4,350 results on '"Humans"'
Search Results
2. Teaching the consultant teachers: identifying the core content.
- Author
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Wall D and McAleer S
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- Consultants, Curriculum, Humans, Medical Staff, Hospital, Education, Teaching standards
- Abstract
Objectives: To determine the key themes for teaching hospital consultants how to teach., Design: 1. In-depth interviews with a total of 19 experts, consultants and junior doctors to identify key topics. 2. Literature review from 1969 to obtain the main themes from the medical educational literature. 3. Analysis of the main themes in 11 'Teaching the teachers' courses. 4. Triangulation of interview data, literature themes and teaching courses content to generate 15 criteria for a questionnaire. 5. Questionnaire study to 593 senior and junior hospital doctors., Setting: Hospitals in the West Midlands Region in England., Subjects: Consultants and junior hospital doctors., Results: Overall, 441 doctors replied (74% response rate). The top five themes were giving feedback constructively, keeping up to date as a teacher, building a good educational climate, assessing the trainee and assessing the trainee's learning needs. Results showed no statistically significant differences in the order of themes for all groups analysed, including seniority, gender, specialty, origin by medical school and consultants of different ages., Conclusions: Consultants need teaching in these topics. There are implications for funding and providing these courses for postgraduate deans, Royal Colleges and universities. Further research is needed to evaluate whether such an initiative does produce better teaching and learning, and a better educational climate in hospitals.
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- 2000
- Full Text
- View/download PDF
3. Promoting effective teaching and learning: hospital consultants identify their needs.
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Gibson DR and Campbell RM
- Subjects
- Consultants, Education, Medical, Continuing, Humans, Medical Staff, Hospital, Program Evaluation, United Kingdom, Education, Teaching standards
- Abstract
Objectives: The aim of this study was to help hospital consultants identify their needs in relation to teaching skills, leading to the development of a teacher training programme., Design: The study was directed at all 869 consultants in the region and initially involved a postal questionnaire which had a 60.5% response rate., Setting: Hospitals throughout Northern Ireland., Subjects: Hospital consultants., Results: Results from this questionnaire indicated that while the majority of respondents were interested teachers, only 34% had received any teacher training. The questionnaire was followed by a focus group study involving three groups of consultants drawn randomly from those who had responded to the questionnaire. Participants in these groups identified the following key areas of hospital education: qualities of hospital teachers; selection procedures; problems of teaching in hospitals; the need for teacher training and how it should be provided., Conclusion: The study highlighted that hospital teachers need to acquire and update their teaching skills through attending courses that should include basic teaching and assessment/appraisal skills. These courses should last 1 or 2 days and be provided at a regional or subregional level. As a result of this study, teacher training courses have been developed in this region.
- Published
- 2000
- Full Text
- View/download PDF
4. Evolving natural language processing towards a subjectivist inductive paradigm.
- Author
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Gin, Brian C
- Subjects
Humans ,Natural Language Processing ,Medical and Health Sciences ,Education ,Psychology and Cognitive Sciences ,Medical Informatics - Published
- 2023
5. Feedback as dialogue for faculty: From peer review to peer‐to‐peer coaching
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Margalit, Noam and Pincavage, Amber T
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Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,Humans ,Feedback ,Mentoring ,Faculty ,Peer Group ,Peer Review ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Abstract
Drawing on the themes identified by Watling et al. regarding feedback in peer review, the authors consider how their findings could be applied more broadly to faculty feedback.
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- 2023
6. Exploring how feedback reflects entrustment decisions using artificial intelligence.
- Author
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Gin, Brian C, Ten Cate, Olle, O'Sullivan, Patricia S, Hauer, Karen E, and Boscardin, Christy
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Humans ,Learning ,Competency-Based Education ,Internship and Residency ,Clinical Competence ,Students ,Medical ,Feedback ,Artificial Intelligence ,Clinical Research ,Quality Education ,Medical and Health Sciences ,Education ,Psychology and Cognitive Sciences ,Medical Informatics - Abstract
ContextClinical supervisors make judgements about how much to trust learners with critical activities in patient care. Such decisions mediate trainees' opportunities for learning and competency development and thus are a critical component of education. As educators apply entrustment frameworks to assessment, it is important to determine how narrative feedback reflecting entrustment may also address learners' educational needs.MethodsIn this study, we used artificial intelligence (AI) and natural language processing (NLP) to identify characteristics of feedback tied to supervisors' entrustment decisions during direct observation encounters of clerkship medical students (3328 unique observations). Supervisors conducted observations of students and collaborated with them to complete an entrustment-based assessment in which they documented narrative feedback and assigned an entrustment rating. We trained a deep neural network (DNN) to predict entrustment levels from the narrative data and developed an explainable AI protocol to uncover the latent thematic features the DNN used to make its prediction.ResultsWe found that entrustment levels were associated with level of detail (specific steps for performing clinical tasks), feedback type (constructive versus reinforcing) and task type (procedural versus cognitive). In justifying both high and low levels of entrustment, supervisors detailed concrete steps that trainees performed (or did not yet perform) competently.ConclusionsFraming our results in the factors previously identified as influencing entrustment, we find a focus on performance details related to trainees' clinical competency as opposed to nonspecific feedback on trainee qualities. The entrustment framework reflected in feedback appeared to guide specific goal-setting, combined with details necessary to reach those goals. Our NLP methodology can also serve as a starting point for future work on entrustment and feedback as similar assessment datasets accumulate.
- Published
- 2022
7. When I say…attitude.
- Author
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Valbuena, Gustavo, van der Schaaf, Marieke, O'Sullivan, Patricia, and O'Brien, Bridget
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Humans ,Attitude ,Medical and Health Sciences ,Education ,Psychology and Cognitive Sciences ,Medical Informatics - Published
- 2021
8. Virtual bedside teaching rounds with patients with COVID‐19
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Hofmann, Heather, Harding, Cameron, Youm, Julie, and Wiechmann, Warren
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Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,COVID-19 ,Humans ,Pandemics ,SARS-CoV-2 ,Teaching Rounds ,Telemedicine ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Published
- 2020
9. Professional identity formation in disorienting times
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Stetson, Geoffrey V, Kryzhanovskaya, Irina V, Lomen‐Hoerth, Catherine, and Hauer, Karen E
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Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,Good Health and Well Being ,COVID-19 ,Humans ,Learning ,Professionalism ,Social Identification ,Students ,Medical ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Published
- 2020
10. Transformative learning as pedagogy for the health professions: a scoping review
- Author
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Van Schalkwyk, Susan C, Hafler, Janet, Brewer, Timothy F, Maley, Moira A, Margolis, Carmi, McNamee, Lakshini, Meyer, Ilse, Peluso, Michael J, Schmutz, Ana MS, Spak, Judy M, Davies, David, and Initiative, the Bellagio Global Health Education
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Faculty ,Health Occupations ,Humans ,Problem-Based Learning ,Qualitative Research ,Bellagio Global Health Education Initiative ,Medical and Health Sciences ,Education ,Psychology and Cognitive Sciences ,Medical Informatics - Abstract
ContextTransformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field.MethodsArksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis.ResultsA mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists.ConclusionsThe training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.
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- 2019
11. Chart stalking, list making, and physicians’ efforts to track patients’ outcomes after transitioning responsibility
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Bowen, Judith L, O'Brien, Bridget C, Ilgen, Jonathan S, Irby, David M, and Cate, Olle ten
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Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,Behavioral and Social Science ,Clinical Research ,Basic Behavioral and Social Science ,Management of diseases and conditions ,7.3 Management and decision making ,Generic health relevance ,Aftercare ,Decision Making ,Electronic Health Records ,Female ,Grounded Theory ,Hospitalists ,Humans ,Internal Medicine ,Interviews as Topic ,Male ,Patient Transfer ,Physicians ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Abstract
ContextTransitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients.MethodsUsing a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up.ResultsThe authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems.ConclusionIn clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.
