Teaching and Learning in Medicine

Construct: High-stakes assessments measure several constructs, such as knowledge, competencies, and skills. In this case, validity evidence for test scores' uses and interpretations is of utmost importance, because of the consequences for everyone involved in their development and implementation. Background: Educational assessment requires an appropriate understanding and use of validity frameworks; however, health professions educators still struggle with the conceptual challenges of validity, and frequently validity analyses have a narrow focus...

Phenomenon: Effective communication between team members is essential during the resuscitation of critically-ill patients. Failure of junior doctors to speak up and challenge erroneous clinical decisions made by their senior doctors is a serious communication failure which can result in catastrophic outcomes and jeopardize patient safety. Crisis resource management (CRM) and conflict resolution tools have been increasingly employed in the healthcare setting to reduce communication failure among healthcare providers and improve patient safety during crisis situations...

Phenomenon: Professional identity formation is a key component of health professional education. Changing expectations of healthcare requires more than competencies, but also an ingrained responsibility to patients, with our values and behaviors aligned with community expectations of patient-centered health professionals. Research into professional identity formation has focused on nursing and medical training, and, although allied health professionals make up one third of the workforce, research is uneven across these disciplines...

Phenomenon: Impostor syndrome (IS) is manifested in the fear of failing and being exposed as incompetent, despite exceptional professional performance. IS has been recognized in many professions, including medicine. Understanding IS prevalence and risk factors is critical to ensure the well-being of medical students and, by extension, future physicians. Approach: I t was expected that IS is highly prevalent in medical students, higher in women and associated with year of study and prior clinical experience...

Phenomenon : Disrespectful behavior between physicians across departments can contribute to burnout, poor learning environments, and adverse patient outcomes. Approach : In this focus group study, we aimed to describe the nature and context of perceived disrespectful communication between emergency and internal medicine physicians (residents and faculty) at patient handoff. We used a constructivist approach and framework method of content analysis to conduct and analyze focus group data from 24 residents and 11 faculty members from May to December 2019 at a large academic medical center...

PHENOMENON: Dissection of cadavers is a common practice in anatomical education. To meet demand for cadavers, some medical institutions facilitate dissection of individuals who did not provide consent during their life. This includes the bodies of individuals who passed away with either no living kin or no kin able to claim and bury their body. Recent literature demonstrates widespread discomfort with this practice among anatomy course directors at U.S. institutions, bringing into question continuation of this practice...

CONSTRUCT & BACKGROUND: In order to determine students' level of interprofessional competencies, there is a need for well-considered and thoroughly designed interprofessional assessments. Current literature about interprofessional assessments focuses largely on the development and validation of assessment instruments such as self-assessments or questionnaires to assess students' knowledge or attitudes. Less is known about the design and validity of integral types of assessment in interprofessional education, such as case-based assessments, or performance assessments...

CONSTRUCT: The McMaster Narrative Comment Rating Tool aims to capture critical features reflecting the quality of written narrative comments provided in the medical education context: valence/tone of language, degree of correction versus reinforcement, specificity, actionability, and overall usefulness. BACKGROUND: Despite their role in competency-based medical education, not all narrative comments contribute meaningfully to the development of learners' competence...

Phenomenon : Ad hoc entrustment decisions reflect a clinical supervisor's estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts...

Issue: Cultural safety enhances equitable communication between health care providers and cultural groups. Most documented cultural safety training initiatives focus on Indigenous populations from high-income countries, and nursing students, with little research activity reported from low- and middle-income countries. Several cultural safety training initiatives have been described, but a modern competency-based cultural safety curriculum is needed. Evidence: In this article, we present the Competency-Based Education and Entrustable Professional Activities frameworks of the Faculty of Medicine at La Sabana University in Colombia, and illustrate how this informed modernization of medical education...

ISSUE: Asians have experienced a rise in racialized hate crimes due to the anti-Asian rhetoric that has accompanied the COVID-19 pandemic. However, there has been little acknowledgement of anti-Asian discrimination within the medical education community. While anti-Asian hate is not new or unfamiliar to us, four authors of Asian descent, it has given us an opportunity to reflect on how we have been complicit in and resistant to the larger racial narratives that circulate in our communities...

PHENOMENON: All individuals and groups have blind spots that can lead to mistakes, perpetuate biases, and limit innovations. The goal of this study was to better understand how blind spots manifest in medical education by seeking them out in the U.S. APPROACH: We conducted group concept mapping (GCM), a research method that involves brainstorming ideas, sorting them according to conceptual similarity, generating a point map that represents consensus among sorters, and interpreting the cluster maps to arrive at a final concept map...

PROBLEM: Enhancing workforce diversity by increasing the recruitment of students who have been historically excluded/underrepresented in medicine (UIM) is critical to addressing healthcare inequities. However, these efforts are inadequate when undertaken without also supporting students' success. The transition to clerkships is an important and often difficult to navigate inflection point in medical training where attention to the specific needs of UIM students is critical. INTERVENTION: We describe the design, delivery, and three-year evaluation outcomes of a strengths-based program for UIM second year medical students...

Issue : The World Federation for Medical Education (WFME) was established in 1972 and in the five decades that followed, has been the de facto global agency for medical education. Despite this apparently formidable remit, it has received little analysis in the academic literature. Evidence : In this article, we examine the historical context at the time WFME was established and summarize the key decisions it has taken in its history to date, highlighting particularly how it has adopted positions and programmes that have seemingly given precedence to the values and priorities of countries in the Global North...

Issue : Historically excluded patient populations-particularly racial, ethnic, and sexually and gender minoritized people-experience gross inequities in health, worsened by the HIV and COVID-19 pandemics. Culturally responsive communication (CRC) is a vital tool health professionals can use to address these inequities. Yet, CRC can be challenging to teach , particularly during pandemics. The authors argue that pandemics magnify the powerful intersecting oppressions of heterosexism, racism, transphobia, nationalism, and sexism, essentially targeting Othered bodies for dying, a phenomenon known as necropolitics...

PHENOMENON: Students become physicians not only by mastering medical knowledge, but also through a process of Professional Identity Formation (PIF). In this study, we used the conceptual framework of Jarvis-Selinger et al. to explore the impact of COVID, as a major public health crisis, on the PIF of preclinical medical students in our country. APPROACH: At two U.S. medical schools, we interviewed 28 medical students twice as they moved from first to second year during the 2020-2021 COVID pandemic and explored the impact of COVID-19 on PIF...

Phenomenon : Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature...

Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach:  The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health...

Issue : Health professions education (HPE) is intimately linked with teaching and learning in the clinical environment. While the value of authentic clinical experiences is acknowledged, whether learning actually occurs is to a large extent dependent on students' behaviors and attitudes. The kinds of student behaviors and attitudes that are necessary to optimize learning in the clinical environment thus becomes relevant. Evidence : Tips and recommendations to maximize clinical learning in a variety of settings have been well documented...

Phenomenon : As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described...