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Teaching and Learning in Medicine

Kyle John Wilby, Marjan Govaerts, Zubin Austin, Diana Dolmans
Construct: Authors examined the use of narrative comments for evaluation of student communications skills in a standardized, summative assessment (Objective Structured Clinical Examinations [OSCE]). BACKGROUND: The use of narrative evaluations in workplace settings is gaining credibility as an assessment tool, but it is unknown how assessors convey judgments using narratives in high-stakes standardized assessments. The aim of this study was to explore constructs (i.e., performance dimensions), as well as linguistic strategies that assessors use to distinguish between poor and good students when writing narrative assessment comments of communication skills during an OSCE...
February 13, 2019: Teaching and Learning in Medicine
Timothy Koschmann, Richard Frankel, Janet Albers
Phenomenon: In high-stakes evaluations of communicative competency, data-gathering skills are commonly assessed through the use of standardized patient encounters. This article seeks to document inquiry practices in 2 such encounters in a setting designed to emulate a consequential, clinical skills examination. Approach: Drawing on the methods and findings of Conversation Analysis, we examine selected fragments seeking to understand how, in the ways in which they are organized, they produce quite different outcomes...
February 3, 2019: Teaching and Learning in Medicine
Holly Wagoner, Barry Seltz
Phenomenon: Academic health centers face significant challenges trying to improve medical education while meeting patient care needs. In response to problems with traditional forms of didactic education, many residency programs have transitioned to Academic Half Day (AHD), a curricular model in which learning is condensed into half-day blocks. In this model, trainees have protected educational time free from clinical responsibilities. However, an understanding of the impact on attending physicians and patient care when residents depart clinical sites for learning activities has not been well described...
February 1, 2019: Teaching and Learning in Medicine
Jeffrey M Landreville, Warren J Cheung, Alexandra Hamelin, Jason R Frank
Phenomenon: The oral case presentation represents a unique method of communication and forms the foundation for trainee-supervisor interactions in the clinical setting. Recently, entrustment has been highlighted as an essential element of trainee-supervisor interactions. Despite the growing body of knowledge concerning entrustment in medical education, how supervisors conceptualize the oral case presentation as a contributor to entrustment decision making during clinical supervision remains unknown. Given their widespread use, oral case presentations may represent a potential tool for future frameworks of workplace-based assessment...
February 1, 2019: Teaching and Learning in Medicine
Katie A Greenzang, Anna C Revette, Jennifer C Kesselheim
Phenomenon: Learning to assume ownership of patient care is a critical objective of medical training. However, little is known about how ownership is best defined and measured or about its value to trainees. The authors aimed to define ownership and elucidate the significance of developing ownership skills over the course of pediatric residency training. Approach: Focus groups and phone interviews were held with pediatric residency program directors (N = 18) and pediatric residents (N = 14). Focus groups and interviews were audio-recorded, transcribed verbatim, and qualitatively analyzed using thematic analysis...
February 1, 2019: Teaching and Learning in Medicine
Jeremy Branzetti, Michael A Gisondi, Laura R Hopson, Linda Regan
ISSUE: Competency-Based Medical Education (CBME) focuses on demonstrable outcomes, as well as upholding medical education's accountability to society. Despite calls for a robust, multifaceted approach to competency-based assessment (CBA), lingering critiques exist. These critiques include reductionism, reinforcement of an external locus of control within learners, an loss of focus on learner development. Both CBME and CBA may be strengthened if viewed through the lens of a complementary curriculum design framework that broadens the focus on the learner...
January 27, 2019: Teaching and Learning in Medicine
Sarah H Michael, Steven Rougas, Xiao C Zhang, Brian Clyne
Construct: For curriculum development purposes, this study examined how the development of residents as educators is reflected in the Accreditation Council for Graduate Medical Education (ACGME) Milestones. BACKGROUND: Residents teach patients, families, medical students, physicians, and other health professionals during and beyond their training. Despite this expectation, it is unclear how the development of residents as educators is reflected in the specialty-specific Milestones. APPROACH: We performed a textual content analysis of 25 specialty Milestone documents available as downloads from the ACGME website in December 2015...