- Published
- 2018
12. Does source matter? Nurses' and Physicians' perceptions of interprofessional feedback
- Author
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van Schaik, Sandrijn M, O'Sullivan, Patricia S, Eva, Kevin W, Irby, David M, and Regehr, Glenn
- Subjects
Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,Clinical Research ,Clinical Trials and Supportive Activities ,Attitude of Health Personnel ,Feedback ,Humans ,Internship and Residency ,Interprofessional Relations ,Nurses ,Pediatrics ,Perception ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Abstract
ObjectiveReceptiveness to interprofessional feedback, which is important for optimal collaboration, may be influenced by 'in-group or out-group' categorisation, as suggested by social identity theory. We used an experimental design to explore how nurses and resident physicians perceive feedback from people within and outside their own professional group.MethodsPaediatric residents and nurses participated in a simulation-based team exercise. Two nurses and two physicians wrote anonymous performance feedback for each participant. Participants each received a survey containing these feedback comments with prompts to rate (i) the usefulness (ii) the positivity and (iii) their agreement with each comment. Half of the participants received feedback labelled with the feedback provider's profession (two comments correctly labelled and two incorrectly labelled). Half received unlabelled feedback and were asked to guess the provider's profession. For each group, we performed separate three-way anovas on usefulness, positivity and agreement ratings to examine interactions between the recipient's profession, actual provider profession and perceived provider profession.ResultsForty-five out of 50 participants completed the survey. There were no significant interactions between profession of the recipient and the actual profession of the feedback provider for any of the 3 variables. Among participants who guessed the source of the feedback, we found significant interactions between the profession of the feedback recipient and the guessed source of the feedback for both usefulness (F1,48 = 25.6; p < 0.001; η(2) = 0.35) and agreement ratings (F1,48 = 8.49; p < 0.01; η(2) = 0.15). Nurses' ratings of feedback they guessed to be from nurses were higher than ratings of feedback they guessed to be from physicians, and vice versa. Among participants who received labelled feedback, we noted a similar interaction between the profession of the feedback recipient and labelled source of feedback for usefulness ratings (F1,92 = 4.72; p < 0.05; η(2) = 0.05).ConclusionOur data suggest that physicians and nurses are more likely to attribute favourably perceived feedback to the in-group than to the out-group. This finding has potential implications for interprofessional feedback practices.
- Published
- 2016
13. Does trainee confidence influence acceptance of feedback?
- Author
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Curtis, Donald A and O'Sullivan, Patricia
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Clinical Clerkship ,Clinical Competence ,Education ,Medical ,Educational Measurement ,Female ,Goals ,Humans ,Male ,Needs Assessment ,Medical and Health Sciences ,Education ,Psychology and Cognitive Sciences ,Medical Informatics - Published
- 2014
14. Does student confidence on multiple‐choice question assessments provide useful information?
- Author
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Curtis, Donald A, Lind, Samuel L, Boscardin, Christy K, and Dellinges, Mark
- Subjects
Curriculum and Pedagogy ,Education ,Specialist Studies In Education ,Attitude of Health Personnel ,Choice Behavior ,Clinical Competence ,Cross-Sectional Studies ,Dental Implantation ,Educational Measurement ,Female ,Humans ,Logistic Models ,Male ,Odds Ratio ,Students ,Dental ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Curriculum and pedagogy ,Specialist studies in education - Abstract
ContextFeedback from multiple-choice question (MCQ) assessments is typically limited to a percentage correct score, from which estimates of student competence are inferred. The students' confidence in their answers and the potential impact of incorrect answers on clinical care are seldom recorded. Our purpose was to evaluate student confidence in incorrect responses and to establish how confidence was influenced by the potential clinical impact of answers, question type and gender.MethodsThis was an exploratory, cross-sectional study conducted using a convenience sample of 104 Year 3 dental students completing 20 MCQs on implant dentistry. Students were asked to select the most correct response and to indicate their confidence in it for each question. Identifying both correctness and confidence allowed the designation of uninformed (incorrect and not confident) or misinformed (incorrect but confident) responses. In addition to recording correct/incorrect responses and student confidence, faculty staff designated incorrect responses as benign, inappropriate or potentially harmful if applied to clinical care. Question type was identified as factual or complex. Logistic regression was used to evaluate relationships between student confidence, and question type and gender.ResultsStudents were misinformed more often than uninformed (22% versus 8%), and misinformed responses were more common with complex than factual questions (p
- Published
- 2013
15. Disability inclusion in Medical Education: Towards a quality improvement approach
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Siobhan Fitzpatrick and Darryl Barrett
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Education, Medical ,Humans ,Disabled Persons ,General Medicine ,Quality Improvement ,Education - Published
- 2022
16. Optimising the educational value of indirect patient care
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Danielle O'Toole, Marina Sadik, Gabrielle Inglis, Justin Weresch, and Meredith Vanstone
- Subjects
Humans ,Internship and Residency ,Workload ,Patient Care ,General Medicine ,Family Practice ,Education - Abstract
Indirect patient care activities (IPCA) such as documentation, reviewing investigations and filling out forms require an increasing amount of physician time. While an essential part of patient care, rising rates of IPCA work correspond with increases in physician burnout and job dissatisfaction. It is not known how best to prepare residents in IPCA-heavy specialties (e.g. family medicine) for this aspect of their career. This study investigates how educators and residency programmes can optimise IPCA work during residency to best prepare residents for future practice.Using Constructivist Grounded Theory, we conducted focus groups and individual interviews with 42 clinicians (19 family medicine residents, 16 family physicians in the first 5 years of practice and 7 family physician educators). All participants were connected to one family medicine residency programme. We analysed interview data iteratively, using a staged approach to constant comparative analysis.While residents, early career physicians and educators perceived the educational value of IPCAs differently, they all reported IPCAs as a necessary weight that family physicians carry throughout their career. Some residents described IPCAs as a burden, creating inequities in workload and interfering with other learning and personal opportunities. In contrast, educators conceptualised IPCAs as an opportunity to build and develop the skills required to carry the weight of IPCAs throughout their career. We make specific recommendations for helping residents recognise this educational opportunity, such as clarifying expectations, navigating equity, understanding purpose and maintaining consistency when teaching IPCAs.IPCAs are a key competency for many medical residents but require explicit pedagogical attention. If the educational opportunities are not made explicit, residents may miss the opportunity to develop strategies for practice management, professional boundaries, and administrative efficiencies.
- Published
- 2022
17. Predictors of faculty narrative evaluation quality in medical school clerkships
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Christopher J. Mooney, Jennifer M. Pascoe, Amy E. Blatt, Valerie J. Lang, Michael S. Kelly, Melanie K. Braun, Jaclyn E. Burch, and Robert Thompson Stone
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Male ,Students, Medical ,Faculty, Medical ,Clinical Clerkship ,Humans ,Female ,Clinical Competence ,General Medicine ,Schools, Medical ,Education, Medical, Undergraduate ,Education - Abstract
Narrative approaches to assessment provide meaningful and valid representations of trainee performance. Yet, narratives are frequently perceived as vague, nonspecific and low quality. To date, there is little research examining factors associated with narrative evaluation quality, particularly in undergraduate medical education. The purpose of this study was to examine associations of faculty- and student-level characteristics with the quality of faculty member's narrative evaluations of clerkship students.The authors reviewed faculty narrative evaluations of 50 students' clinical performance in their inpatient medicine and neurology clerkships, resulting in 165 and 87 unique evaluations in the respective clerkships. The authors evaluated narrative quality using the Narrative Evaluation Quality Instrument (NEQI). The authors used linear mixed effects modelling to predict total NEQI score. Explanatory covariates included the following: time to evaluation completion, number of weeks spent with student, faculty total weeks on service per year, total faculty years in clinical education, student gender, faculty gender, and an interaction term between student and faculty gender.Significantly higher narrative evaluation quality was associated with a shorter time to evaluation completion, with NEQI scores decreasing by approximately 0.3 points every 10 days following students' rotations (p = .004). Additionally, women faculty had statistically higher quality narrative evaluations with NEQI scores 1.92 points greater than men faculty (p = .012). All other covariates were not significant.The quality of faculty members' narrative evaluations of medical students was associated with time to evaluation completion and faculty gender but not faculty experience in clinical education, faculty weeks on service, or the amount of time spent with students. Findings advance understanding on ways to improve the quality of narrative evaluations which are imperative given assessment models that will increase the volume and reliance on narratives.
