Stages Of Medical Training Research Articles

Physicians’ and residents’ educational needs regarding shared decision making: A focus group study

ObjectivesTo explore the educational needs of physicians and residents regarding shared decision making (SDM). MethodsWe conducted eight focus groups with 12 general practitioners (GPs), 14 hospital specialists, 12 hospital specialist residents and 13 GP residents in Belgium. We used thematic analysis to guide data analysis. ResultsWe identified five educational needs: (1) the need for a clear understanding of the definition of SDM and its scope; (2) how to deal with a changing professional identity; (3) acquisition of skills to perform SDM; (4) the need for reflective practice in a supportive environment; and (5) sustainable and longitudinal integration in education. ConclusionsThis is the first focus group study emphasizing dealing with a changing professional identity as an educational need, besides the need for SDM-related knowledge and skills. Physicians stated that implementing spiral learning is needed at all stages of medical training, aimed at all specialties to foster interprofessional collaboration. Practice implicationsOur findings can support development of future educational SDM interventions, integrating both competence development and professional identity formation. We provide practical recommendations on didactic formats and strategies, hoping to finally reach better implementation of SDM in daily practice.

Competency in medical training: current concepts, assessment modalities, and practical challenges.

In the past two decades, competency-based medical education (CBME) has rapidly become the cornerstone of medical training and accreditation programmes worldwide. It has increasingly replaced traditional time-based educational approaches which were often rigid, fragmented, and overly emphasized clinical content knowledge over practical skillsets and attitudes. CBME adoption was in the hope of better preparing medical graduates for the demands and responsibilities of real-world clinical practice. For all the supposed merits of CBME, there hitherto remains difficulties in arriving at comprehensive and practical 'competency' definitions, and actual challenges with implementation of clinical competency assessment modalities pertaining to construct validity, reliability, and applicability with the use and interpretation of evaluation metrics. Therefore, in this article, we describe the various conceptualizations of 'competency' in medical education literature and attempt to refine its usage in practice to meet the evolving needs and expectations of healthcare stakeholders, as well as incorporate emerging concepts in the medical education discourse. We herein propose that clinical 'competencies' should be defined as multi-domain clinical expertise, comprising medical knowledge, skills, attitudes and metacognitive capabilities that reflects the prevailing needs of healthcare stakeholders, and is inferred from performance evaluations of medical trainees. In order to attain 'competence', there must then be a process of integrating multi-domain competencies into meaningful professional identity formation that is commensurate with the context and stage of medical training. In addition, we review the current competency assessment modalities, including common pitfalls with their usage, and sought to provide practical strategies to mitigate the identified challenges.

A Game-Based Tool for Reducing Jargon Use by Medical Trainees.

Physicians can be unaware that many US adults have intermediate or lower health literacy. Avoiding medical jargon in patient communication can improve poor outcomes associated with lower health literacy, but physicians may struggle to do so as health literacy education is neither standardized nor universal at US allopathic medical schools. As with other skills-based proficiencies in medical education, repeat exposure and active learning help build competency. Medical students developed the Patient Communication Challenge (PCC), an adaptation of the Hasbro game Taboo, to facilitate practice of patient-centered communication skills among medical trainees. Hour-long workshops were held for groups of preclinical medical students. Students watched a communication exemplar video, played the PCC game, and completed a postworkshop survey. To play, two teams competed to earn points by identifying medical concepts as explained by a teammate who described the term without using medical jargon. Evaluations indicated that the game was enjoyable and reinforced didactic concepts through active learning, with self-reported participant satisfaction and competency gain. Overall, 59% of participants (53 of 90) completed postworkshop surveys; 91% (48 of 53) agreed they felt more proficient in avoiding jargon, 94% (50 of 53) would recommend the workshop to a classmate, and 100% (53 of 53) would play again. The PCC can help early medical trainees develop health communication skills through gamification with utilization of adult learning principles and adequate frequency for skill retention. Future applications include longitudinal assessment and expanding to later stages of medical training and other health professions.

