Stakeholders In Medical Education Research Articles

Perceptions and experiences of undergraduate medical students regarding social accountability: a cross-sectional study at a Subsaharan African medical school

BackgroundMedical schools are called to be socially accountable by medical education and healthcare system stakeholders. Social accountability is a feature of excellent medical education. Medical students are essential to the development of socially accountable medical schools. Therefore, understanding the perceptions and experiences of medical students regarding social accountability is critical for efforts to improve social accountability practices and outcomes.MethodsThis cross-sectional online questionnaire-based survey used Google Forms and involved medical students in their fourth and fifth years of study at the Makerere University School of Medicine. The survey was conducted between September 2022 and October 2023. We used a study questionnaire and a validated toolkit designed by students as part of The Training for Health Equity Collaborative to gauge a school’s progress towards social accountability in medical schools to collect data on demographics, perceptions and experiences and evaluate social accountability.ResultsOut of 555 eligible medical students, 426 responded to the online questionnaire. The response rate was 77%. The mean age of the students was 25.24 ± 4.4 years. Almost three fourths of the students were male (71.3%), and slightly less than two thirds were in their fourth year of study (65%). Almost half of the students (48.1%%) evaluated the school as doing well with regard to social accountability. The evaluation items referring to community-based research and positive impact on the community had the highest mean scores. Only 6 (3.6%) students who reported hearing of social accountability had a clear understanding of social accountability. Students receiving career guidance in secondary school was associated with evaluating social accountability in the medical school as strong (p-0.003).ConclusionsMedical students evaluated the medical school favorably forsocial accountability despite lacking a clear understanding of social accountability. Receiving career guidance in secondary school was significantly associated with a positive evaluation of social accountability.

Culinary Medicine Experiences for Medical Students and Residents in the U.S. and Canada: A Scoping Review

Phenomenon Despite the importance of diet in the prevention and management of many common chronic diseases, nutrition training in medicine is largely inadequate in medical school and residency. The emerging field of culinary medicine offers an experiential nutrition learning approach with the potential to address the need for improved nutrition training of physicians. Exploring this innovative nutrition training strategy, this scoping review describes the nature of culinary medicine experiences for medical students and resident physicians, their impact on the medical trainees, and barriers and facilitators to their implementation. Approach This scoping review used the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist as guides. Eligible publications described the nature, impact, facilitators, and/or barriers of nutrition and food preparation learning experiences for medical students and/or residents. Additional inclusion criteria were location (U.S. or Canada), allopathic or osteopathic, English, human subjects, and publication year (2002 or later). The search strategy included 4 electronic databases. Two reviewers independently screened titles/abstracts and a third reviewer resolved discrepancies. The full-text review consisted of 2 independent reviews with discrepancies resolved by a third reviewer or by consensus if needed, and the research team extracted data from the included articles based on the nature, impact, barriers, and facilitators of culinary medicine experiences for medical trainees. Findings The publication search resulted in 100 publications describing 116 experiences from 70 institutions. Thirty-seven publications described pilot experiences. Elective/extracurricular and medical student experiences were more common than required and resident experiences, respectively. Experiences varied in logistics, instruction, and curricula. Common themes of tailored culinary medicine experiences included community engagement/service-based learning, interprofessional education, attention to social determinants of health, trainee well-being, and cultural considerations. Program evaluations commonly reported the outcome of experiences on participant attitudes, knowledge, skills, confidence, and behaviors. Frequent barriers to implementation included time, faculty, cost/funding, kitchen space, and institutional support while common facilitators of experiences included funding/donations, collaboratives and partnerships, teaching kitchen access, faculty and institutional support, and trainee advocacy. Insights Culinary medicine is an innovative approach to address the need and increased demand for improved nutrition training in medicine. The findings from this review can guide medical education stakeholders interested in developing or modifying culinary medicine experiences. Despite barriers to implementation, culinary medicine experiences can be offered in a variety of ways during undergraduate and graduate medical education and can be creatively designed to fulfill some accreditation standards.

Preparing future general practitioners: the effects of individual, familial, and institutional characteristics