- Published
- 2022
18. Supervising the senior medical resident: Entrusting the role, supporting the tasks
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Rose Hatala, Shiphra Ginsburg, Stephen Gauthier, Lindsay Melvin, David Taylor, and Andrea Gingerich
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Canada ,Attitude of Health Personnel ,Decision Making ,Humans ,Internship and Residency ,Clinical Competence ,General Medicine ,Education - Abstract
Postgraduate competency-based medical education has been implemented with programmatic assessment that relies on entrustment-based ratings. Yet, in less procedurally oriented specialties such as internal medicine, the relationship between entrustment and supervision remains unclear. We undertook the current study to address how internal medicine supervisors conceptualise entrusting senior medical residents while supervising them on the acute care wards.Guided by constructivist grounded theory, we interviewed 19 physicians who regularly supervised senior internal medicine residents on inpatient wards at three Canadian universities. We developed a theoretical model through iterative cycles of data collection and analysis using a constant comparative process.On the internal medicine ward, the senior resident role is viewed as a fundamentally managerial and rudimentary version of the supervisor's role. Supervisors come to trust their residents in the senior role through an early 'hands-on' period of assessment followed by a gradual withdrawal of support to promote independence. When considering entrustment, supervisors focused on entrusting a particular scope of the senior resident role as opposed to entrustment of individual tasks. Irrespective of the scope of the role that was entrusted, supervisors at times stepped in and stepped back to support specific tasks.Supervisors' stepping in and stepping back to support individual tasks on the acute care ward has an inconsistent relationship to their entrustment of the resident with a particular scope of the senior resident role. In this context, entrustment-based assessment would need to capture more of the holistic perspective of the supervisor's entrustment of the senior resident role. Understanding the dance of supervision, from relatively static overall support of the resident in their role, to fluidly stepping in and out for specific patient care tasks, allows us insight into the affordances of the supervisory relationship and how it may be leveraged for assessment.
- Published
- 2022
19. How argumentation theory can inform assessment validity: A critical review
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Benjamin Kinnear, Daniel J. Schumacher, Erik W. Driessen, and Lara Varpio
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AUDIENCE ,PROGRAMMATIC ASSESSMENT ,IMPACT ,Logic ,SKILLS ,Humans ,General Medicine ,COMPETENCE ,Dissent and Disputes ,VALIDATION ,Problem Solving ,Education - Abstract
Introduction Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways. Methods The authors followed a five-step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE. Results We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real-world settings, with a variety of normative standards used to evaluate argument validity. Discussion Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation.
- Published
- 2022
20. Disability inclusion in medical education: Towards a quality improvement approach
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Lisa M. Meeks and Satendra Singh
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Education, Medical ,Humans ,General Medicine ,Quality Improvement ,Education - Abstract
The shift to a more diverse workforce that includes physicians with disabilities has gained considerable international traction. Indeed, disability inclusion is experiencing a renaissance in medical education. However, the philosophy of disability inclusion must be adjusted from one where disabled trainees are viewed as problematic and having to 'overcome' disability to one where institutions anticipate and welcome disabled trainees as a normative part of a diverse community.Most trainees with disabilities will enter an unregulated, uninformed system leaving them vulnerable to under-accommodation, systems barriers and lack of informed support. Further, the perception of the super human good doctor creates disincentives for candidates to disclose their disability, creating structural barriers that the system needs to address. A less often discussed contributor to health care inequities is the inadequate training of health professional educators on disability rights and disability competencies. Indeed, the lack of education, coupled with minimal exposure to disability outside of the hierarchical patient-provider relationship, perpetuates to stereotypes and biases that impact clinical care.Disability inclusion has not been reviewed through the lens of quality improvement. To close this gap, we examine the state of the science through the lens of disability inclusion and offer considerations for a quality improvement approach in medical education that addresses the global revised trilogy of World Federation for Medical Education standards of quality improvement at all three levels of education, training and practice.We propose a vision of systems-based disability-inclusive, accessible and equitable medical education using 9 of Deming's 14 points as applicable to medical education.
- Published
- 2022
21. Improving uncertainty tolerance in medical students: A scoping review
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Priya Patel, Jason Hancock, Morwenna Rogers, and Samuel R. Pollard
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Students, Medical ,Education, Medical ,Uncertainty ,Humans ,Curriculum ,General Medicine ,Delivery of Health Care ,Education - Abstract
Uncertainty is an inevitable part of medical practice. An ability to tolerate uncertainty is viewed as a key competency across many health-care systems. Poor uncertainty tolerance (UT) has been linked to negative outcomes including reduced psychological well-being in medical students. A variety of medical education interventions have been developed with the intention of increasing medical students' UT. However, there is no synthesis of these studies available to inform education and research practice. Our aim was to conduct a scoping review of medical education interventions that evaluate their impact on UT.Medline, PsycInfo, Embase and ERIC databases were searched for articles published from inception to December 2020. An extensive supplementary search was conducted and both quantitative and qualitative evaluations were included. For each intervention, we categorised the stimulus of uncertainty (ambiguity, complexity and/or probability) and mapped the students' reported cognitive, behavioural, and/or emotional response(s) to uncertainty onto an existing conceptual framework.Twenty-two of 24 included studies reported a positive impact on medical student UT in at least one domain (cognitive, behavioural or emotional). Interventions included problem based learning-based curricula, medical humanities, simulation, reflection and assessment. We found in four studies that a negative response in the emotional domain was reported despite positive responses also being reported in the cognitive and/or behavioural domains.We identified a range of medical education interventions which report a positive impact on medical student UT. Further research is required to understand why a single intervention may stimulate a negative emotional response alongside a positive cognitive or behavioural response. In turn, this could support stakeholders such as policymakers and institutions to adapt the medical curriculum to better prepare their medical students for practice by enhancing their UT.
- Published
- 2022
22. Building a theoretical model for virtual interprofessional education
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Arden Azim, Etri Kocaqi, Sarah Wojkowski, Derya Uzelli‐Yilmaz, Sarah Foohey, and Matt Sibbald
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Canada ,Communication ,Interprofessional Relations ,Interprofessional Education ,Humans ,General Medicine ,Models, Theoretical ,Education - Abstract
Virtual interprofessional education (IPE) has emerged as a promising alternative to traditional in-person IPE. However, theoretical frameworks to support virtual interprofessional learning are not well established. Two theoretical frameworks emerged as relevant to virtual IPE: (1) the Canadian Interprofessional Health Collaborative (CIHC) interprofessional learning framework and (2) Dornan's Experience-Based Learning Model (ExBL) of workplace learning. In this study, we sought to explore virtual IPE using both frameworks to develop new theoretical understandings and identify assumptions, gaps and barriers.This was a qualitative study. Semi-structured interviews were conducted with medical and nursing student participants (n = 14) and facilitators (n = 3) from virtual IPE workshops. Transcripts were analysed using directed content analysis methodology, informed by the CIHC and ExBL frameworks. Themes were explored using mind-mapping transitional coding. Data collection and analysis were continued iteratively until themes with adequate conceptual depth, relevance and plausibility were identified.Three themes were identified: (1) a shift in the balance of personal and professional, (2) blunted sociologic fidelity and (3) uncertainty and threats to interpersonal connections. Professional distinctions and hierarchies are blurred virtually. This contributed to an increased sense of psychological safety among most learners and lowered the threshold for participation. Separation from workplace sociologic complexity facilitated communication and role clarification objectives. However, loss of immersion may limit deeper engagement. Interprofessional objectives that rely on deeper sociological fidelity, such as conflict resolution, may be threatened. Informal interactions between learners are hindered, which may threaten organic development of interprofessional relationships.Role clarification and communication objectives are preserved in virtual IPE. Educators should pay close attention to psychological safety and sociologic fidelity-both to leverage advantages and guard against threats to connection and transferability. Virtual IPE may be well suited as a primer to in-person activities or as scaffolding towards interprofessional workplace practice.