January 22, 2019: Teaching and Learning in Medicine
Tyler Callese, Roy Strowd, Benino Navarro, Ilene Rosenberg, Christine Waasdorp Hurtado, Joanna Tai, Janet M Riddle, Anna T Cianciolo
This Conversation Starter article uses four selected abstracts, one each from the four regional Association of American Medical Colleges (AAMC) Group on Educational Affairs (CGEA) 2018 spring meetings, as a springboard for unpacking the definition of peer-assisted learning (PAL). The aim of this article is to prompt deeper reflection on this phenomenon and, in so doing, to foster scholarly program evaluation of this widely adopted instructional approach. This analysis calls for a more nuanced definition of PAL, one that emphasizes process over structure, one that stimulates examination of "doing" PAL and how this affects the personal and professional development of all involved...
January 21, 2019: Teaching and Learning in Medicine
John Encandela, Nicole S Zelin, Michael Solotke, Michael L Schwartz
PROBLEM: Sexual and gender minority patients face well-documented health disparities. One strategy to help overcome disparities is preparing medical trainees to competently provide care for sexual and gender minority patients. The Association of American Medical Colleges has identified professional competencies that medical students should develop to meet sexual and gender minority health needs. However, challenges in the medical education environment may hinder the adoption and implementation of curricular interventions to foster these competencies...
January 19, 2019: Teaching and Learning in Medicine
Daniel G Lannin, Jeritt R Tucker, Lisa Streyffeler, Steven Harder, Bret Ripley, David L Vogel
THEORY: Despite high rates of psychiatric illnesses, medical students and medical professionals often avoid psychological help. Stigma may prevent medical students from seeking psychological help when experiencing distress, which may hinder their job performance and mental health. Compassionate values-preferred principles that guide attitudes and behaviors to focus on the wellness of others-may be a relevant predictor of medical students' perceptions of psychological help. The present study examined the association between medical students' compassionate values, help-seeking stigma, and help-seeking attitudes in a convenience sample of medical students...
January 7, 2019: Teaching and Learning in Medicine
Belinda Fu
ISSUE: The practice of medicine is intrinsically unpredictable. Clinicians must respond skillfully to this uncertainty; therefore, medical educators are using improvisational theater training methods to teach improvisational ability in areas such as communication and professionalism. This teaching approach is called "medical improv." Although early reports of medical improv suggest promise, the collective descriptions of curricular content lack consistency. This ambiguity creates impediments for further implementation and research of this new educational technique...
December 31, 2018: Teaching and Learning in Medicine
Andrew Perrella, Tal Milman, Shiphra Ginsburg, Sarah Wright
Phenomenon: Clerkship is a challenging transition during which medical students must learn to navigate the responsibilities of medical school and clinical medicine. We explored how clerks understand their roles as both medical learners and developing professionals and some of the tensionss that arise therein. Understanding how the clinical learning environment shapes the clerkship role can help educators foster compassionate care. Approach: We conducted 5 focus groups and 1 interview with 3rd-year medical students (n = 14) at University of Toronto between January and June 2016 regarding the perceived role of the clerk, compassionate care, assessment and feedback...
December 31, 2018: Teaching and Learning in Medicine
Aliya Kassam, Michèle Cowan, Maureen Topps
Phenomenon: Fatigue is a significant risk factor for deterioration in performance, which may lead to medical errors and reduced well-being in resident physicians (residents). Sleep deprivation, which has been studied extensively, is only one contributor to fatigue. Given the complexity of fatigue and its relationship with resident performance, the National Steering Committee on Resident Duty Hours in Canada recommends that all residency education programs develop a fatigue risk management plan (FRMP) for their residents...