BackgroundThere is a substantially increasing need for general practitioners (GPs) for future unpredictable pandemic crises, especially at the community-based health services (CBHS) level to protect the vast and varied grassroot-level population in China. Thus, it is crucial to understand the factors that affect Chinese medical students’ GP career choices and commitments to CBHS.MethodsLeveraging the self-administered data collected across the country, this study conducted logistic regressions with 3,438 medical students. First, descriptive statistics of outcome variables and independent variables were provided. Then, stepwise logistic regression models were built, starting from adding individual characteristics, and then familial and institutional characteristics. Last, post-estimation was conducted to further assess whether there were significant marginal effects.ResultsResults showed that women students were 24% less likely to choose GP careers but were 1.25 times more likely to commit to CBHS than their men peers, holding other individual, familial, and institutional characteristics constant. In addition, students who major in GP-orientated were more likely to choose GP careers and commit to CBHS, respectively, than those who major in clinical medicine. Furthermore, familial characteristics like annual income and mother’s educational level only significantly predicted commitments to CBHS. Notably, sex-related differences in GP career choices and commitments to CBHS – by different regions – were observed.ConclusionsUnderstanding the factors that affect medical students’ GP career choices sheds light on how medical education stakeholders can make informed decisions on attracting more medical students to GP-orientated majors, which in turn cultivates more GP professionals to meet the nation’s demand for GPs. In addition, by understanding the factors that influence medical students’ commitment to CBHS, policymakers could make beneficial policies to increase medical students’ motivations to the grassroot-level health institutions, and devote to CBHS as gatekeepers for a large population of residents’ health.

What is the role of global health and sustainable development in Swedish medical education? A qualitative study of key stakeholders’ perspectives

BackgroundGlobal health and sustainable development have increasingly been recognised as important parts of medical education, yet education on these issues remains fragmented and scarce. In 2020, a bill to reform the national medical curricula across all Swedish medical schools was introduced, including a greater emphasis on global health and sustainable development. This study aimed to explore the perspectives of key stakeholders in medical education on the role of global health and sustainable development in Swedish medical education.MethodsThis was a qualitative study based on semi-structured interviews with 11 key stakeholders in medical education, broadly defined as faculty board members (dean and/or vice-deans for medical education) and/or programme chairs representing six universities. Data were analysed using qualitative content analyis (QCA). The study was conducted according to the Consolidated Criteria for Reporting Qualitative research (COREQ) guidelines.ResultsStakeholders discussed the challenges and opportunities associated with the modification of medical education, which was seen as necessary modernisation to fit the changing societal perception of the role of medical doctors. The anchoring process of redesigning the curriculum and integrating global health and sustainable development was discussed, with emphasis on ownership and mandate and the role of teachers and students in the process. Finding a shared understanding of global health and sustainable development was perceived as a challenge, associated with resistance due to fear of curriculum overload. To overcome this, integrating global health and sustainable development with other topics and developing existing components of the curricula were seen as important. Additionally, it was stressed that fostering capacity building and developing infrastructure, including utilization of digital tools and collaborations, were essential to ensure successful implementation.ConclusionsMedical institutions should prepare future doctors to respond to the needs of a globalised world, which include knowledge of global health and sustainable development. However, conceptual uncertainties and questions about ownership remain among key stakeholders in medical education. Yet, key stakeholders also highlight that the inclusion of global health and sustainable development in the new curricula represents multiple overarching educational opportunities that can bring about necessary improvement.

Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners.

Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality. This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students. Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software. Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints. Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

Competency-based medical education in the United States: What the otolaryngologist needs to know.

Competency-based medical education (CBME) is an outcomes-focused approach to educating medical professionals that will be central to future efforts to improve resident training in otolaryngology. The transition to CBME for otolaryngology in the United States will require the development of specialty-specific assessments and benchmarks, the financial and administrative support for implementation, the professional development of faculty and learners, and the cooperation of all major stakeholders in graduate medical education. In this article, we describe the need for evidence-based innovation in surgical training, the history of CBME in the United States, and the progress towards defining "entrustable professional activities" as the building blocks of assessments for CBME. We explore what such a paradigm shift in surgical education could mean for academic otolaryngologists by examining innovative educational practices in other surgical specialties and discussing foreseeable challenges in implementation for the American healthcare system.

Feasibility of Including Hands-On Microteaching in the Medical Faculty Development Program in India: A Mixed-Methods Study.

Background Medical faculty development programs (FDPs) often lack hands-on training in teaching skills. Microteaching, a short, focused teaching practice, could be a feasible way to bridge this gap. This study aimed to explore the feasibility of including hands-on microteaching in a medical FDP in India. Methodology This mixed-methods study involved fresh medical faculty members who never attended FDP on the basics of medical education technologies, stakeholders, and students from a recently established autonomous medical institute of national importance in India. Participants completed a pre-test survey on their teaching skills and received a hands-on microteaching session during an FDP. After the session, participants completed a post-test survey and provided feedback on the feasibility and acceptability of hands-on microteaching in the program. Program evaluation was done by application of Kirkpatrick's Model levels one, two, and three. Results According to the Kirkpatrick Model of Evaluation level one (Reaction), the participants reported improved teaching skills and greater confidence in their ability to teach after the microteaching session. They also reported that hands-on microteaching was an effective way to learn teaching skills and receive feedback. Stakeholders opined that microteaching is a very effective tool for improving teaching skills and should be a part of FDP. Evaluation at level two (Learning) shows that there was a significant improvement in the mean score of post-tests. As per level three (Behaviour Change) evaluation, the majority of the students informed that there is observable improvement in the effectiveness of teaching of faculties in the past two months, i.e., since the participation of faculty in hands-on microteaching in FDP. Conclusions Hands-on microteaching could be a feasible and effective way to enhance the teaching skills of medical faculty members in India. The study findings suggest that including hands-on microteaching in FDPs could help bridge the gap between theoretical knowledge and practical teaching skills.