Medical students’ and residents’ views on euthanasia

BackgroundDoctors are increasingly faced with end-of-life decisions. Little is known about how medical students approach euthanasia. The objective of this study was to evaluate, among medical students and residents, the view on euthanasia and its variants; correlate such a view with empathy and religiosity/spiritualism; and with the stages of medical training in Brazil.MethodsThis is an exploratory cross-sectional study using an online questionnaire to be filled out on a voluntary basis among medical students and residents, consisting of: socio-demographic data, an empathy questionnaire and questions with elaborate clinical cases that typify situations of the variants of euthanasia.ResultsFrom 1550 invitations, 273 volunteer participants responded (17.6%). The percentages of strong agreement/agreement on the concepts were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%). Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. Religious belief and degree of empathy did not significantly influence the opinion about the concepts. Strong agreement/agreement were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%).ConclusionsPassive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. The external validation of our findings relies on the distinct legal, cultural, and religious frameworks found across various countries.

Evaluating the Impact of Residency Research Productivity on Craniofacial Surgeons' Career Trajectory.

To elucidate trends in publication productivity over the past 50 years and how they correlate with the stage of training as well as the competitiveness of residency and fellowship programs. The authors hypothesize that research qualifications play an important role in obtaining a competitively ranked craniofacial surgery fellowship and that over the past 50 years, there has been an upward shift in the research qualifications held by applicants at the time of application. A cross-sectional study was performed involving all 121 academic craniofacial surgeons in the United States for whom sex, years since fellowship, current institution rank, current academic position, and years since graduation were available. The relationship between research qualifications, as determined by the overall number of publications, number of first authorship publications, H-index scores, and years since fellowship completion, was examined. The study also analyzed the placement of surgeons at programs ranked in the top 25 versus the lower 25. As the number of decades since beginning craniofacial fellowship decreased, the average number of first authorship publications and average H-index increased. Those who attended higher-ranking residency and fellowship programs had a higher average number of publications, number of first authorship publications, and H-index. Over the past 5 decades, research productivity at all stages of medical training has surged, potentially fueled by the trend toward pass/fail grading in medical school evaluations and standardized exams and the need to differentiate oneself in an increasingly competitive field.

Entrustment Decision Making in the Intensive Care Unit: It's About More Than the Learner.

The provision of graded supervision affording progressive autonomy is fundamental to the progression of a medical learner toward competency for independent practice; the decision of how much supervision versus autonomy to provide a trainee in the execution of clinical care constitutes an entrustment decision. Despite entrustment decision making occurring both daily in practice and summatively at points of matriculation through stages of medical training, the factors influencing entrustment decisions remain poorly understood across clinical contexts. This study was designed to explore the central research question: How are entrustment decisions made in the medical intensive care unit (ICU)? This qualitative case study used semistructured interviews with attending pulmonary and critical care physicians in the medical ICU at a major midwestern medical center to explore the entrustment decision-making process as it was enacted in the clinical environment. Five major themes emerged from the data: 1) task, circumstance, and trainee factors contribute to entrustment decision making; 2) ad hoc entrustment decisions are enacted by supervisors with a consideration of the care team as a unit, not only an individual; 3) autonomy does not only arise out of entrustment, but outcomes of prior autonomous actions by the trainee inform the intention to entrust; 4) entrustment decision making includes a social process of back-and-forth akin to negotiation; and 5) entrustment is a learned skill. The process of entrustment decision making in the ICU is more complex than prior frameworks have captured; a model with more complete incorporation of the factors that influence entrustment in the ICU is presented. It is not clear how often ad hoc entrustment decisions in clinical practice are primarily driven by factors pertaining directly to trainee competence, which carries implications in the use of entrustment for assessment.

Gender Differences in Medical Student Perceptions of a Career in Cardiology.

