Interprofessional learning through shadowing: Insights and lessons learned

Background: Interprofessional education (IPE) aims to improve patient outcomes. Interprofessional shadowing improves students’ knowledge of different roles and attitudes toward other professionals.

Aim: This study evaluates (1) how pre-clinical medical students describe the roles of the healthcare professionals they shadowed, and (2) whether shadowing can be used to introduce medical students to the benefits of interprofessional collaboration, and if so, in what ways.

Methods: Second-year medical students shadow another discipline and write a reflection on the shadowed discipline (SD)’s role and collaboration in patient care. A non-proportional stratified random sample of these reflections was coded during an iterative process. Any number of the 13 possible codes could be assigned to each reflection. Codes relevant to the research questions underwent narrative analysis.

Results: The most frequent codes were “specific function of SD” (88%), “SD’s general purpose” (86%), and “value of SD’s role” (68%). One-third of reflections referenced “communication,” and one-third mentioned “teamwork.” Insights gained included an appreciation for interprofessional care and a global perspective on patient care, extending beyond the inpatient encounter.

Conclusion: Through shadowing, students achieve several IPE core competencies and a broader perspective on patient care. Shadowing is an effective pedagogical method for IPE in the pre-clerkship curriculum.     

Factors influencing the educational impact of Mini-CEX and DOPS: A qualitative synthesis

Introduction: The educational impact of Mini-CEX and DOPS varies greatly and can be influenced by several factors. However, there is no comprehensive analysis and synthesis of the described influencing factors.

Methods: To fill this gap, we chose a two-step approach. First, we performed a systematic literature review and selected articles describing influencing factors on the educational impact of Mini-CEX and DOPS. Second, we performed a qualitative synthesis of these factors.

Results: Twelve articles were included, which revealed a model consisting of four themes and nine subthemes as influencing factors. The theme context comprises “time for Mini-CEX/DOPS” and “usability of the tools”, and influences the users. The theme users comprises “supervisors’ knowledge about how to use Mini-CEX/DOPS”, “supervisors’ attitude to Mini-CEX/DOPS”, “trainees’ knowledge about Mini-CEX/DOPS”, and “trainees’ perception of Mini-CEX/DOPS”. These influence the implementation of Mini-CEX and DOPS, including “observation” and “feedback”. The theme implementation directly influences the theme outcome, which, in addition to the educational impact, encompasses “trainees’ appraisal of feedback”.

Conclusions: Our model of influencing factors might help to further improve the use of Mini-CEX and DOPS and serve as basis for future research.     

Reproductive Travel to Ghana: Testimonies,Transnational Relationships,and Stratified Reproduction

ABSTRACT

In this article, I address reproductive travel to Ghana, based on research conducted in two private fertility clinics. Both clinics attract clients from West African countries as well as Ghanaian people living in the US and Europe. Their motivations to visit these clinics include positive “testimonies” about treatment results, “bioavailability” of matching donor material and surrogates, lower treatment costs and the circumvention of restricting regulations in the country of residence. Communication technologies are central in facilitating reproductive travel. Finally, I argue that the “international choreographies” of reproductive travel are co-shaped by the unique biographies and transnational relationships of the people involved.     

Right to Health: A Buzzword in Health Policy in Indonesia

ABSTRACT

The “right to health” operates as a buzzword in Indonesia to frame health policies as beneficial to citizens. Right to health is equated with access to Western biomedical services. Within the policy on partnership between biomedical and traditional midwives, only the biomedical midwife can fulfill the right to health. The “traditional” midwife is reframed as her assistant. Right to health language hides underlying tensions in relationships between these two categories of midwives by presenting the policy as mutually beneficial. Right to health language is effective in the post-Suharto era as it aligns with other incontestable values, including democracy and modernity.     

Yields and Rabbit Holes: Medical Students’ Typologies of Sufficient Knowledge

ABSTRACT

Given the vastness of bioscientific knowledge and regular changes in evidence and protocol, how do individual clinicians make decisions about what to know and what to ignore? In this article I identify a process termed “sufficient knowledge:” the prioritizing of medical knowledge perceived as most important, while ignoring information that is not deemed essential or applicable. Drawing on 14 months of ethnographic fieldwork at an allopathic medical school in the American Midwest, I describe three typologies of sufficient knowledge that medical students devised to distinguish what to know and what to ignore or deemphasize: high yield knowledge, low yield knowledge and “rabbit holes.” I aim here to contribute to a growing topical and theoretical discussion of ignorance by social scientists, especially to generate a more balanced picture of physician training and practice beyond depictions of knowledge and expertise.     

Medical educators: How they define themselves – Results of an international web survey

Background: Little is known about medical educators’ self-definition.

