Authors:Michael Paget; Gurbir Brar; Pamela Veale; Kevin Busche; Sylvain Coderre; Wayne Woloschuk; Kevin McLaughlin Pages: 241 - 247 Abstract: Prior studies have shown a correlation between the grades students receive and how they rate their teacher in the classroom. In this study, the authors probe this association on clinical rotations and explore potential mechanisms. All In-Training Evaluation Reports (ITERs) for students on mandatory clerkship rotations from April 1, 2013 to January 31, 2015 were matched with the corresponding student’s rating of their teacher (SRT). The date and time that ITERs and SRTs were submitted was used to divide SRTs into those submitted before versus after the corresponding ITER was submitted. Multilevel, mixed effects linear regression was used to examine the association between SRT, ITER rating, and whether the ITER was submitted before or after SRT. Of 2373 paired evaluations, 1098 (46.3%) SRT were submitted before the teacher had submitted the ITER. There was a significant interaction between explanatory variables: when ITER ratings had not yet been submitted, the regression coefficient for this association was 0.25 (95% confidence interval [0.17, 0.33], p < 0.001), whereas the regression coefficient was significantly higher when ITER ratings were submitted prior to SRT (0.40 [0.31, 0.49], p < 0.001). Finding an association between SRT and ITER when students do not know their ITER ratings suggests that SRTs can capture attributes of effective teaching, but the effect modification when students have access to their ITER rating supports grade satisfaction bias. Further studies are needed to explain the mechanism of grade satisfaction and to identify other biases that may impact the validity of SRT. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9783-0 Issue No:Vol. 23, No. 2 (2018)
Authors:Claudio Violato; Hong Gao; Mary Claire O’Brien; David Grier; E Shen Pages: 249 - 263 Abstract: The distinction between basic sciences and clinical knowledge which has led to a theoretical debate on how medical expertise is developed has implications for medical school and lifelong medical education. This longitudinal, population based observational study was conducted to test the fit of three theories—knowledge encapsulation, independent influence, distinct domains—of the development of medical expertise employing structural equation modelling. Data were collected from 548 physicians (292 men—53.3%; 256 women—46.7%; mean age = 24.2 years on admission) who had graduated from medical school 2009–2014. They included (1) Admissions data of undergraduate grade point average and Medical College Admission Test sub-test scores, (2) Course performance data from years 1, 2, and 3 of medical school, and (3) Performance on the NBME exams (i.e., Step 1, Step 2 CK, and Step 3). Statistical fit indices (Goodness of Fit Index—GFI; standardized root mean squared residual—SRMR; root mean squared error of approximation—RSMEA) and comparative fit \((X_{D}^{2} ,X^{2} )\) of three theories of cognitive development of medical expertise were used to assess model fit. There is support for the knowledge encapsulation three factor model of clinical competency (GFI = 0.973, SRMR = 0.043, RSMEA = 0.063) which had superior fit indices to both the independent influence and distinct domains theories ( \(X_{29}^{2} = 88.11\) vs \(X_{29}^{2} = 443.91\) [ \(X_{D}^{2} = 355.80\) ] vs \(X_{29}^{2} = 514.93\) [ \(X_{D}^{2} = 426.82\) ], respectively). The findings support a theory where basic sciences and medical aptitude are direct, correlated influences on clinical competency that encapsulates basic knowledge. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9784-z Issue No:Vol. 23, No. 2 (2018)
Authors:Eunbae B. Yang; Myung Ae Lee; Yoon Soo Park Pages: 265 - 274 Abstract: In 2012, the National Health Personnel Licensing Examination Board of Korea decided to publicly disclose all test items and answers to satisfy the test takers’ right to know and enhance the transparency of tests administered by the government. This study investigated the effects of item disclosure on the medical licensing examination (MLE), examining test taker performance, psychometric characteristics, and factors affecting pass rates. This paper analyzed examinee performance data (n = 20,455) from 41 medical schools who took the MLE before (2009–2011) and after (2012–2014) the item disclosure policy (5548 total items). Changes in passing rates, performance of examinee, difficulty and reliability of the test, and factors affecting pass rate of the medical licensing examination before and after item disclosure were analyzed. In order to identify changes caused by item disclosure in the effects of student and school variables on the passing rate of MLE, Binary Logistic Hierarchical Linear Model was used. There was no significant change in pass rates before and after item disclosure. There was a modest increase in the proportion of test takers in the high-scoring group, following item disclosure. Degree completion status, gender, age of applicants and school mean were significant factors affecting pass rates, regardless of item disclosure. There was no difference between passing rates before and after item disclosure with respect to student- and school-level variables. Despite potential concerns for changes in test and examinee characteristics, empirical findings indicate that there was no significant difference caused by implementing item disclosure. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9788-8 Issue No:Vol. 23, No. 2 (2018)