Worldwide, the cardiology profession has an under-representation of women. We assessed medical students'perceptions of cardiology as a career choice with the aim of identifying barriers to gender diversity. An anonymous survey was distributed to medical students studying at three Australian medical universities.Questions pertained to demographics, year and stage of medical training, desire to pursue cardiology, and perceived barriers to a cardiology career. Results were analysed according to identified gender and desire to pursue or not pursue a cardiology career. Multivariable logistic regression evaluated for independent associations. The primary outcome were barriers identified to pursuing a career in cardiology. From 127 medical student respondents (86.6% female, mean age 25.9±4.8 years), 37.0% stated they wanted to pursue a career in cardiology (39.1% of women versus 23.5% of men, p=0.54). The top four perceived barriers to a cardiology career included: poor work-life balance (92/127, 72.4%), physician training process (63/127, 49.6%), on-call requirements (50/127, 39.4%) and lack of flexibility (49/127, 38.6%), with no gender differences. Women were more likely to report gender-related barriers (37.3% versus 5.9%, p=0.01) and less likely to identify procedural aspects as a barrier (5.5% women versus 29.4% men, p=0.001). Students in their pre-clinical years were more likely to want a career in cardiology (odds ratio 3.0, 95% confidence interval 1.2-7.7, p=0.02). A high proportion of female and male medical students want to pursue a career in cardiology with both genders identifying major barriers of poor work-life balance, lack of flexibility, on-call requirements and the training process.

Assessing Levels of Empathy among Undergraduate Medical Students: Results of a Cross-Sectional Study Conducted in a Medical College in Sohar, Oman

OBJECTIVE: Empathy is an essential aspect of communication skills for physicians, especially primary care physicians. The study aims to explore the empathy scores among medical students at different stages of medical training and to analyze the effect of gender and career choice on the empathy scores of medical students. METHODOLOGY: A cross-sectional study was conducted from October 2021 to January 2022 in a medical college in Sohar, Oman. All the students were eligible to participate in this study. Simple random sampling was employed, and participants were administered a 20-item Jefferson Scale of Empathy-Student (JSE-S) Version. Data were analyzed using SPSS version 22. Mean and standard deviation were reported for continuous variables. Subgroup comparisons were conducted using t-test and ANOVA. RESULTS: Out of 424 participants, the majority were female (n=390,92%), and over half of the students (56%) were less than 22 years of age. The mean empathy score of students on the JSE-S scale was 104.6 ± 17.43 (range: 37-140). Subgroup analysis revealed that males had a slightly high score on JSE-S (male: 105.7+14.56, female: 104.5+17.6, p-0.23). Empathy scores showed an increasing trend as the student progressed through medical school (6th year: 106.2+16.16). Empathy scores were almost similar for students who had preferred people or procedure-oriented fields as their career pathway (p-0.59). CONCLUSION: The study reflects the need to include empathy in teaching communication skills to medical students as an integral part of the medical school curriculum, which could assist them in becoming compassionate physicians and increasing patient satisfaction. KEYWORDS: Empathy, empathy scores, JSPE, Medical Students, Physicians, Undergraduate Medical Students.

217 Attitudes towards Physician-Assisted Dying among medical students in an Irish medical school

Abstract Background Physician-Assisted Dying (PAD) is a controversial topic, particularly among medical practitioners, While PAD is currently illegal in Ireland, it has been legalised in several European countries. It is likely PAD will become an increasingly contentious issue as current medical students progress through their training and over the course of their future careers. Methods This project comprised of a fully anonymised survey (using the platform Qualtrics), exploring Trinity College Dublin (TCD) medical students’ attitudes towards PAD. All TCD medical students, aged 18 and above, were invited to take part in the online survey. The survey included thirteen questions, addressing student: sex, age, stage of medical training, exposure to geriatric medicine rotations, opinions on training in relation to PAD, and overall attitude to PAD. A participation information leaflet containing a link & QR code to the survey was distributed to students at lectures. An email inviting students to take part in the study was also circulated. Consent was implied by completion of the survey. Results 200 students completed the survey. 119/200 (59.5%) of students were in favour of PAD, 53/200 (26.5%) were unsure, and 28/200 (14%) were opposed to PAD. Only 42/200 (21.%) students felt that their medical training adequately prepared them for potential discussions with patients about PAD The majority of students (31/37) who had completed rotations in Gerontology also felt that they were not adequately prepared for such discussions. 173/200 students feel that additional medical training related to PAD is warranted. Conclusion The majority of TCD medical students, across all genders, year of training and age groups, were in favour of PAD. Most students feel that their medical training does not prepare them for potential discussions about PAD in the future. Those who had clinical rotations in Gerontology did not feel more prepared for future discussions regarding PAD, suggesting the need for more formal teaching on the subject.