- Published
- 2022
23. Good for patients but not learners? Exploring faculty and learner virtual care integration
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Lisa Shepherd, Allison McConnell, and Christopher Watling
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Canada ,Humans ,COVID-19 ,Learning ,General Medicine ,Faculty ,Education - Abstract
The pandemic catapulted the adoption of virtual care far ahead of its anticipated maturation date, forcing faculty to role model and teach learners with barely enough time to master it themselves. With a scant body of prepandemic literature now accompanied by experience gained under extraordinary circumstances, we can benefit from understanding ad hoc strategies implemented by those on the front lines and from listening to learners about what is working and what is not. The purpose of this study was to explore the experience of learner integration into virtual care from both the faculty and learner perspectives.Using a constructivist grounded theory methodology and sociomateriality as a sensitising concept, we recruited participants using purposeful and theoretical sampling from a Canadian University with limited prepandemic virtual care provision. We interviewed 16 faculty and 5 learners spanning a breadth of specialties and years of practice/education to probe their experience of teaching and learning virtual care. Data collection and analysis were conducted iteratively with themes identified through constant comparative analysis.Integrating learners into virtual care proved challenging initially because of a lack of familiarity with the process and later because of disrupted workflow, triggered by the structure and logistics of the virtual care clinic. Both faculty and learners identified learning deficiencies in the virtual care experience when compared with in-person clinics, but several unique and valuable learning affordances were noted. All faculty expressed a desire to keep virtual care as part of their future clinic practice, but paradoxically most felt that they were unlikely to include learners.Training learners in virtual care is an educational challenge that will not disappear with COVID-19, even if our participants wished it could. The perceived value for patients but not learners begs a reconsideration of the sociomaterial contribution to this pandemic paradox.
- Published
- 2022
24. Training the clinical eye and mind: using the arts to develop medical students' observational and pattern recognition skills.
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Shapiro, Johanna, Rucker, Lloyd, and Beck, Jill
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Art ,Clinical Competence: standards ,Education ,Medical ,Undergraduate: methods ,Humans ,Observation: methods ,Pattern Recognition ,Visual ,Students ,Medical: psychology ,Teaching Materials ,article ,clinical competence ,clinical education ,controlled study ,human ,medical decision making ,medical education ,medical student ,pattern recognition ,photography ,skill ,teaching hospital ,Art ,Clinical Competence ,Education ,Medical ,Undergraduate ,Humans ,Observation ,Pattern Recognition ,Visual ,Students ,Medical ,Teaching Materials - Abstract
Observation, including identification of key pieces of data, pattern recognition, and interpretation of significance and meaning, is a key element in medical decision making. Clinical observation is taught primarily through preceptor modelling during the all-important clinical years. No single method exists for communicating these skills, and medical educators have periodically experimented with using arts-based training to hone observational acuity. The purpose of this qualitative study was to better understand the similarities and differences between arts-based and clinical teaching approaches to convey observation and pattern recognition skills.A total of 38 Year 3 students participated in either small group training with clinical photographs and paper cases (group 1), or small group training using art plus dance (group 2), both consisting of 3 2-hour sessions over a 6-month period.Students in both conditions found value in the training they received and, by both self- and instructor-report, appeared to hone observation skills and improve pattern recognition. The clinically based condition appeared to have been particularly successful in conveying pattern recognition concepts to students, probably because patterns presented in this condition had specific correspondence with actual clinical situations, whereas patterns in art could not be generalised so easily to patients. In the arts-based conditions, students also developed skills in emotional recognition, cultivation of empathy, identification of story and narrative, and awareness of multiple perspectives.The interventions studied were naturally complementary and, taken together, can bring greater texture to the process of teaching clinical medicine by helping us see a more complete 'picture' of the patient.
- Published
- 2006
25. Resident doctors' understanding of their roles as clinical teachers.
- Author
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Morrison, Elizabeth H, Shapiro, Johanna F, and Harthill, Miriam
- Subjects
Attitude of Health Personnel ,Clinical Competence: standards ,Education ,Medical ,Undergraduate: methods ,Humans ,Internship and Residency ,Physician's Role ,Teaching ,clinical education ,interview ,resident ,review ,self concept ,skill ,teaching ,university hospital ,Attitude of Health Personnel ,Clinical Competence ,Education ,Medical ,Undergraduate ,Humans ,Internship and Residency ,Physician's Role ,Teaching - Abstract
Limited data illuminate how resident doctors view their important roles as teachers, supervisors and role models. Analysing qualitative data about resident teachers' self-perceptions can offer helpful insights.One year after a randomised trial of a residents-as-teachers curriculum at a university medical centre, we invited its 23 resident participants to participate in semistructured interviews. We interviewed 21 third year residents from internal medicine, family medicine and paediatrics, including 12 intervention residents who had been randomly assigned to receive a 13-hour teacher training programme and 9 control residents who had received no training. We used grounded theory techniques. Two investigators independently content-analysed the transcribed interviews for emerging themes and we then developed a schema for a third investigator to code the transcripts.Three key themes consistently emerged: enthusiasm for teaching (current and future), learner-centredness, and self-knowledge about teaching. Compared with control residents, the intervention residents expressed greater enthusiasm for teaching, more learner-centred and empathic approaches, and a richer understanding of teaching principles and skills. Most intervention residents wanted to continue teaching during and after training. Fewer control residents enjoyed their current teaching, and fewer still wanted to teach in the future. The control residents seemed easily frustrated by time constraints and they often expressed cynicism and blame toward learners.One year after participating in a randomised trial of a residents-as-teachers curriculum, generalist residents revealed fairly consistent perceptions of their teaching roles. Teacher training may offer residents lasting benefits, including improved teaching skills and satisfaction.
- Published
- 2005
26. All the world's a stage: the use of theatrical performance in medical education.
- Author
-
Shapiro, Johanna and Hunt, Lynn
- Subjects
Attitude of Health Personnel ,Drama ,Education ,Medical ,Undergraduate: methods ,Empathy ,Humans ,acquired immune deficiency syndrome ,article ,community care ,empathy ,experience ,human ,medical education ,medical school ,medical staff ,medical student ,ovary cancer ,performance ,physician attitude ,role playing ,Attitude of Health Personnel ,Drama ,Education ,Medical ,Undergraduate ,Empathy ,Humans - Abstract
Student exposure to illness-related theatrical performances holds intriguing educational possibilities. This project explored uses of theatrical performance within the context of medical education.Two 1-person shows, dramatically addressing AIDS and ovarian cancer, were presented to audiences totalling approximately 150 medical students, faculty, community doctors, staff and patients.Evaluations for both performances indicated increased understanding of the illness experience and greater empathy for patients. They also showed that respondents obtained additional insights into patient care issues, and developed new ways of thinking about their situations.Presenting illness-related dramatic performances as an adjunct method of enhancing empathy and insight toward patients in a self-selected group of students, doctors, staff and patients was successful. Although this approach might not be effective with all learners, those who participated felt they gained important insights into the nature of the patient experience.