Aims: The aim of this study is to survey an international community of medical educators focusing on the medical educators’ self-definition.

Methods: Within a comprehensive, web-based survey, an open question on the participants’ views of how they would define a “medical educator” was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.

Results: Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a “medical educator”. The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as “Professional Expert”, “Facilitator”, “Information Provider”, “Enthusiast”, “Faculty Developer”, “Mentor”, “Undergraduate and Postgraduate Trainer”, “Curriculum Developer”, “Assessor and Assessment Creator”, and “Researcher”.

Conclusions: Our survey revealed that medical educators predominantly define themselves as “Professional Experts” and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.     

Development of cognitive processing and judgments of knowledge in medical students: Analysis of progress test results

Background: Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students’ cognitive processing, and awareness of their knowledge during medical school.

Methods: Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom’s taxonomy: “simple questions” requiring lower and “vignette questions” requiring higher-order cognitive processing. Subsequently, we compared students’ performance and awareness of their knowledge in 2008 to that in 2011 for each question type.

Results: Students’ performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students’ judgment of knowledge decreased over time.

Conclusions: The progress test is a useful tool to assess students’ cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.     

New perspectives on health professions students’ e-learning: Looking through the lens of the “visitor and resident” model

Background: The growth of e-learning in health professional education reflects expansion of personal use of online resources. Understanding the user perspective in a fast-changing digital world is essential to maintain the currency of our approach.

Methods: Mixed methods were used to investigate a cohort of postgraduate, e-learning healthcare students’ perspectives on their use of online resources for personal and/or professional roles, via questionnaire and student-constructed diagrams, capturing use of online resources (underpinned by White’s model of “resident” and “visitor” online engagement). Semistructured interviews explored the use and value of resources afforded via the online environment.

Results: The 45 study participants described a range of prior experiences with online resources in personal and professional capacities, but overall students tended to use online “tools” (“visitor” mode) rather than highly collaborative networks (“resident” mode). In relation to e-learning, the dominant interview theme was valuing knowledge transfer from the tutor and using “visitor” behaviors to maximize knowledge acquisition. Peer-learning opportunities were less valued and barriers to collaborative “resident” modes were identified.

Conclusions: These findings help to inform e-learning course design to promote engagement. The results enable recommendations for use of the “Visitor and Residents” model and for planning activities that learners might utilize effectively.     

Reproductive Governance and the (Re)definition of Human Rights in Poland

ABSTRACT

Reproductive rights struggles have continued to dominate public debates in Poland since the political resurgence of the Catholic church in 1989. In 2015, the state passed a landmark “In Vitro Policy” to regulate assisted reproductive technologies. Its religiously based compromises may jeopardize other reproductive rights. I argue that the new policy negotiations demonstrate how versions of competing human rights claims are central to reproductive governance and struggles in the new Polish “ethical order.” These negotiations reveal a reciprocal and temporal effect between infertility and abortion laws, in which previously enacted abortion restrictions are used to limit and define “In Vitro” rights.     

Doctors of Plural Medicine,Knowledge Transmission,and Family Space in India

ABSTRACT

The transmission of traditional medical knowledge – either institutionally or through established lineages – is assumed to involve one single tradition or another. In India however, families of doctors often engage with multiple traditions, including Ayurveda, Unani, homeopathy, yoga, and biomedicine. Parents, children, siblings and spouses trained in different medical systems occasionally share knowledge and clinical space, producing versatile therapies. By exploring such cases, I challenge studies focused on single traditions and propose to examine “family space” as the physical and relational proximity that enables kin doctors to experiment with plural therapies while negotiating legitimacy and authority within the changing institution of the Indian family.     

Boosting clinical performance: The impact of enhanced final year placements

Background: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery.

Aims: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced “super-assistantship” placement introduced to a randomly selected sample of 2013–14 final year medical students at Leeds medical school.

Methods: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not.

Results: There was a small overall improvement in the “super-assistantship” student scores across the whole assessment (effect size?=?0.085). “Pre-op Capacity”, “Admissions Prescribing” and “Hip Pain” stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107–0.191), mostly in favor of the intervention group.

Conclusions: The “super-assistantship” experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making “in a simulated environment”. The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed.     

An online app platform enhances collaborative medical student group learning and classroom management

Purpose: The authors presented their results in effectively using a free and widely-accessible online app platform to manage and teach a first-year pathology course at Mayo Medical School.

Methods used: The authors utilized the Google “Blogger”, “Forms”, “Flubaroo”, “Sheets”, “Docs”, and “Slides” apps to effectively build a collaborative classroom teaching and management system. Students were surveyed on the use of the app platform in the classroom, and 44 (94%) students responded.

