our curriculum achieves both of these objectives by providing advanced specialty-specific training and also collecting valuable assessment information. To our knowledge, this is the only paging curriculum that has demonstrated evidence for students entering multiple specialties. This curriculum could be easily expanded to other medical schools as well as residency programs as the cases are administered by phone and the grading is electronic. Given how common these paging scenarios are for new interns, this curriculum fills an important gap in the transition to residency.

Knowledge of Musculoskeletal Medicine in Junior Doctors in Australia: Is It Adequate?

PurposeThe incidence of musculoskeletal disease is increasing in Australia and around the world. However, medical student education does not necessarily reflect current and projected trends in musculoskeletal medicine. The aim of this study was to assess junior doctors’ competency in musculoskeletal medicine using the Freedman and Bernstein Basic Competency Examination in Musculoskeletal Medicine questionnaire.MethodsWe conducted a cohort study of interns (first year post medical school) across four teaching hospitals in Australia. Interns were asked to take the Freedman and Bernstein examination during organised intern teaching sessions, and results were analysed using the original Freedman and Bernstein marking criteria and validated pass mark.ResultsThe mean score for the 92 interns was 13.9 out of 25 (55%) with scores ranging from 8 to 20.8 (29–83%). Only 8 of the 92 interns (8.7%) achieved a score of greater than 73%, the pre-specified pass mark.ConclusionOur study identifies inadequacies in musculoskeletal medical knowledge in Australian interns. Review of undergraduate medical education may be required to reflect current and predicted trends in the prevalence of musculoskeletal disease and adequately prepare junior doctors.

Blue Skies With Clouds: Envisioning the Future Ideal State and Identifying Ongoing Tensions in the UME-GME Transition.

The transition from medical school to residency in the United States consumes large amounts of time for students and educators in undergraduate and graduate medical education (UME, GME), and it is costly for both students and institutions. Attempts to improve the residency application and Match processes have been insufficient to counteract the very large number of applications to programs. To address these challenges, the Coalition for Physician Accountability charged the Undergraduate Medical Education to Graduate Medical Education Review Committee (UGRC) with crafting recommendations to improve the system for the UME-GME transition. To guide this work, the UGRC defined and sought stakeholder input on a "blue-skies" ideal state of this transition. The ideal state views the transition as a system to support a continuum of professional development and learning, thus serving learners, educators, and the public, and engendering trust among them. It also supports the well-being of learners and educators, promotes diversity, and minimizes bias. This manuscript uses polarity thinking to analyze 3 persistent key tensions in the system that require ongoing management. First, the formative purpose of assessment for learning and growth is at odds with the use of assessment data for ranking and sorting candidates. Second, the function of residents as learners can conflict with their role as workers contributing service to health care systems. Third, the current residency Match process can position the desire for individual choice-among students and their programs-against the workforce needs of the profession and the public. This Scholarly Perspective presents strategies to balance the upsides and downsides inherent to these tensions. By articulating the ideal state of the UME-GME transition and anticipating tensions, educators and educational organizations can be better positioned to implement UGRC recommendations to improve the transition system.

Narrative Reviews in Medical Education: Key Steps for Researchers.

Narrative Reviews in Medical Education: Key Steps for Researchers.

The Accreditation Council for Graduate Medical Education's Recent Changes to Radiation Oncology Training Program Standards: Raising the Bar for Postgraduate Training Quality to Better Reflect Our Specialty and Better Serve Our Patients

The Accreditation Council for Graduate Medical Education's Review Committee for Radiation Oncology recently made a number of significant changes to the required institution specialties and program participating sites for radiation oncology programs, in addition to requiring procedure minima for specific disease sites for residents. This article outlines the change process and essence of the changes made.

Realist Reviews: A Brief How-To.