- Published
- 2003
27. Bridging health equity and quality improvement in medical education
- Author
-
Javeed Sukhera
- Subjects
Health Equity ,Education, Medical ,Humans ,General Medicine ,Quality Improvement ,Education - Published
- 2022
28. Character‐based leadership in medicine: A valuable concept that is not without challenges
- Author
-
Ali Asghar Hayat and Mitra Amini
- Subjects
Leadership ,Character ,Humans ,Medicine ,General Medicine ,Education - Published
- 2022
29. Entrustable professional activities in longitudinal clinical programmes
- Author
-
Linda H. A. Bonnie, General practice, APH - Personalized Medicine, and APH - Quality of Care
- Subjects
Education, Medical, Graduate ,Humans ,Internship and Residency ,General Medicine ,Clinical Competence ,Competency-Based Education ,Education - Published
- 2022
30. What do student experiences of programmatic assessment tell us about scoring programmatic assessment data?
- Author
-
Jacob Pearce
- Subjects
Humans ,Educational Measurement ,General Medicine ,Students ,Education - Published
- 2022
31. Teaching: The expression of freedom?
- Author
-
Zareen Zaidi
- Subjects
Freedom ,Faculty, Nursing ,Teaching ,Humans ,General Medicine ,Education - Published
- 2022
32. The educational affordances of external clinician observation of GP trainee consultations
- Author
-
Nancy Sturman, Elizabeth Fitzmaurice, Erin Waters, Michelle Sheldrake, and Cathy Lee
- Subjects
Communication ,General Practice ,Educational Status ,Humans ,Clinical Competence ,General Medicine ,Focus Groups ,Referral and Consultation ,Education - Abstract
There is widespread agreement about the importance of direct observation of trainee practice by clinical supervisors. Less is known about observation by observers external to the supervisory team. We explored the educational affordances of external observation of GP trainee consultations for educational and assessment purposes, from the perspectives of both observers and trainees.GP medical educators, who were scheduled to observe sessions of GP trainee consultations, were recruited as participant observers. They completed field notes, reflective memos and a focus group discussion, and conducted post-observation interviews with trainees, focused on trainee experiences of accessing educational input from supervisors and observers during the sessions. Thematic analysis was guided by constructivist realism and socio-cultural theory.A total of 23 observation sessions (131 observed patient consultations), 33 trainee interviews and 23 observer reflections were completed. External observers embraced teaching, coaching and pastoral opportunities, rather than being 'flies on the wall', despite also having research and assessment roles. They gained useful insights into the challenges of obtaining and providing in-consultation supervisory assistance and provided some in-consultation guidance themselves. Both trainees and observers experienced the sessions as valuable and collegial. Trainees appreciated post-consultation feedback conversations: topics included consultation challenges, managing uncertainty and variation in clinical practice. Patient expectations and pre-existing relationships influenced the distinctive interpersonal dynamic of the externally observed consultation.The educational affordances and interpersonal dynamics of external observation differ from supervisor observation. We recommend wider use in clinical training of observers who cross between educator and clinician communities.
- Published
- 2022
33. Fate and future of the medical students in Ukraine: A silently bubbling educational crisis
- Author
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Nityanand Jain, Deepkanwar Singh Panag, Mahek Srivastava, Srinithi Mohan, Swarali Yatin Chodnekar, Amir Reza Akbari, Divyam Raj, Dionysia Kravarioti, Dorota Świątek, Emilia Platos, Ketevani Khetsuriani, Kitija Lucija Gristina, Kyriacos Evangelou, Marinela Lica, Revathi Sairaj Thirumushi, Sofia Rozani, Shivani Jain, Pavlo Fedirko, Aigars Reinis, and Mara Pilmane
- Subjects
Students, Medical ,Education, Medical ,Educational Status ,Humans ,General Medicine ,Ukraine ,Education - Published
- 2022
34. Mental health self‐disclosure: From stigma to empowerment
- Author
-
Karen E. Hauer and Erick Hung
- Subjects
Stereotyping ,Mental Health ,Mental Disorders ,Social Stigma ,Humans ,General Medicine ,Self Concept ,Education - Published
- 2022
35. Student perspectives on programmatic assessment in a large medical programme: A critical realist analysis
- Author
-
Chris Roberts, Priya Khanna, Jane Bleasel, Stuart Lane, Annette Burgess, Kellie Charles, Rosa Howard, Deborah O'Mara, Inam Haq, and Timothy Rutzou
- Subjects
Humans ,Learning ,Curriculum ,General Medicine ,Students ,Faculty ,Education - Abstract
Fundamental challenges exist in researching complex changes of assessment practice from traditional objective-focused 'assessments of learning' towards programmatic 'assessment for learning'. The latter emphasise both the subjective and social in collective judgements of student progress. Our context was a purposively designed programmatic assessment system implemented in the first year of a new graduate entry curriculum. We applied critical realist perspectives to unpack the underlying causes (mechanisms) that explained student experiences of programmatic assessment, to optimise assessment practice for future iterations.Data came from 14 in-depth focus groups (N = 112/261 students). We applied a critical realist lens drawn from Bhasker's three domains of reality (the actual, empirical and real) and Archer's concept of structure and agency to understand the student experience of programmatic assessment. Analysis involved induction (pattern identification), abduction (theoretical interpretation) and retroduction (causal explanation).As a complex educational and social change, the assessment structures and culture systems within programmatic assessment provided conditions (constraints and enablements) and conditioning (acceptance or rejection of new 'non-traditional' assessment processes) for the actions of agents (students) to exercise their learning choices. The emergent underlying mechanism that most influenced students' experience of programmatic assessment was one of balancing the complex relationships between learner agency, assessment structures and the cultural system.Our study adds to debates on programmatic assessment by emphasising how the achievement of balance between learner agency, structure and culture suggests strategies to underpin sustained changes (elaboration) in assessment practice. These include; faculty and student learning development to promote collective reflexivity and agency, optimising assessment structures by enhancing integration of theory with practice, and changing learning culture by both enhancing existing and developing new social structures between faculty and the student body to gain acceptance and trust related to the new norms, beliefs and behaviours in assessing for and of learning.
- Published
- 2022
36. Maintaining health professional education during war: A scoping review
- Author
-
Valerie A. Dobiesz, Madeline Schwid, Roger D. Dias, Benjamin Aiwonodagbon, Baraa Tayeb, Adrienne Fricke, Phuong Pham, and Timothy B. Erickson
- Subjects
Education, Medical ,Health Personnel ,Humans ,Internship and Residency ,Students, Nursing ,Curriculum ,General Medicine ,Education - Abstract
War negatively impacts health professional education when health care is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarise the research.We conducted a scoping review between 20 June 2018 and 2 August 2018. The search was restricted to English publications including peer-reviewed publications without date ranges involving war and health professional education (medical school, residency training and nursing school), with interventions described to maintain educational activities. Two independent reviewers completed inclusion determinations and data abstraction. Thematic coding was performed using an inductive approach allowing dominant themes to emerge. The frequency of barrier and intervention themes and illustrative quotes were extracted. Articles were divided into modern/postmodern categories to permit temporal and historical analysis of thematic differences.Screening identified 3271 articles, with 56 studies meeting inclusion criteria. Publication dates ranged from 1914-2018 with 17 unique wars involving 17 countries. The studies concerned medical students (61.4%), residents (28.6%) and nursing students (10%). Half involved the modern era and half the postmodern era. Thematic coding identified five categories of barriers and targeted interventions in maintaining health professions education during war: curriculum, personnel, wellness, resources, and oversight, with most involving curriculum and personnel. The distribution of themes among various health professional trainees was similar. The frequency and specifics changed temporally reflecting innovations in medical education and war, with increased focus on oversight and personnel during the modern era and greater emphasis on wellness, curriculum, and resources during the postmodern era.There are overarching categories of barriers and targeted interventions in maintaining health professional education during war which evolve over time. These may serve as a useful framework to strategically support future research and policy efforts.