December 31, 2018: Teaching and Learning in Medicine
Jennifer G Christner, Gary Beck Dallaghan, Greg Briscoe, Scott Graziano, Elza Mylona, Sarah Wood, David V Power
Phenomenon: Pairing medical students with community-based preceptors has provided unique medical education advantages. However, due to an increase in the number of M.D.-granting medical schools and medical school class sizes, academic medical institutions have struggled to recruit community preceptors to teach their students. This task has been made more difficult due to rising pressures upon institutions and clinicians-for example, increased productivity demands, greater volume and oversight of electronic health record documentation, and competition for community preceptors from both D...
December 31, 2018: Teaching and Learning in Medicine
David H Salzman, William C McGaghie, Timothy W Caprio, Kathryn K Hufmeyer, Nabil Issa, Elaine R Cohen, Diane B Wayne
PROBLEM: Thirteen measurable Entrustable Professional Activities (EPAs) have been proposed by the Association of American Medical Colleges as a means to operationalize medical school graduates' patient care qualifications. Mastery learning is an effective method for boosting clinical skills, but its applicability to the EPAs remains to be studied. The authors designed this study to evaluate a mastery learning intervention to teach and assess components of 3 of the 13 EPAs in a 4th-year capstone course...
December 31, 2018: Teaching and Learning in Medicine
Yang Shi, P Cristian Gugiu, Remle P Crowe, David P Way
Construct: Burnout is a psychological construct characterized by emotional exhaustion that arises from an excess of physical, emotional, and social demands over an extended period. Symptoms of burnout include withdrawal or disengagement from work. Burnout has become an important public health concern due to its association with severe negative consequences across numerous professions. BACKGROUND: The most widely used instrument for measuring burnout is the Maslach Burnout Inventory (MBI)...
December 21, 2018: Teaching and Learning in Medicine
Jody E Steinauer, Arianne Teherani, Felisa Preskill, Olle Ten Cate, Patricia O'Sullivan
Phenomenon: Medical students, like physicians, experience negative emotions such as frustration when interacting with some patients, and many of these interactions occur for the first time during clinical clerkships. Students receive preclinical training in the social and behavioral sciences, often including learning about "difficult patient" interactions, yet little is known about their desire for training during clinical education. We explored students' strategies in these difficult clinical interactions, whether they felt prepared by the curriculum, and what support they would have liked...
December 15, 2018: Teaching and Learning in Medicine
Brian Mavis, Steven J Durning, Sebastian Uijtdehaage
Phenomenon: With scholarly collaborations come questions about the order of authorship. Authorship order is an important consideration because it often used as an indicator of seniority, expertise, leadership, and scholarly productivity. As a result, authorship order factors into decisions about hiring, salary, resource allocation, and professional advancement. This study describes principles commonly applied to authorship order decisions within the medical education community and educators' opinions about the significance of authorship order...
December 15, 2018: Teaching and Learning in Medicine
Saskia Mol Sl, Chen H Carrie, Hm Steerneman Anke, Esther de Groot, L M Zwart Dorien
PROBLEM: Longitudinal patient contacts are being implemented worldwide as a way to enhance a patient-centered orientation among medical students. In large medical schools, longitudinal integrated clerkships may not be feasible, so other ways must be sought to expose students to prolonged contact with patients. INTERVENTION: Medical students were attached to a family practice and assigned a panel of 4 patients to follow over the 3 years of their clinical training...
December 15, 2018: Teaching and Learning in Medicine
Maria C Cusimano, Daniel K Ting, Jonathan L Kwong, Elaine Van Melle, Susan E MacDonald, Cheryl Cline
PROBLEM: Medical educators recognize that professionalism is difficult to teach to students in lecture-based or faculty-led settings. An underused but potentially valuable alternative is to enroll near-peers to teach professionalism. INTERVENTION: We describe a novel near-peer curriculum on professionalism developed at Queen's University School of Medicine. Senior medical students considered role models by their classmates were nominated to facilitate small-group seminars with junior students on topics in professionalism...
December 15, 2018: Teaching and Learning in Medicine
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