Prediction of medical sciences students’ performance on high-stakes examinations using machine learning models: a protocol for a systematic review

IntroductionPredicting medical science students’ performance on high-stakes examinations has received considerable attention. Machine learning (ML) models are well-known approaches to enhance the accuracy of determining the students’ performance. Accordingly, we...

Impact of family rejection and racism on sexual and gender minority stress among LGBTQ young people of color during COVID-19.

Given the inequitable impact of COVID-19 on sexual and gender minority (SGM) youth and current sociopolitical racial justice concerns in the United States, this study examines the impact of SGM-related family rejection and racism since the start of COVID-19 on SGM-related internalized homophobia and identity concealment among SGM college students of color (SOC). Participants were a subset of SOC (n = 200) from a larger nonprobability cross-sectional study about minority stress and COVID-19 pandemic experiences among SGM college students. Participants completed survey items specifically related to changes in minority stress and racism experiences since the start of COVID-19. Logistic regression models were used to examine the independent and interactive effects of racism and family rejection on identity concealment and internalized homophobia since the start of COVID-19 (adjusting for covariates). Main effects models revealed that increased racism and family rejection were significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. The interaction of increased racism and family rejection was also significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. Study findings suggest that the intersection of racism and family rejection since the start of COVID-19 consequently translates to increased experiences of identity concealment. Such experiences are known to negatively impact mental health across the life course among SGM young people. Public health, medical, mental health, and higher education stakeholders must implement SGM-affirmative and antiracist practices and interventions to support SGM SOC during COVID-19 and beyond its containment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Clinical Teaching Fellow role: views of the Heads of Academy in the West Midlands

BackgroundIncreasingly junior doctors are taking a year out of the traditional training pathway, and some opt to spend a year in a clinical teaching fellow (CTF) post. The CTF post mainly involves delivering hospital-based teaching to undergraduate medical students. In NHS hospital Trusts in the West Midlands, Heads of Academy (HoAs) have oversight of medical education at each Trust and therefore have responsibility for employing and directing the work of CTFs. Currently, only limited literature exists about the CTF role and exploring this from the point of view of different stakeholders in medical education is important in terms of contributing towards development of the role. This study aimed to explore the views of HoAs in the West Midlands region regarding CTFs employed at their Trusts.MethodsAll HoAs at the NHS Trust/teaching hospitals associated with the University of Birmingham were invited to take part in an in-depth interview about CTFs at their Trusts. Interviews were held via Zoom recorded using Zoom’s recording functionality. Interview transcripts were then coded and analysed using thematic analysis.ResultsSeven out of 11 HoAs participated in an interview. Seven themes were identified: CTF duties/Job role, Relationship with students, Benefits of having CTFs, Challenges associated with CTFs, Popularity of the role, What Trust offers CTFs, and Future of the role. Primarily it was felt that having CTFs at their Trust was beneficial in terms of the amount of teaching they provide for medical students. The HoAs were keen to ensure the CTF posts were of maximum benefit to both the post holders and to the Trusts where they were based. The CTF role is one that they felt would continue and develop in the future.ConclusionThis study has provided the first insight into the CTF role from the point of view of senior doctors with responsibility for delivery of undergraduate medical education. The consistency and reliability of teaching provided by the CTFs was identified as a key benefit of the role. Future work exploring the role from the point of view of post holders themselves would be beneficial to contribute to development of the role.