- Published
- 2022
37. Preparing for selection success: Socio‐demographic differences in opportunities and obstacles
- Author
-
Dawn Jackson, Derek Ward, Juliana Chizo Agwu, and Austen Spruce
- Subjects
Students, Medical ,Humans ,School Admission Criteria ,General Medicine ,Family Practice ,Students ,Schools, Medical ,Demography ,Education - Abstract
There is a growing drive to improve the heterogeneity of medical school cohorts. However, those from lower socio-economic groups remain under-represented. Understanding the methods used by applicants to prepare for medical school selection, and the challenges they face with respect to opportunities and access, may provide important insights to this lack of diversity. This research considered the influence of socio-demographic background on preparation for medical school selection and on the successful offer of a place.All eligible applicants to a large UK medical school were invited to complete an anonymous online survey (international and mature applicants excluded), detailing demographic data and experiences of preparing for selection and challenges faced (n = 1885). Selection outcomes across all UK medical schools were examined for consenting students (n = 955). Univariate and multivariate analyses explored the associations of preparatory activities and demographic data with subsequent offer of a place at a UK medical school.The survey response rate was 66.4%. Clinical work experience (hospital or general practice), fee-based courses for admissions tests and school preparation courses for interview were activities significantly associated with the offer of a place (P .05). Those attending independent (private) schools most frequently reported school support and fee-based courses to support preparation (P .01). Applicants from state non-selective (SNS) schools and lower socio-economic groups more frequently reported challenges in accessing fee-based support, school interview courses and clinical work experience (P ≤ .02).Clinical work experience, commercial courses for admissions tests and school-based support for interview represent areas of preparation that are associated with success. However, they also represent areas that are more challenging to access for demographic groups traditionally under-represented in medicine. Addressing complex issues of fairness in highly selective higher education settings can appear an insurmountable task. These preparatory activities represent key areas for applicants, schools and institutions to explore and address.
- Published
- 2022
38. Medical student engagement in small‐group active learning: A stimulated recall study
- Author
-
Anne De la Croix, Jan Willem Grijpma, Marianne Mak-van der Vossen, Rashmi Kusurkar, Martijn Meeter, Team Higher Education, Educational and Family Studies, LEARN! - Learning sciences, IOO, General practice, Other Research, APH - Quality of Care, and APH - Methodology
- Subjects
Students, Medical ,Emotions ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Problem-Based Learning ,General Medicine ,SDG 4 - Quality Education ,Education - Abstract
BackgroundActive learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small-group active learning settings, teachers could be facilitated in effectively engaging their students.MethodsWe conducted a video-stimulated recall study to explore medical students' engagement during small-group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi-structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components.ResultsThe analysis uncovered three main findings: (1) In-class student engagement followed a spiral-like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable.DiscussionThis study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re-)engage students in their classrooms.
- Published
- 2022
39. I, we and they: A linguistic and narrative exploration of the authorship process
- Author
-
Erik W. Driessen, Anthony R. Artino, Christopher Watling, Abigail Konopasky, Lauren A. Maggio, Bridget C. O’Brien, RS: SHE - R1 - Research (OvO), and Onderwijsontw & Onderwijsresearch
- Subjects
Male ,Canada ,IMPACT ,media_common.quotation_subject ,Verb ,Space (commercial competition) ,CREDIT ,INQUIRY ,Education ,Narrative inquiry ,PHYSICIANS ,Pedagogy ,Agency (sociology) ,Humans ,Narrative ,Sociology ,media_common ,Dialectic ,ISSUES ,Descriptive statistics ,Publications ,Linguistics ,General Medicine ,Authorship ,Research Personnel ,Negotiation ,Female ,HONORARY AUTHORSHIP - Abstract
Introduction While authorship plays a powerful role in the academy, research indicates many authors engage in questionable practices like honorary authorship. This suggests that authorship may be a contested space where individuals must exercise agency-a dynamic and emergent process, embedded in context-to negotiate potentially conflicting norms among published criteria, disciplines and informal practices. This study explores how authors narrate their own and others' agency in making authorship decisions. Method We conducted a mixed-methods analysis of 24 first authors' accounts of authorship decisions on a recent multi-author paper. Authors included 14 females and 10 males in health professions education (HPE) from U.S. and Canadian institutions (10 assistant, 6 associate and 8 full professors). Analysis took place in three phases: (1) linguistic analysis of grammatical structures shown to be associated with agency (coding for main clause subjects and verb types); (2) narrative analysis to create a 'moral' and 'title' for each account; and (3) dialectic integration of (1) and (2). Results Descriptive statistics suggested that female participants used we subjects and material verbs (of doing) more than men and that full professors used relational verbs (of being and having) more than assistant and associate. Three broad types of agency were narrated: distributed (n = 15 participants), focusing on how resources and work were spread across team members; individual (n = 6), focusing on the first author's action; and collaborative (n = 3), focusing on group actions. These three types of agency contained four subtypes, e.g. supported, contested, task-based and negotiated. Discussion This study highlights the complex and emergent nature of agency narrated by authors when making authorship decisions. Published criteria offer us starting point-the stated rules of the authorship game; this paper offers us a next step-the enacted and narrated approach to the game.
- Published
- 2022
40. How does multisource feedback influence residency training? A qualitative case study
- Author
-
Eva K. Hennel, Andrea Trachsel, Ulrike Subotic, Andrea C. Lörwald, Sigrid Harendza, and Sören Huwendiek
- Subjects
Education, Medical, Graduate ,Humans ,Internship and Residency ,Clinical Competence ,General Medicine ,Child ,Qualitative Research ,Feedback ,Education - Abstract
Multisource feedback (MSF), also called 360-degree assessment, is one form of assessment used in postgraduate training. However, there is an ongoing discussion on its value, because the factors that influence the impact of MSF and the main impact of MSF are not fully understood. In this study, we investigated both the influencing factors and the impact of MSF on residency training.We conducted a qualitative case study within the boundaries of the residency training for paediatricians and paediatric surgeons at a University Hospital. We collected data from seven focus group interviews with stakeholders of MSF (residents, raters and supervisors). By performing a reflexive thematic analysis, we extracted the influencing factors and the impact of MSF.We found seven influencing factors: MSF is facilitated by the announcement of a clear goal of MSF, the training of raters on the MSF instrument, a longitudinal approach of observation, timing not too early and not too late during the rotation, narrative comments as part of the ratings, the residents' self-assessment and a supervisor from the same department. We found three themes on the impact of MSF: MSF supports the professional development of residents, enhances interprofessional teamwork and increases the raters' commitment to the training of residents.This study illuminates the influencing factors and impact of MSF on residency training. We offer novel recommendations on the continuity of observation, the timing during rotations and the role of the supervisor. Moreover, by discussing our results through the lens of identity formation theory, this work advances our conceptual understanding of MSF. We propose identity formation theory as a framework for future research on MSF to leverage the potential of MSF in residency training.