Realist reviews in medical education are designed to add to our understanding of what intervention works, for whom, how, and in what circumstances. The foundational premise of realism is that interventions work differently in different contexts and for different people.1 Realist reviews add to our understanding of how context and mechanisms relate to educational outcomes, referred to as context-mechanism-outcome (CMO) configurations.The steps below introduce key elements when considering a realist review.Context matters: education programs that are effective in one context may not be effective elsewhere. Educational literature reviews tend to explore if a program works; a realist review seeks to understand how a program works and for whom. A realist review seeks to understand why a program might be effective in some contexts and for some learners but not others, and it is useful when seeking to understand both intended and unintended outcomes.A realist review is theory driven. Researchers will propose an initial program theory (or theories) as a potential explanation for how a program works, which is then refined iteratively as the review progresses. The initial program theory may come from the formal program documentation, education literature, expert stakeholders, and/or the researchers' own experiences. A refined theory is the result of a realist review and would be expected to influence the design and implementation of education programs in the future.2Familiarize yourself with the formal guidelines for conducting a realist review3 and realist review reporting standards.4 Strategically assemble a research team to include both content and realist method expertise. Consider seeking input from a librarian or information specialist. Develop initial program theories through brainstorming, speaking with experts in the field, familiarity with the literature, and initial scoping of literature.Initial scoping of the literature is required before determining the area of focus. Then a formal literature search is undertaken. A later search may also be required to seek out additional studies to refine the program theory as the theory develops. Literature selection is not limited to a particular study design type but is determined by its usefulness and contributions to theory. Literature is sought that provides information about CMO configurations. A document flow diagram is useful to show the number of articles assessed for eligibility and included in the review, with reasons for exclusion at each stage.Literature is assessed for inclusion based on relevance (paper's ability to contribute to theory building or theory testing) and rigor (methods used to generate the data are credible and trustworthy). A realist review does not seek to exclude literature based on the traditional hierarchy of evidence, as multiple methods may contribute usefully to theory building. However, papers judged as low quality may be excluded especially when dealing with large data sets. Alternatively, they may be included to inform understandings of context even if not considered for answering whether a complex intervention is effective. Thus, when studies are deemed low in quality, they may be retained for theory development or for testing in a subsequent realist evaluation.Each manuscript is coded for CMO configurations and for its potential to inform program theory. Both quantitative and qualitative data may be considered relevant and extracted. Deductive and inductive coding are relevant when seeking to understand reasons for positive and negative outcomes. Coding for both positive and negative outcomes enables further exploration of where and why programs might not work and for whom. Data to inform a program theory may be found in any manuscript section, not just the results section. Starting with the outcomes and working backward to identify the mechanism and context can be helpful. Another strategy is to try to articulate the CMO configuration as an “if, then” statement.The purpose of synthesis is to refine the program theory. This may involve testing the initial theory, adjudicating between different theories, or reviewing how the theory holds within different settings. In this process researchers find and align the evidence to demonstrate that particular mechanisms generate particular outcomes. This involves looking for CMO configurations that occur across the literature. Expert stakeholders may again be useful to contribute to building and confirming the program theory.Realist reviews can extend our understanding of how a program works, with statements that make explicit the C and M which will contribute to an educational O. Quantitative and qualitative data, both confirming and disconfirming, from primary studies are sought and used to support the theoretical explanation. This new explanation can inform future educational interventions. Contexts where a program is unsuccessful or mechanisms that are key to success should be highlighted. Please see Box 1 for further resources and Box 2 for examples of realist reviews in medical education.

UGRC 2021 recommendations on GME transition: pros and cons, opportunities and limitations

The Coalition for Physician Accountability's Undergraduate Medical Education-Graduate Medical Education (UME-GME) Review Committee (UGRC): Recommendations for Comprehensive Improvement of the UME-GME Transition final report includes a total of 34 recommendations and outlines opportunities to transform the current processes of learner transition from a US-based MD- or DO-granting medical school or international medical education pathway into residency training in the United States. This review provides a reflection on the recommendations from the authors, all members ofthe UGRC, describing the pros and cons and the opportunities and limitations, in the hopes that they might inspire readers to dig deeper into the report and contribute to meaningful improvements to the current transition. The UGRC Recommendations highlight the many opportunities for improvement in the UME-to-GME transition. They are built on the connection to the system of education and formation of physicians to a more just healthcare system, with attention to diversity, equity, andinclusion to improve health disparities and to the quality of care that patients receive. However, there are justifiable concerns about changes that are not fully understood orthat could potentially lead to unintentional consequences. This analysis, reached through author consensus, considers the pros and cons in the potential application of the UGRC Recommendations to improve the UME-to-GME transition. Further debate and discussion are warranted, without undue delay, all with the intention to continue to improve the education of tomorrow's physicians and the care for the patients who we have the privilege to serve.

Systematic Reviews in Medical Education.

Systematic Reviews in Medical Education.

Reimagining the Transition to Residency: A Trainee Call to Accelerated Action.

The transition from medical student to resident is a pivotal step in the medical education continuum. For applicants, successfully obtaining a residency position is the actualization of a dream after years of training and has life-changing professional and financial implications. These high stakes contribute to a residency application and Match process in the United States that is increasingly complex and dysfunctional, and that does not effectively serve applicants, residency programs, or the public good. In July 2020, the Coalition for Physician Accountability (Coalition) formed the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) to critically assess the overall transition to residency and offer recommendations to solve the growing challenges in the system. In this Invited Commentary, the authors reflect on their experience as the trainee representatives on the UGRC. They emphasize the importance of trainee advocacy in medical education change efforts; reflect on opportunities, concerns, and tensions with the final UGRC recommendations (released in August 2021); discuss factors that may constrain implementation; and call for the medical education community-and the Coalition member organizations in particular-to accelerate fully implementing the UGRC recommendations. By seizing the momentum created by the UGRC, the medical education community can create a reimagined transition to residency that reshapes its approach to training a more diverse, competent, and growth-oriented physician workforce.

COMLEX-USA and USMLE for Osteopathic Medical Students: Should We Duplicate, Divide, or Unify?

COMLEX-USA and USMLE for Osteopathic Medical Students: Should We Duplicate, Divide, or Unify?