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

In the United States, disparities in health outcomes are driven by various population- and area-based factors, including social drivers of health and geographic access to care.1,2 The health care system may contribute to reducing these disparities by ensuring access to cost-effective care that is satisfactory to patients and health care professionals.3,4 Progress in reaching this goal is limited by the scarcity of physician services in many rural and urban areas, with hospital closures and physician retirements putting additional pressure on strained resources.5-8 Graduate medical education (GME) is a major contributor to the professional formation of physicians, and the literature has shown that physicians' selection of practice locations is strongly influenced by the GME programs they complete.9,10Consistent with its mission to improve health care and population health by assessing and enhancing the quality of resident and fellow physicians' education through advancements in accreditation and education,11 the Accreditation Council for Graduate Medical Education's (ACGME's) accreditation model is responsive to societal needs. Recent circumstances have underlined the need for the ACGME to clarify its role in facilitating sponsoring institutions' and residency and fellowship programs' preparation of physicians to address the needs of medically underserved areas and populations (MUA/Ps). While the number of first-year US residency positions is increasing, this growth has not kept pace with the increasing number of eligible applicants for these positions.12 Health system leaders, policymakers, and the public increasingly view GME as an important component of educational pathways that advance diversity, equity, and inclusion in the medical profession and health care. The successful transition to a single accreditation system for GME in the United States has provided new opportunities to collaborate with allopathic and osteopathic medical educators in efforts to advance the ACGME mission.13In this context, the ACGME Board of Directors requested in 2018 that the ACGME convene a work group to study GME and MUA/Ps and to make recommendations for the organization.The MUA/P and GME work group included ACGME staff and Board of Directors members as well as external representation from the GME community, public, and resident members. The group met in May, June, and July 2018 to hear presentations from experts on GME financing and accreditation in rural and urban underserved areas. The work group discussed initial considerations for GME and MUA/P before traveling to Washington, DC; Jackson, Mississippi; New York, New York; Tulsa, Oklahoma; and Portland, Oregon, for regional visits from August to November 2018.During these visits, work group members interviewed 124 GME stakeholders to discuss local contexts for health care and GME, the current need for resident and fellow education in MUA/Ps, challenges to building educational and health system capacity, and opportunities for the ACGME to join sponsoring institutions, programs, and others in efforts to address those challenges. Participants in the visits included residents, fellows, program directors, faculty members, designated institutional officials (DIOs), health system and education leaders, medical students, interprofessional health care team members, legislators, health services researchers, policymakers, and representatives of organizations with an interest in GME and MUA/Ps.Following these discussions, the work group held additional meetings to develop and finalize an accreditation framework with recommendations to enhance physician workforce development in communities that face substantial shortages of practicing physicians in various medical specialties and subspecialties.The accreditation framework for MUA/Ps and GME aims to encourage the development of GME that results in greater access to and availability of health care in MUA/Ps. The framework is divided into 4 sections outlining initial actions to (1) enhance ACGME support; (2) engage with ACGME review processes; (3) understand ACGME compliance challenges; and (4) facilitate effective institutional oversight and administration (Figure).The work group recommended the creation of a programmatic unit with dedicated ACGME staff to organize and support the implementation of the accreditation framework. The framework calls for the formation of a permanent advisory body for work on GME in MUA/Ps. To facilitate learning about GME and MUA/Ps, the work group proposed that the ACGME should enhance relevant systems, data collection practices, and educational activities.The work group identified collaborative efforts to include specialty review committees, the Institutional Review Committee, and ACGME staff members as critical to facilitating the development of GME that enhances health care in underserved communities. In recognition of the ongoing work to address physician shortages through law and policy, the framework recommends that the ACGME attempt to align its requirements, policies, and procedures with those of governmental agencies and other organizations where possible. The work group recommended that the ACGME take steps toward monitoring, evaluating, and sharing national and regional progress in GME development.The work group's conversations with stakeholders revealed a number of organizational, common, and specialty-specific barriers to creating and maintaining ACGME-accredited sponsoring institutions and programs. The framework recommends that the ACGME should promote dialogue and learning that results in a better understanding of compliance challenges in areas such as program director and faculty appointments and retention, curriculum, educational experiences, participating sites, and supervision.The work group's visits across the United States offered an opportunity to study multiple successful institutional models for overseeing and supporting GME. The framework encourages the ACGME to promote the sharing of knowledge concerning institutional GME structures, processes, and outcomes among DIOs, program directors, institutional and program coordinators, and others. The framework calls upon the ACGME to streamline accreditation application processes and remove administrative barriers to support GME development in MUA/Ps.In May 2019, the ACGME Board of Directors approved the accreditation framework for MUA/Ps and GME. The ACGME programmatic unit for MUA/P and GME was established with the arrival of its first director, Laney McDougal, in spring 2020. Appointed in the ACGME departments of Accreditation, Recognition, and Field Activities as well as Sponsoring Institutions and Clinical Learning Environments, the director collaborates with ACGME staff, review committees, and the ACGME Council of Review Committee Chairs to implement the framework.The ACGME's Rural Track Program (RTP) designation process14 was the first project completed under the framework. This process, which is designed to be consistent with the rules and regulations of the Centers for Medicare & Medicaid Services, defines a structure for educating residents and fellows in rural areas for more than 50% of the duration of their ACGME-accredited programs. As of January 2023, 13 ACGME-accredited programs have obtained designation as RTPs, and reports identifying RTPs are now available on the public website of the ACGME Accreditation Data System.15 The MUA/P and GME team is building on these changes and providing leadership on how to improve GME location data to accurately and reliably measure the presence of GME in rural and underserved areas and populations (rural data enhancement project), in alignment with Section I of the framework.The ACGME appointed an advisory group for MUA/Ps and GME, which held its first meeting from December 1 to 2, 2022. The charge of the advisory group has 3 components:The advisory group has begun to fulfill its charge by making initial suggestions to the ACGME for learning and collaboration that will be pursued at future meetings.The early implementation of the accreditation framework for MUA/Ps and GME has opened new lines of communication among GME stakeholders and new opportunities for the ACGME to learn with the GME community, organizational and governmental partners, and the public. The ACGME will continue building its stakeholder engagement through conferences, data project focus groups, and community-building.At the 2023 ACGME Annual Educational Conference, the MUA/P and GME team held a panel session featuring members of the MUA/P Advisory Group and Dr. Randy Longenecker of the Rural Training Track Collaborative. In this session, panelists discussed relevant topics, such as challenges related to training in rural and underserved settings; retention of graduates to practice in areas of need; recruitment of those underrepresented in medicine; developing relationships with the Indian Health Service, Tribal, and Urban Indian (I/T/U) communities; and available funding and resources for developing programs in MUA/Ps. The Annual Educational Conference provided additional opportunities for engagement in MUA/P through a first-ever MUA/P interest group facilitated by the panelists, as well as a focus group for program directors, DIOS, and institutional coordinators to provide input into the rural data enhancement project.The MUA/P and GME team will take the information learned from the Annual Educational Conference and project focus groups into consideration and discussion with the MUA/P Advisory Group for development of the rural data enhancement project as well as developing opportunities for community-building and educational programming. Additional updates and opportunities for engagement will be discussed at the National Learning Community of Sponsoring Institutions meeting in fall 2023. The MUA/P and GME team will continue to support new RTPs and other program development in areas of high need.16The ACGME would like to thank the members of the 2018-2019 work group and the graduate medical education stakeholders they interviewed for their contributions to the development of the MUA/Ps and GME framework. A full listing of individuals is provided as online supplementary data.