- Published
- 2022
41. ‘Poorly relaxed women’: A situational analysis of pelvic examination learning materials for medical students
- Author
-
Sarah Towle
- Subjects
Canada ,Students, Medical ,Humans ,Learning ,Female ,Curriculum ,Gynecological Examination ,General Medicine ,Education, Medical, Undergraduate ,Education - Abstract
Certain clinical pelvic examination (PE) teaching methods have been critiqued for prioritising student learning over patient autonomy and for not accurately representing diverse patient communities. As such, patient-centred and culturally competent approaches to the PE may need further emphasis in the medical curriculum-in particular, in content delivered to students before patient interaction. Classroom materials serve as students' first exposure to the sensitive procedure. This research explores how patients are represented in these materials.A situational analysis was conducted on 10 purposively sampled PE learning materials for the 2019/20 academic year from five undergraduate medical schools in Canada. Situational analysis focuses on analysing discourse but is epistemically aligned with post-structuralism (most notably Foucault's theories involving discursive power) and allows for specific consideration of 'silences' in the data. Collected data were analysed using cartographic approaches according to this methodology, with particular attention paid to the tenets and frameworks of patient-centred and culturally competent care.Overall, content in these materials misrepresented and under-represented patients. Materials contained both outdated and unnecessarily sexualised language, in addition to a lack of patient diversity. Clinical authority was often centred over patient agency, and several updated PE techniques known to improve patient experience were absent. Patient-centred and culturally competent approaches were therefore inadequately highlighted in most of the materials.Depictions contained in these materials may be perpetuating stereotypes and biases in medicine and may be working to maintain teaching practices that cause harm to patients (standardised and regular) who students interact with in both clinical and educational settings. Efforts may be needed to improve classroom materials on the PE so that they more adequately centre patients and provide opportunities to discuss culturally competent approaches to the procedure that (i) may not be covered in other parts of the PE curriculum and (ii) can reduce known health disparities.
- Published
- 2022
42. An Interpretive Phenomenological Analysis of paediatric cardiology trainee experiences during COVID‐19
- Author
-
Sadia Quyam and Mohammad Abumehdi
- Subjects
Surveys and Questionnaires ,Cardiology ,COVID-19 ,Humans ,General Medicine ,Empathy ,Child ,Pandemics ,Education - Abstract
Medical training during the COVID-19 pandemic has placed extra-ordinary demands on individuals within a context of rapid and iterative systems changes. The contemporaneous lived experience of trainees during this time has mainly been examined with surveys. Our study aims to provide a rich account of the experience of being a trainee during the pandemic to deepen our conceptual understanding of wellness. This holds relevance as we move away from examining the immediate innovations of the pandemic and towards long-term adjustments.We used Interpretative Phenomenological Analysis (IPA) to explore the experiences of trainees in paediatric cardiology during the pandemic. Five trainees were purposively recruited. Initial semi-structured interviews were held during the first wave of the pandemic with follow-up interviews held during the second wave.Three superordinate paradoxical themes were recognised in the data: connectedness and isolation, disruption and stasis and vulnerability and strength.Disruption to routine activities of service delivery, training and home-life pervaded the pandemic and was experienced as stasis. Technology maintained the trainee's connection to the content of work but left them feeling isolated from its context. Vulnerability arose from interplay between illness, uncertainty and perception of risk, contrasted against strength drawn from compassion and the discovery of resilience. Supporting trainees as we emerge from the initial phase of the pandemic requires us to review how we understand and address wellness, including the contribution of organisational and systemic factors to its protection. Participants described varying states of impaired wellness and experienced a normalisation of aspects of vulnerability. We theorise that trainees were able to find opportunities for growth and the development of resilience within the space that this created.
- Published
- 2022
43. Explicit teaching in the operating room
- Author
-
Mike Huiskes, Sjoerd K. Bulstra, Martin Stevens, Fokie Cnossen, Debbie Jaarsma, Patrick Nieboer, Artificial Intelligence, Public Health Research (PHR), Restoring Organ Function by Means of Regenerative Medicine (REGENERATE), and Lifelong Learning, Education & Assessment Research Network (LEARN)
- Subjects
Motivation ,Operating Rooms ,Medical education ,Structured analysis ,Process (engineering) ,Communication ,Teaching ,media_common.quotation_subject ,Internship and Residency ,Videotape Recording ,Context (language use) ,General Medicine ,Outcome (game theory) ,Preference ,Education ,Conversation analysis ,Humans ,Observational study ,Quality (business) ,Psychology ,media_common - Abstract
CONTEXT: Residents need their supervisors in the operating room to inform them on how to use their expertise in present and future occasions. A few studies hint at such explicit teaching behaviour, however without explaining its underlying mechanisms. Understanding and improving explicit teaching becomes more salient nowadays, as access of residents to relevant procedures is decreasing, while end-terms of training programs remain unchanged: high quality patient care.OBJECTIVES: A structured analysis of 1. The practices supervisors use for explicit teaching and 2. How supervisors introduce explicit teaching in real time during surgical procedures.METHODS: An observational qualitative collection study in which all actions of nine supervisor-resident dyads during a total hip replacement procedure were videotaped. Interactions in which supervisors explicitly or implicitly inform residents how to use their expertise now and in future occasions were included for further analysis, using the iterative inductive process of conversation analysis.RESULTS: 1. Supervisors used a basic template of if/then rules for explicit teaching, which they regularly customized by adding metaphors, motivations, and information about preference, prevalence and consequence. 2. If/then rules are introduced by supervisors to solve a (potential) problem in outcome for the present patient in reaction to local circumstances, e.g. what residents said, did or were about to do.CONCLUSIONS: If/then rules add the why to the what. Supervisors upgrade residents' insights in surgical procedures (professional vision) and teach the degree of individual freedom and variation of their expert standards for future occasions. These insights can be beneficial in improving supervisors' teaching skills.
- Published
- 2022
44. Addressing harm and establishing trust in peer review: Recommendations for action
- Author
-
Archna Eniasivam, Aimee Medeiros, and Megha Garg
- Subjects
Humans ,General Medicine ,Trust ,Peer Group ,Education - Published
- 2022
45. Who's on your team? Specialty identity and inter‐physician conflict during admissions
- Author
-
Caitlin Schrepel, Ashley E. Amick, Maralyssa Bann, Bjorn Watsjold, Joshua Jauregui, Jonathan S. Ilgen, and Stefanie S. Sebok‐Syer
- Subjects
Communication ,Physicians ,Emergency Medicine ,Internal Medicine ,Humans ,Patient Care ,General Medicine ,Education - Abstract
Despite the implementation of professionalism curricula and standardised communication tools, inter-physician conflict persists. In particular, the interface between emergency medicine (EM) and internal medicine (IM) has long been recognised as a source of conflict. The social nuances of this conflict remain underexplored, limiting educators' ability to comprehensively address these issues in the clinical learning environment. Thus, the authors explored EM and IM physicians' experiences with negotiating hospital admissions to better understand the social dynamics that contribute to inter-physician conflict and provide foundational guidance for communication best practices.Using a constructivist grounded theory (CGT) approach, the authors conducted 18 semi-structured interviews between June and October 2020 with EM and IM physicians involved in conversations regarding admissions (CRAs). They asked participants to describe the social exchanges that influenced these conversations and to reflect on their experiences with inter-physician conflict. Data collection and analysis occurred iteratively. The relationships between the codes were discussed by the research team with the goal of developing conceptual connections between the emergent themes.Participants described how their approaches to CRAs were shaped by their specialty identity, and how allegiance to members of their group contributed to interpersonal conflict. This conflict was further promoted by a mutual sense of disempowerment within the organisation, misaligned expectations, and a desire to promote their group's prerogatives. Conflict was mitigated when patient care experiences fostered cross-specialty team formation and collaboration that dissolved traditional group boundaries.Conflict between EM and IM physicians during CRAs was primed by participants' specialty identities, their power struggles within the broader organisation, and their sense of duty to their own specialty. However, formation of collaborative inter-specialty physician teams and expansion of identity to include colleagues from other specialties can mitigate inter-physician conflict.