Investigating the Skill Development of Medical Students in Focused Assessment With Sonography for Trauma (FAST) Ultrasound: A Comparative Analysis Across Different Stages of Medical Training.

Focused assessment with sonography for trauma (FAST) ultrasound (US) is a valuable medical examination used in trauma settings, particularly for rapid responses to events such as natural disasters. Although the efficacy and benefits of FAST in patient care have been extensively studied, there is limited research on training medical students in FAST. Previous studies have found that medical students can proficiently perform a FAST US after two days of training. However, these studies exclusively included first-year medical students without considering variations in their medical knowledge. Particularly, the advantage of medical students having US experience before undergoing FAST training has not been previously examined. Assess the performance and knowledge acquisition of medical students with and without prior US experience after completing a FAST training course. The study included a total of 71 students, consisting of 33 males and 38 females, who were between the ages of 18 and 31, with an average age of 24.6 and a standard deviation of 2.4. The inclusion criteria targeted first- and second-year medical school students who participated on a volunteer basis. Students were divided into two groups: group A, consisting of those without prior USexperience, and group B, made up of those who had previous US experience. All students completed a pre-training survey to share their comfort and confidence in US use and knowledge. A baseline FAST exam was conducted to establish initial performance. A comprehensive three-hour training session was then provided. Post-training, students performed another FAST exam to assess improvement, followed by a post-training survey to evaluate comfort and confidence. Medical students who had prior experience in the US (group B) performed significantly better (p<0.01) in both the pre- and post-training FAST exams when compared to students without previous US experience. Specifically, in locating the liver, right kidney, hepatorenal recess, and left kidney, as well as detecting fluid accumulation when in a supine position. Additionally, medical students with prior US experience (group B) exhibited higher baseline confidence (p<0.005-p<0.01) in their ability to perform a FAST exam, as indicated by the results of the pre-testing survey. Previous experience with USsignificantly boosted confidence and knowledge gains following FAST training. This emphasizes the value of including US training in medical school programs after earlier exposure, offering evident benefits. The study reveals the unexplored benefit of having prior US experience for medical students undergoing FAST training, thus addressing a previously unexplored area in current research. The conclusions stress the necessity of integrating US training into medical school curricula after initial exposure. This understanding can direct medical educators in refining the education process, enabling students to be better equipped for real-world medical situations involving FAST.

Analysis of Changes in the Selected Nutritional Parameters of Patients within a Year from the Admission to the Enteral Nutrition Clinic.

(1) The following research question was formulated: What are the relationships between enteral nutrition and selected anthropometric and blood biochemical parameters? The aim of this study was to provide an assessment of the nutritional status of patients within one year from their admission to the Enteral Nutrition Clinic. (2) The study group included 103 participants. For the purpose of analysing their nutritional status, the Subjective Global Assessment (SGA) and Nutritional Risk Score (NRS) scales were used, anthropometric measurements were taken, and blood laboratory tests were performed. The assessment of changes in the indicated parameters was conducted at three time intervals: upon admission (T0) and 6 and 12 months after admission (T6 and T12, respectively). (3) The study group showed a significant improvement in the circumference of their upper and lower limbs. Nutrition therapy had an effect on the levels of erythrocytes, iron concentration, the activity of liver enzymes, and C-reactive protein levels. (4) The enrolment of patients into the Nutritional Therapy Programme had a positive effect on the selected results. 1. Twelve months after the introduction of nutritional intervention, an increase in erythrocyte count was particularly marked, and there was a decrease in the CRP (C Reactive Protein) level as well as the activity of liver enzymes. There was no significant effect of enteral nutrition on albumin and protein values. 2. To ensure the greatest efficiency of enteral nutritional therapy, it is to be continued for more than six months. 3. Nutritional interventions resulted in a significant increase in upper and lower limb circumferences among the study group. 4. For the purpose of identifying patients at risk of malnutrition, medical personnel should systematically raise their qualifications, and educational measures on this issue should be implemented at the stage of medical training at medical universities.