Will ChatGPT Match to Your Program?

ChatGPT and other artificial intelligence word prediction large database models are now readily available to the public. Program directors should be aware of the general features of this technology and consider its effect in graduate medical education, including the preparation of materials such as personal statements. The authors provide a sample ChatGPT-generated personal statement and general considerations for program directors and other graduate medical education stakeholders. The authors advocate that programs and applicants will be best served by transparent expectations about how/if programs will accept application materials created using artificial intelligence, starting with this application cycle. Graduate medical education will have many additional factors to consider for the innovative use and safeguards for the ethical application of artificial intelligence in clinical care and educational processes. However, the exponential increase in the application of this technology requires an urgent review for appropriate management of program procedures, iteration of policies, and a meaningful national discussion.

41. Defining Predictors of Academic Productivity in Plastic Surgery Residency: A Bibliometric Analysis of Research Experiences Throughout Training

Background: It is likely that the importance of research experience in plastic and reconstructive surgery residency candidates will increase as the Step 1 exam and medical school rotations transition to pass/fail scoring. Institutional characteristics in undergraduate and graduate medical education that may influence academic productivity have not been collectively explored prior to this study. This study aims to assess predictors of academic productivity in residency, including medical school academic productivity, graduate institutional characteristics, and career intentions. Methods: This study utilizes a retrospective correlational study design to examine associations between academic history and research productivity during residency for chief residents of 2019 and 2020 of integrated programs. Background characteristics such as the following were collected for each resident: dedicated research time during medical school and residency, gap year after medical school, completion of other degrees, completion of fellowship, and academia versus private practice. Variables such as the following were collected to measure productivity: number of publications during medical school, number of publications during residency, and h-index. Descriptive statistics and linear regressions were generated to assess associations between medical school-related variables and residency-related variables with measures of academic productivity. Results: Overall, there were 221 graduates included, 95 (43.0%) of which were class of 2019 and 126 (57.0%) of which were class of 2020. The number of publications while in medical school and h-index calculated at the end of residency was positively associated with dedicated research time in medical school (coefficient=0.74, p=0.000; coefficient=2.96, p=0.002). For h-index calculated at the end of residency, having dedicated medical school research time was positively related and statistically significant (coefficient=2.96, p=0.002). Conclusion: The findings demonstrate that dedicated research time during medical school was an independent predictor of the number of publications and h-index by the end of residency, markers of quality and quantity of academic productivity. The study demonstrates that dedicated research time included in mandatory curricula shows impact, while optional research time, such as during gap years, does not. The findings have important implications for stakeholders in graduate medical education, including those considering taking extra research years and those looking to recruit candidates with academic potential.

Anti-oppressive pedagogy in medical education: A qualitative study of trainees and faculty.