Results: Thirty-two (73%) of the students reported that “Blogger” was an effective place for online discussion of pathology topics and questions. 43 (98%) of the students reported that the “Forms/Flubaroo” grade-reporting system was helpful. 40 (91%) of the students used the remote, collaborative features of “Slides” to create team-based learning presentations, and 39 (89%) of the students found those collaborative features helpful. “Docs” helped teaching assistants to collaboratively create study guides or grading rubrics. Overall, 41 (93%) of the students found that the app platform was helpful in establishing a collaborative, online classroom environment.

Conclusions: The online app platform allowed faculty to build an efficient and effective classroom teaching and management system. The ease of accessibility and opportunity for collaboration allowed for collaborative learning, grading, and teaching.     

The stories they tell: How third year medical students portray patients,family members,physicians, and themselves in difficult encounters

Background: Physicians have long had patients whom they have labeled “difficult”, but little is known about how medical students perceive difficult encounters with patients.

Methods: In this study, we analyzed 134 third year medical students’ reflective essays written over an 18-month period about difficult student–patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students’ observations and reflections.

Results: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in “standard” behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.

Conclusions: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.     

Defining curricular priorities for student-as-teacher programs: A National Delphi Study

Background: “Student-as-Teacher” (SaT) programs have been growing in number to prepare medical students for their teaching roles in residency and beyond, but it remains unknown what content areas should be covered in SaT curricula.

Aim: To determine five to ten “essential” content areas for inclusion in SaT curricula using expert opinion.

Methods: Using a three-round Delphi process, moderators iteratively surveyed a panel of 28 medical educators (25 academy directors and three individuals identified as having expertise in undergraduate medical education) representing 25 medical schools in the United States. This “SaT Delphi Working Group” was tasked with rating topics for inclusion in SaT curricula on a 3-point scale (i.e. 1. “essential,” 2. “important, but not essential” 3. “not important”). Topics achieving ≥70% consensus as “essential,” “important” or “not important” were accepted by the moderators and removed from subsequent rounds.

Results: Hundred per cent response rate (n?=?28) was achieved for all survey rounds. Five content areas reached consensus as “essential” for inclusion in a SaT curriculum: feedback, bedside teaching and clinical precepting, small-group teaching, case-based teaching and professionalism as a medical educator.

Conclusion: This consensus from a group of leaders in medical education is a first step toward the implementation of more developmentally-appropriate SaT competencies.     

Lyme Disease and the Epistemic Tensions of “Medically Unexplained Illnesses”

ABSTRACT

In the US, disagreement over the biological basis of “chronic Lyme disease” has resulted in the institutionalization of two standards of care: “mainstream” and “Lyme-literate.” For mainstream physicians, chronic Lyme disease is a “medically unexplained illness” that presents with an abundance of “symptoms” in the absence of diagnostic “signs.” For Lyme-literate physicians, and complementary and alternative medicine practitioners more generally, symptoms alone provide sufficient evidence for medical explanation. Drawing upon ethnographic research among mainstream and Lyme-literate physicians, I suggest that medically unexplained illness is not a biomedical anomaly but an intrinsic feature of biomedicine.     

Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial

Objective: The objective of this study is to compare the effectiveness of a “cartoon-style” handout with a “traditional-style” handout in a self-study assignment for preclinical medical students.

Methods: Third-year medical students (n?=?93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a “cartoon-style” or a “traditional-style” handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion.

Results: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p?=?0.018). A higher proportion of students in the cartoon-style group reported reading ≥75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score.

Conclusions: Students given a cartoon-style handout reported reading more of the material and achieved higher post-learning test scores than students given a traditional handout.     

Using a meta-ethnographic approach to explore the nature of facilitation and teaching approaches employed in interprofessional education

Background: Interprofessional facilitators and teachers are regarded as central to the effective delivery of interprofessional education (IPE). As the IPE literature continues to expand, most studies have focused on reporting learner outcomes, with little attention paid to IPE facilitation. However, a number of studies have recently emerged reporting on this phenomenon.

Aim: To present a synthesis of qualitative evidence on the facilitation of IPE, using a meta-ethnographic approach.

Methods: Electronic databases and journals were searched for the past 10 years. Of the 2164 abstracts initially found, 94 full papers were reviewed and subsequently 12 papers were included. Teams of two reviewers independently completed each step in the review process. The quality of these papers was assessed using a modified critical appraisal checklist.

Results: Seven key concepts embedded in the included studies were synthesized into three main factors which provided an insight into the nature of IPE facilitation. Specifically, the synthesis found that IPE facilitation is influenced by “contextual characteristics”; “facilitator experiences”; and the “use of different facilitation strategies”.

Conclusions: IPE facilitation is a complex activity affected by contextual, experiential and pedagogical factors. Further research is needed to explore the effects of these factors on the delivery of IPE.