Impacting surgical training: Role of surgical anatomy dissection courses

INTRODUCTION: Human anatomy is one of the fundamental pillars of basic medical sciences, which forms the cornerstone of the ever-evolving medical practice. It is, therefore, important to strengthen anatomy education at all stages of medical training. Since 2020, the Department of Human Anatomy, in collaboration with the Department of Surgery, organized surgical anatomy dissection courses to improve surgical practice safety and competence. This educational study aimed to share lessons learned from organizing anatomy dissection courses and measure the impact on knowledge and skills acquisition by surgical trainees. METHODS: Courses were designed with clear learning objectives and programs. A pre-test was administered to trainees before the dissection course, and a post-test was organized at the end of the course. Descriptive statistics were used to compare pre- and post-test scores. A p-value less than 0.05 was considered statistically significant. The Likert scale was used to measure trainees’ satisfaction at the end of every course.RESULTS: From August 2020 to December 2021, 11 cadaveric dissection courses were organized, and 173 trainees from 6 Surgical Residency programs: Plastic surgery, General surgery, Orthopedic surgery, Urology, Neurosurgery, ENT, and Obstetrics and Gynecology. Nineteen trainers from the Surgery Department and Anatomy Department were involved.There was a significant improvement in marks in the post-test test as compared to the pre-test score. The average increase in the mark was 26.4% with a 95% CI [23-0 – 29.7], p-value &lt; 0.001. There was a negative correlation (r=-0.8948, p-value &lt; 0.001) between the marks at pre-test and the improvement score, suggesting that the lowest performers on the pre-test had the biggest post-test improvement. Trainees’ satisfaction was at a high level. 87.6% of trainees reported a desire to pursue training to become anatomy educators in the future. CONCLUSION: Surgical anatomy dissection courses positively impacted surgical knowledge and skills acquisition, integrating anatomy into surgical training. Cadaver-based surgical procedures simulation should be encouraged and integrated into surgical curricula.

Preclinical and Clinical Medical Student Attitudes Toward the Care of the Dying: Testing the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale.

The demand for palliative care is increasing worldwide. Beyond the acquisition of technical knowledge, the development of adequate personal disposition toward the relationship with the dying is a key aspect of the future training of doctors. This study evaluates the psychometric properties of the 9-Item Version of the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD-9IT) the authors recently developed and its capability to distinguish medical students with different attitudes toward the care of the dying and at different stages of medical training. The study included 595 medical students, 400 at the first and 195 at the fifth year. The Rasch rating scale model was specified to assess scale dimensionality, functioning and measurement invariance. Internal consistency, test-retest reliability and between-group difference sensitivity (first-vs fifth-year students) were evaluated using Cronbach's alpha, Intraclass correlation coefficients, Paired sample t-test and Mann-Whitney U. Scale unidimensionality, rating scale functioning and measurement invariance were established. The scale demonstrated good internal consistency and test-retest reliability, and adequately discriminated between first- and fifth-year students. The study supports the validity and reliability of the FATCOD-9IT. Its effectiveness, simplicity of compilation and score calculation, and gratuitousness encourage its widespread use as fast assessment of the medical student attitudes toward the care of the dying.

Continued underrepresentation of historically excluded groups in the neurosurgery pipeline: an analysis of racial and ethnic trends across stages of medical training from 2012 to 2020.