Despite the proliferation of interest in health equity and justice in medical education, there is limited research into the practical implementation of pedagogical approaches that align with anti-oppressive practices. This study sought to explore how to integrate anti-oppressive pedagogy into medical education. Using constructivist grounded theory, the authors conducted 19 semi-structured interviews with a continuum of medical education stakeholders including learners and faculty in a Canadian context between June and August 2021. Transcripts were iteratively analysed using constant comparative analysis. Findings suggest that existing approaches to anti-oppressive pedagogy in medical education are misaligned with the perceived values, priorities, pace, biomedical focus and hierarchical nature of medical education, and medical practice. Although some learners are motivated to advance anti-oppressive teaching, their motivations are often related to their personal experiences of oppression. Participants suggested that transformative and structural changes are required to effectively integrate anti-oppressive pedagogy into medical education. Suggestions included a shift to community-based learning while ensuring adequate compensation for educators and addressing resistance at individual and institutional levels. Anti-oppressive pedagogy does not presently align with existing medical education practices. Effectively integrating anti-oppressive approaches will require individual and institutional reflection on the values and assumptions that underpin the field before progress can be made in a meaningful and sustainable way.

Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education.

Several “calls to action” have imposed upon medical schools to include physical activity content in their overextended curricula. These efforts have often neither considered medical education stakeholders’ views nor the full complexity of medical education, such as competency-based learning and educational inflation. With this external pressure for change, few medical schools have implemented physical activity curricula. Moreover, Canada’s new 24-Hour Movement Guidelines focus on the continuum of movement behaviours (physical activity, sedentary behaviour, and sleep). Thus, a more integrated process to overcome the “black ice” of targeting all movement behaviours, medical education stakeholder engagement, and the overextended curriculum is needed. We argue for co-production in curriculum change and offer five strategies to integrate movement behaviour curricula that acknowledge the complexity of the medical education context, helping to overcome our “black ice.” Our objectives were to investigate 24-Hour Movement Guideline content in the medical curriculum and develop an integrated process for competency-based curriculum renewal. Stakeholders were equal collaborators in a two-phased environmental scan of 24-Hour Movement Guideline content in the Queen’s University School of Medicine. Findings and a working curriculum map highlight how new, competency-based content may be embedded in an effort to guide more relevant and feasible curriculum changes.

Family Rejection during COVID-19: Effects on Sexual and Gender Minority Stress and Mental Health among LGBTQ University Students

This study examines the relationship between family rejection and moderate to severe psychological distress during COVID-19 among LGBTQ university students. Data were obtained from a national cross-sectional electronic survey of LGBTQ university students (N = 565) collected in the summer of 2020. Hierarchical logistic regression models were used to examine the predictive association between increased family rejection and moderate to severe psychological distress. Respondents who reported increased rejection were more than twice as likely to report moderate to severe psychological distress, with social isolation and LGBTQ identity concealment being significant covariate predictors in the model. These results demonstrate the importance of public health, medical, mental health, and higher education stakeholders understanding the significance of LGBTQ-identity related family rejection when addressing the mental health and well-being of LGBTQ young people.

“Design and implementation challenges of massive open online course on research methods for Indian medical postgraduates and teachers –descriptive analysis of inaugural cycle”

BackgroundIn view of the growing popularity, reach and access for Massive Open Online Courses (MOOCs), India’s apex body for medical education, the National Medical Commission (NMC) mandated uniform foundational course on research methods for the medical post graduates (PGs) and faculty members of the medical institutions under NMC as MOOC. This course is a pioneering effort in the field of India’s PG medical education. NMC entrusted Indian Council of Medical Research (ICMR)-National Institute of Epidemiology (NIE) to design and offer the MOOC, named as Basic Course in Biomedical Research (BCBR). We describe the experience of designing and that of implementation challenges in the inaugural cycle of the course.MethodsThe course objective was to inculcate the fundamental concepts in research methods covering epidemiology and biostatistics in the form of video lectures, resource materials, discussion forum, assignments, feedback and a final proctored examination. The course was delivered over 16 weeks through MOOCs platform under the Indian Ministry of Education. We reviewed records, documents and faculty notes and described the course conceptualization, development, design and implementation process. We abstracted information from course portal on enrolment profile of the participants, self-reported course feedback (structured and open-ended on format, lectures and quality of contents), examination registration form, scores obtained in the assignments/examination and that of the participant queries. We described quantitative data using descriptive statistics. We presented the thematic analysis of qualitative data from open-ended questions in the feedback system and that of email interactions.ResultsThe inaugural cycle (September-December 2019) was taken by 24,385 participants. Majority, 15,879 (65%) were from medical background. 13,242 (54%) were medical postgraduates and 2637 (11%) were medical teachers. Among the enrolled, 14,720 (60%) cleared the assignments. A total of 11,392 (47%), 8,205 (62%) medical PGs and 896 (34%) faculty members successfully completed the course. Feedback from 1305 (5%) participants had mean score of 4.5/5 (±0.7) for quality of teaching. We faced challenges in customizing the course for medical participants, unawareness among target group, digital illiteracy and the ongoing pandemic.ConclusionsDuring the inaugural cycle of the online Basic Course in Biomedical Research course, nearly half of the enrolled participants successfully completed and received the certificate. India’s MOOC for enhancing research capabilities of future medical researchers encountered successes and challenges. Lessons learnt from the inaugural cycle will guide future directions and to address larger issues in terms of sustainability and replication by stakeholders in medical education in India or elsewhere.