- Published
- 2022
46. Patient involvement in assessment of postgraduate medical learners: A scoping review
- Author
-
Roy Khalife, Manika Gupta, Carol Gonsalves, Yoon Soo Park, Janet Riddle, Ara Tekian, and Tanya Horsley
- Subjects
Education, Medical ,Humans ,Medicine ,General Medicine ,Patient Participation ,Education - Abstract
Competency-based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent.We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment.We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand-alone group or part of a multi-source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise.Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading-comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.
- Published
- 2022
47. Determining influence, interaction and causality of contrast and sequence effects in objective structured clinical exams
- Author
-
Peter Yeates, Alice Moult, Natalie Cope, Gareth McCray, Richard Fuller, and Robert McKinley
- Subjects
Humans ,Clinical Competence ,Educational Measurement ,General Medicine ,Education - Abstract
Differential rater function over time (DRIFT) and contrast effects (examiners' scores biased away from the standard of preceding performances) both challenge the fairness of scoring in objective structured clinical exams (OSCEs). This is important as, under some circumstances, these effects could alter whether some candidates pass or fail assessments. Benefitting from experimental control, this study investigated the causality, operation and interaction of both effects simultaneously for the first time in an OSCE setting.We used secondary analysis of data from an OSCE in which examiners scored embedded videos of student performances interspersed between live students. Embedded video position varied between examiners (early vs. late) whilst the standard of preceding performances naturally varied (previous high or low). We examined linear relationships suggestive of DRIFT and contrast effects in all within-OSCE data before comparing the influence and interaction of 'early' versus 'late' and 'previous high' versus 'previous low' conditions on embedded video scores.Linear relationships data did not support the presence of DRIFT or contrast effects. Embedded videos were scored higher early (19.9 [19.4-20.5]) versus late (18.6 [18.1-19.1], p 0.001), but scores did not differ between previous high and previous low conditions. The interaction term was non-significant.In this instance, the small DRIFT effect we observed on embedded videos can be causally attributed to examiner behaviour. Contrast effects appear less ubiquitous than some prior research suggests. Possible mediators of these finding include the following: OSCE context, detail of task specification, examiners' cognitive load and the distribution of learners' ability. As the operation of these effects appears to vary across contexts, further research is needed to determine the prevalence and mechanisms of contrast and DRIFT effects, so that assessments may be designed in ways that are likely to avoid their occurrence. Quality assurance should monitor for these contextually variable effects in order to ensure OSCE equivalence.
- Published
- 2022
48. International medical graduates' experiences before and after migration: A meta‐ethnography of qualitative studies
- Author
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Evi Germeni, Susan Jamieson, and Mo Al-Haddad
- Subjects
Medical education ,education ,MEDLINE ,Conceptual model (computer science) ,Psychological intervention ,General Medicine ,PsycINFO ,Education ,Argument ,Physicians ,Humans ,Foreign Medical Graduates ,Psychology ,Inclusion (education) ,Anthropology, Cultural ,Qualitative Research ,Disadvantage ,Qualitative research - Abstract
Introduction: \ud International Medical Graduates (IMGs) represent a large portion of practicing doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK’s General Medical Council (GMC) recently set targets to ‘eliminate disproportionate complaints’ and ‘eradicate disadvantage and discrimination in medical education’. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs, to identify factors affecting IMGs’ professional practice (either directly or indirectly).\ud \ud Methods: \ud In September 2019 we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors’ themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts.\ud \ud Results: \ud Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practicing in all 6 continents in a range of settings, including primary and secondary care. We developed 5 key concepts: Migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the 4 main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented.\ud \ud Conclusions: \ud This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
- Published
- 2022
49. Unpacking economic programme theory for supervision training: Preliminary steps towards realist economic evaluation
- Author
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Stephen Maloney, Ella Ottrey, Claire Palermo, Jonathan Foo, Charlotte E. Rees, Van N. B. Nguyen, and Vicki Edouard
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Program evaluation ,Victoria ,Cost-Benefit Analysis ,Context (language use) ,General Medicine ,Education ,Facilitator ,Economic evaluation ,Mathematics education ,Humans ,Program Design Language ,Duration (project management) ,Psychology ,Competence (human resources) ,Dyad - Abstract
INTRODUCTION Cost studies are increasingly popular given resource constraints. While scholars stress the context-dependent nature of cost, and the importance of theory, cost studies remain context-blind and atheoretical. However, realist economic evaluation (REE) privileges context and the testing/refinement of economic program theory. This preliminary REE serves to test and refine economic program theory for supervision training programs of different durations to better inform future program design/implementation. METHODS Our preliminary REE unpacked how short (half-day) and extended (12-week) supervision training programs in Victoria, Australia produced costs and outcomes. We employed mixed methods: qualitative realist and quantitative cost methods. Economically optimised program models were developed guided by identified cost-sensitive mechanisms and contexts. RESULTS As part of identified context-mechanism-outcome configurations (CMOCs) for both training programs, we found a wider diversity of positive outcomes but greater costs for the extended program (11 outcomes; AU$3,069/learner) compared with the short program (7 outcomes; $385/learner). We identified four shared cost-sensitive mechanisms for both programs (training duration, learner protected time, learner engagement, and facilitator competence), and one shared cost-sensitive context (learners' supervisory experience). We developed two economically optimised program models: (1) short program for experienced supervisors facilitated by senior educators ($406/learner); and (2) extended program for inexperienced supervisors facilitated by junior educators ($2,104/learner). DISCUSSION Our initial economic program theory was somewhat supported, refuted, and refined. Results were partly consistent with previous research, but also extended it through unpacking cost-sensitive mechanisms and contexts. While our preliminary REE fills a pressing gap in the methodology literature, conducting REE was challenging given our desire to integrate economic and realist analyses fully, and remain faithful to realist principles. Attention to training duration and experience levels of the facilitator-learner dyad may help to balance the cost and outcomes of training programs.
- Published
- 2021
50. Longitudinal placements for trainee pharmacists: Learning whilst improving patient care
- Author
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Jeremy Sokhi, David T. Wright, Hannah Kinsey, and Maria Christou
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Medical education ,Health professionals ,education ,Professional development ,General Medicine ,Pharmacists ,Patient care ,Education ,Learning experience ,Practice learning ,Community of practice ,Qualitative longitudinal ,Humans ,Learning ,Clinical Competence ,Patient Care ,Psychology ,Hospital ward ,Education, Medical, Undergraduate - Abstract
Introduction: Longitudinal Integrated Clerkships (LICs) have demonstrated benefits for students' learning and development in medical education globally. The model emphasises importance with respect to continuity and time in the workplace for learners. There is a need to explore how LICs become a viable training model for learners. An amalgamative LIC model was drawn upon to inform the design of a placement for trainee pharmacists on a hospital ward. This study sought to determine the local viability of a longitudinal placement for trainee pharmacists, using communities of practice learning theory to interpret findings. Methods: A design-based research approach informed study design. A longitudinal placement was implemented on two hospital wards for 13 weeks. Trainees (n = 3) were interviewed four times over a 14-week period. Ward staff (n = 14) were interviewed at week 14. Interviews were transcribed verbatim. Qualitative longitudinal analysis, using the trajectory approach, was conducted using abductive analysis. The coded data were organised into a framework and subthemes were created. Results: Trainees acquired membership within the multi-disciplinary ward team over time. This led to an enriched learning experience and the trainee's professional development improved as they attained more responsibilities. This enabled them to make a greater contribution to patient care; more medication consultations occurred, and discharge times improved. Discussion: The local viability of the longitudinal placement appears to be linked to the trainee's ability to acquire membership within the ward community of practice. Membership gave trainee's access to learning opportunities, supporting their development, and they earnt the trust of staff, leading to more responsibilities for providing patient care. Further research into developing longitudinal placements that support trainee healthcare professionals to acquire membership within communities of practice is warranted.
- Published
- 2021
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