US allopathic medical schools have experienced improvements in racial and ethnic diversity among matriculants in the past decade. It is not clear, however, whether better representation of historically excluded racial and ethnic groups at medical school entry impacts subsequent stages of the medical training pipeline leading into a specific field. The aim of this study was to examine these trends as they relate to the neurosurgical medical education pipeline and consider the drivers that sustain barriers for underrepresented groups. Race and ethnicity reports from the American Association of Medical Colleges were obtained on allopathic medical school applicants, acceptees, and graduates and applicants to US neurosurgical residency programs from 2012 to 2020. The representation of groups categorized by self-reported race and ethnicity was compared with their US population counterparts to determine the representation quotient (RQ) for each group. Annual racial composition differences and changes in representation over time at each stage of medical training were evaluated by estimating incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using non-Hispanic Whites as the reference group. On average, Asian and White individuals most frequently applied and were accepted to medical school, had the highest graduation rates, and applied to neurosurgery residency programs more often than other racial groups. The medical school application and acceptance rates for Black individuals increased from 2012 to 2020 relative to Whites by 30% (95% CI 1.23-1.36) and 42% (95% CI 1.31-1.53), respectively. During this same period, however, inequities in neurosurgical residency applications grew across all non-Asian racialized groups relative to Whites. While the incidence of active Black neurosurgery residents increased from 2012 to 2020 (0.6 to 0.7/100,000 Black US inhabitants), the prevalence of White neurosurgery residents grew in the active neurosurgery resident population by 16% more. The increased racial diversity of medical school students in recent years is not yet reflected in racial representation among neurosurgery applicants. Disproportionately fewer Black relative to White US medical students apply to neurosurgery residency, which contributes to declining racial representation among all active neurosurgery resident physicians. Hispanic individuals are becoming increasingly represented in neurosurgery residency but continue to remain underrepresented relative to the US population. Ongoing efforts to recruit medical students into neurosurgery who more accurately reflect the diversity of the general US population are necessary to ensure equitable patient care.

Attitudes and practices of ophthalmology doctors in London (UK) on the importance of discussing work as a clinical outcome with patients during consultations: A cross sectional survey.

BackgroundLimited research suggests that non-occupational health doctors rarely discuss occupation with their patients. There is a gap in research regarding the attitudes and practices of doctors towards discussing patient occupation and return to work. The aim of this work was to explore the attitudes of ophthalmology doctors towards work as a clinical outcome and assess the need for occupational health training among participants (doctors).MethodsA cross-sectional survey among doctors working in ophthalmology in two London teaching hospitals. The survey focused on the attitudes of doctors towards ‘work’ as a clinical outcome, their practices of asking patients about occupation, their perceived level of competency in this area of clinical practice and the level of training doctors had received in this field. Descriptive data analysis was undertaken and results presented as frequencies and proportions.ResultsThe response rate was 30/72 (42%). Approximately a quarter (8/30;27%) of doctors ‘always’ discussed return to work during care planning whilst the majority (25/30;87%) of doctors agreed or strongly agreed that this should always be the case. Over half of the doctors had received no formal OH training on how to discuss or assess the impact of health on work and only 17/30 (57%) considered themselves competent in discussing these work outcomes with patients. Over half agreed that additional training would be useful, with the majority believing that it would be most useful at all stages of medical training.ConclusionWe found the majority of ophthalmology doctors regard ‘return to work’ as an important clinical outcome yet most do not routinely discuss work outcomes with patients to inform care planning. Majority of doctors lack training in how to discuss issues relating to work and would benefit from additional OH training.

Sexual and Gender Minority Identity Disclosure from Undergraduate to Graduate Medical Education: Perceptions of Professional “Outness” Among Medical Students

Increasingly, medical schools and residency programs seek to recruit trainees from diverse backgrounds, including sexual and gender minority (SGM) people. However, many trainees do not disclose their SGM identity during medical training due to fear of discrimination, which remains a challenge for institutional diversity and inclusion efforts. Despite this, relatively few studies have rigorously quantified trainees’ SGM identity self-disclosure across different stages of medical training. In 2018 and 2019, the Medical Student Pride Alliance (MSPA) distributed a 33-item online questionnaire interrogating practices and attitudes about SGM identity disclosure to medical students at allopathic and osteopathic medical schools in the United States. Here, we analyze these data to compare 1) the degree to which medical students disclose SGM identity in various professional contexts during undergraduate and graduate medical training and 2) students’ attitudes regarding SGM identity disclosure across those contexts. Overall, 1,162 medical students from 125 medical schools responded to the survey. Of these respondents, 629 (54%) were SGM-identified. Among SGM-identified respondents, students were most likely to report SGM identity self-disclosure to peers (91%) and least likely to report SGM identity self-disclosure on applications to residency or post-doctoral work (29%). Cisgender women were less likely to report SGM identity self-disclosure than other genders, and students performing research were more likely to report SGM identity self-disclosure among mentors. Overall, most (&gt;90%) survey respondents supported trainees’ ability to disclose their sexual orientation or gender identity during medical training. This exploratory study provides preliminary evidence that SGM-identifying medical students often do not disclose their sexual orientation or gender identity in evaluative professional contexts. Future work should assess this phenomenon in a larger national sample and propose targeted policies to support SGM inclusion throughout medical training in general and on applications to graduate medical education specifically.