Patients' perspectives on medical students' professionalism: Blind spots and opportunities.

Research has acknowledged the value of patients as essential stakeholders in medical education, yet educators have not adequately incorporated patients' perspectives into medical students' developing professionalism. Our purpose was to explore patients' perceptions of professional behaviour in medical students as a first step to considering patients' potential roles in assessing professionalism. Building on the existing framework of the 'disavowed curriculum', we used a constructivist grounded theory approach to interview and analyse data from 19 patients (11 W, 8 M) at one urban hospital. Each participant watched five video scenarios that depict professionally challenging situations commonly faced by medical students, after which they were asked to put themselves in the position of both the patient and the student depicted in each scenario, and to discuss what they felt would be appropriate or inappropriate behaviours from each perspective. Patients' responses replicated all elements of the disavowed curriculum, including principles of professionalism, the student's affect or internal factors, and potential implications of actions. Their responses reflected avowed, unavowed and disavowed rationales. Participants also identified novel principles, including hide dissension in the ranks, respect privacy, advocate for yourself and have trust in the system. Patients conveyed an understanding of the multiple competing factors students must balance (e.g., providing optimal care while maximising educational opportunities) and appeared to empathise with some of the pressures students face. Our findings point to significant blind spots in previous research based on faculty and student perspectives of professionalism. Knowing what patients perceive as important will allow educational and assessment efforts to be refined to reflect their values. Our work begins the process of understanding how best to include patients in the assessment of medical learners.

Cultivating self-directed learning skills in the budding doctors: An attempt to transform an ‘Indian medical graduate’ into a ‘lifelong learner’

Medical Education is a dynamic professional entity and the practice trends for the physicians evolve rapidly to reflect advancement in the scientific technology and also, to keep pace with the health care needs of the society. Cultivating self-regulated lifelong learning skills and attitude in the medical graduates is now included as one of the competencies by Medical Council of India. Self-directed Learning (SDL) is a dynamic learning journey in which the onus of learning lies with the student and teacher is the facilitator of learning. This learning experience can be enhanced with the appropriate utilization of Information and computer technology. For effective implementation, the faculty and the students must be sensitized and trained on various modules, strategies, virtue, time and stress management techniques for SDL session. Concurrently, a large body of available literature believes that the self-directed learning is more enjoyable and at the same time, as effective as the traditional methods of education. The key component of this active learning is self-monitoring, self-assessment and reflective writing by the students. The tendency to master SDL skills is an integral link between under graduate and post graduate training and hence, is essential for enhancing professional development. The medical education stake-holders are facing numerous challenges in implementation of SDL sessions and they are still struggling to bring about flawless transitions in the medical education from one phase to another. Nevertheless, this novel learning approach would create more refined physicians who are capable of handling the rapid transformations in the medical policies.

LGBTQ+ Equity in Virtual Residency Recruitment: Innovations and Recommendations.

Medical students identifying as lesbian, gay, bisexual, transgender, queer/questioning, and other sexual/gender minorities (LGBTQ+) face unique challenges and discrimination during medical training and when applying to medical residency.1–6 The current evidence base is full of examples, and through fear of possible discrimination, medical students and physicians who identify as LGBTQ+ may choose to conceal their identities.2,4,6 Research suggests that LGBTQ-identified medical students are more likely to experience and report mistreatment, and more likely than straight-identified peers to experience burnout.3,5 A recent small study reported that over 50% of surveyed trans and/or nonbinary residents felt unsafe sharing their gender identities during residency interviews, and over 40% were misgendered during the interview process.4 As has been well described, the 2020–2021 residency interview season in the United States was conducted virtually due to the COVID-19 pandemic.7 This article will explore how the recent US virtual residency interview season may have both mitigated and exacerbated challenges and discriminatory practices facing LGBTQ+ trainees, and will propose best practices for recruiting these trainees.Virtual interviews might enable increased equity for LGBTQ+ applicants with regard to minoritized sexual orientation and gender identity. As applicants in the 2020–2021 virtual residency match season in a variety of specialties (internal medicine, internal medicine–pediatrics, pediatrics, radiology, and child neurology), the authors observed that, during this season, many programs incorporated virtual social events that focused on diversity and inclusivity. Many of these events or initiatives included specific sessions for LGBTQ+ identified applicants.8,9 Through personal experiences of researching programs, interviewing virtually, and participating in social media such as #MedTwitter, the authors observed that, in addition to social hours, certain programs offered to connect LGBTQ+ applicants with residents via email or video call. This intervention created additional space to ask specific questions about the work atmosphere and program culture with less perceived risk of feeling judged or discriminated against. As the ability to identify LGBTQ+ mentors and allies has been shown to positively impact the personal and professional experience of LGBTQ+ medical trainees,1 this intervention has substantial potential to recruit and support LGBTQ+ residents.10 With these innovations, programs can connect LGBTQ+ applicants with LGBTQ+ faculty and residents who share professional interests, allowing further rapport and improved comfort level potentially greater than that formed during traditional methods of interviewing.Virtual interviews offer additional ways for both applicants and programs to signal their identities as, or in solidarity with, LGBTQ+ applicants. In the authors' experience, some programs encouraged medical students to publicly designate their pronouns (he/she/they/etc) along with their names on Zoom (Zoom.us, San Jose, CA) or other platforms, allowing applicants to be properly gendered throughout the interview day. One author interviewed at a program which sent a survey out before the interview day that requested information, such as gender identity, pronouns, and preferred name, in order to better accommodate interviewees and connect them to residents and faculty with shared identities. This is especially important as the Electronic Residency Application Service (ERAS) does not offer comprehensive identity designations, such as nonbinary, within the application portal. Program initiatives such as these offer a novel method of connecting LGBTQ+ applicants and creating a stronger community.While virtual interviews allowed programs to demonstrate their commitment to LGBTQ+ trainees, it is possible that virtual interactions prevented candidates from gaining a holistic understanding of program culture. For some LGBTQ+ applicants, the virtual interview process affected their ability to gauge the authenticity of programs' claims around diversity and equity. For example, in programs that did not offer dedicated, structured sessions for LGBTQ+ applicants, it is the authors' experience that it could be challenging to disclose personal identifying information (such as gender identity or sexual orientation) in order to ask important questions about the work environment. While residency programs can (and often do) share their commitment to diversity with applicants, without seeing concrete examples or participating in one-on-one conversations, it can be challenging for LGBTQ+ applicants to understand how they might actually feel in the learning environment. The main goal of the interview day is to provide the applicant with an in-depth understanding of the program; it is crucial for programs to intentionally present and discuss their work environment. The lack of in-person interactions may have affected LGBTQ+ applicants' abilities to feel certain about which programs offered an affirming, non-discriminatory work environment.Another challenge for LGBTQ+ applicants may have been the inability to visit residency programs in person due to travel restrictions related to the COVID-19 pandemic. Without the opportunity to visit in person, it may have been harder to confirm whether a program offered a vibrant LGBTQ+ community. Desired geographic location is one of the most frequently cited considerations among US allopathic senior medical students when applying to (88%) and ranking (77%) programs.11 While geographic considerations are multifactorial for all applicants, this inability to visit new geographic locations in person may have disproportionately affected applicants with (often intersectional) marginalized identities.Best practices for enhancing equity in the residency interview and Match process for LGBTQ+ applicants are essential to trainees' well-being and their ability to find a good fit for residency. To improve equity for LGBTQ+ residency applicants, we suggest 4 improvements for future recruitment, whether virtual, in-person, or a hybrid of both: (1) provide opportunities for applicants to self-identify their gender identity, pronouns, name, and sexual orientation prior to interviewing (ie, leave a space for manual input, rather than offering a drop-down list, or create a drop-down list that has been recently peer reviewed by LGBTQ-identified experts); (2) offer connections with LGBTQ+ residents, faculty, and other applicants via email or identity-focused social hours; (3) share a list of LGBTQ+ local organizations and LGBTQ-specific health training opportunities; and (4) provide training on supporting LGBTQ+ residents for all program administration involved in the interview process. Additionally, we strongly urge ERAS to include an optional section for applicants to include their gender identities, pronouns, and identification as LGBTQ+ at the time of application; this would reduce the work each individual program must do to collect data and connect applicants appropriately.Overall, there is still work to be done to improve the equity of LGBTQ+ applicants in the residency interview season. In the coming years, residency recruitment stakeholders must continue to assess each interview season, whether in-person or virtual, and implement changes that stand to benefit applicants of all identities. Graduate medical education stakeholders should elicit routine LGBTQ+ medical student, resident, and faculty input to identify mechanisms to improve residency candidate recruitment equity and eliminate systemic bias.