Enhancing the one-minute preceptor method for clinical teaching with a DEFT approach

Few validated methods that are grounded in educational theory exist to effectively teach medical knowledge, clinical skills, and diagnostic reasoning to learners at different stages of medical training. The goal of this Perspective was to address potential gaps in clinical education pedagogy by modeling new concepts for teaching in the field of infectious diseases. Our approach involved synthesizing the relevant literature, identifying proven approaches, and enhancing an existing educational microskills model — the one-minute preceptor. Our strategy was to emphasize the essential core elements of the one-minute preceptor using a descriptive acronym — DEFT (Diagnosis, Evidence, Feedback, Teaching), meaning skillful — as a potentially helpful reminder to improve the quality of interactions between learners and preceptors. The need for learners to discuss risk factors, mechanisms of disease, and potential complications, and for preceptors to model analytical and diagnostic skills, was further illustrated using a practical example of a teacher–learner interaction about a child with a respiratory infection. The one-minute preceptor/DEFT approach is experiential, adaptable, case-driven, and skills-focused, and also applicable to clinical training in other specialties.

Towards equitable learning environments for medical education: Bias and the intersection of social identities.

Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.

Objective and Subjective Investigation of Physical Activity Levels and Its Relation with Socio-Demographic Characteristics among Medical Students.

BackgroundCombining the results of objective and subjective assessments of physical activity (PA) can provide a more complete assessment of PA patterns in medical students. This study aimed to determine the relationships between objective and subjective measured PA and its relation with socio-demographic characteristics among different stages of medical training.MethodsThis cross-sectional study was conducted on 186 students of four stages of medical training. The International Physical Activity Questionnaire Short-Form (IPAQ-SF) and pedometer were used.ResultsThere were significant differences in total PA in terms of gender, weight, and serious illness. Differences between four stages of medical training in total (p = 0.002), vigorous (p < 0.001), and moderate PA (0.026) based on IPAQ-SF as well as pedometer-counted steps in Tuesday (p = 0.002) and Wednesday (p = 0.006) were significant. The results demonstrated a positive significant relationship between total PA based on IPAQ-SF and pedometer-determined steps in four days of the week.ConclusionThere were positive low correlations between PA based on IPAQ-SF and pedometer among medical students. The PA of medical students at different years of medical training was different based on both IPAQ-SF and pedometer, which shows the need to pay attention to the special needs of students in terms of PA at each stage.

Benefits of simulation using standardized patients for training dermatology residents in breaking bad news

IntroductionSimulation in healthcare is a rapidly developing teaching method in the training of technical procedures. It is also used to enable caregivers to learn how to inform patients of serious illness and complex health status. However, its use is not widespread in the field of dermatology. This study investigated the utility of simulation as regards disclosing melanoma diagnosis, taking resident physician satisfaction as a primary endpoint. Materials and methodsFifteen dermatology residents were recruited as trainees. Four scenarios were allocated based on length of residency. An introductory briefing was held prior to the training sessions. Debriefing took place on completion of the diagnosis disclosure consultation. The participants completed questionnaires after the simulation session, after debriefing, and 3 months after the simulation session. The primary endpoint was usefulness of the session felt by trainees several months after the simulation. ResultsThe majority of participants (93.3%) thought the session helped with stress management, improved their attitude and control over their reaction (86.6%), and improved their communication skills (100%). They rated the usefulness of the simulation at 7.79/10 on average (range: 5–10). DiscussionAccording to our findings the resident physicians involved, particularly those with the least experience, were satisfied with this type of learning technique. Any difficulties encountered by these residents were brought to light and addressed during debriefing. ConclusionThere would appear to be real benefits to be reaped from simulation, whatever the stage of medical training at which it takes place. Simulation should become an increasingly important part of contemporary pregraduate specialty programs.