Authors:Andrea Oudkerk Pool; Marjan J. B. Govaerts; Debbie A. D. C. Jaarsma; Erik W. Driessen Pages: 275 - 287 Abstract: While portfolios are increasingly used to assess competence, the validity of such portfolio-based assessments has hitherto remained unconfirmed. The purpose of the present research is therefore to further our understanding of how assessors form judgments when interpreting the complex data included in a competency-based portfolio. Eighteen assessors appraised one of three competency-based mock portfolios while thinking aloud, before taking part in semi-structured interviews. A thematic analysis of the think-aloud protocols and interviews revealed that assessors reached judgments through a 3-phase cyclical cognitive process of acquiring, organizing, and integrating evidence. Upon conclusion of the first cycle, assessors reviewed the remaining portfolio evidence to look for confirming or disconfirming evidence. Assessors were inclined to stick to their initial judgments even when confronted with seemingly disconfirming evidence. Although assessors reached similar final (pass–fail) judgments of students’ professional competence, they differed in their information-processing approaches and the reasoning behind their judgments. Differences sprung from assessors’ divergent assessment beliefs, performance theories, and inferences about the student. Assessment beliefs refer to assessors’ opinions about what kind of evidence gives the most valuable and trustworthy information about the student’s competence, whereas assessors’ performance theories concern their conceptualizations of what constitutes professional competence and competent performance. Even when using the same pieces of information, assessors furthermore differed with respect to inferences about the student as a person as well as a (future) professional. Our findings support the notion that assessors’ reasoning in judgment and decision-making varies and is guided by their mental models of performance assessment, potentially impacting feedback and the credibility of decisions. Our findings also lend further credence to the assertion that portfolios should be judged by multiple assessors who should, moreover, thoroughly substantiate their judgments. Finally, it is suggested that portfolios be designed in such a way that they facilitate the selection of and navigation through the portfolio evidence. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9793-y Issue No:Vol. 23, No. 2 (2018)
Authors:Jeromy Anglim; Stefan Bozic; Jonathon Little; Filip Lievens Pages: 311 - 321 Abstract: The current study examined the degree to which applicants applying for medical internships distort their responses to personality tests and assessed whether this response distortion led to reduced predictive validity. The applicant sample (n = 530) completed the NEO Personality Inventory whilst applying for one of 60 positions as first-year post-graduate medical interns. Predictive validity was assessed using university grades, averaged over the entire medical degree. Applicant responses for the Big Five (i.e., neuroticism, extraversion, openness, conscientiousness, and agreeableness) and 30 facets of personality were compared to a range of normative samples where personality was measured in standard research settings including medical students, role model physicians, current interns, and standard young-adult test norms. Applicants had substantially higher scores on conscientiousness, openness, agreeableness, and extraversion and lower scores on neuroticism with an average absolute standardized difference of 1.03, when averaged over the normative samples. While current interns, medical students, and especially role model physicians do show a more socially desirable personality profile than standard test norms, applicants provided responses that were substantially more socially desirable. Of the Big Five, conscientiousness was the strongest predictor of academic performance in both applicants (r = .11) and medical students (r = .21). Findings suggest that applicants engage in substantial response distortion, and that the predictive validity of personality is modest and may be reduced in an applicant setting. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9796-8 Issue No:Vol. 23, No. 2 (2018)
Authors:Jerome I. Rotgans; Henk G. Schmidt; Preman Rajalingam; Joey Wong Ying Hao; Claire Ann Canning; Michael A. Ferenczi; Naomi Low-Beer Pages: 339 - 351 Abstract: The objective of the paper is to report findings of two studies that attempted to find answers to the following questions: (1) What are the levels of cognitive engagement in TBL' (2) Are there differences between students who were more exposed to TBL than students who were less exposed to TBL' (3) To which extent does cognitive engagement fluctuate as a function of the different activities involved in TBL' And (4) How do cognitive engagement scores collected over time correlate with each other and with academic achievement' The studies were conducted with Year-1 and -2 medical students enrolled in a TBL curriculum (N = 175, 62 female). In both studies, six measurements of cognitive engagement were taken during the distinct TBL activities (preparation phase, individual/team readiness assurance test, burning questions, and application exercises). Data were analysed by means of one-way repeated-measures ANOVAs and path modelling. The results of the repeated-measures ANOVA revealed that cognitive engagement systematically fluctuated as a function of the distinct TBL activities. In addition, Year-1 students reported significantly higher levels of cognitive engagement compared to Year-2 students. Finally, cognitive engagement was a significant predictor of performance (β = .35). The studies presented in this paper are a first attempt to relate the different activities undertaken in TBL with the extent to which they arouse cognitive engagement with the task at hand. Implications of these findings for TBL are discussed. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9801-2 Issue No:Vol. 23, No. 2 (2018)
Authors:Assaf Givati; Chris Markham; Ken Street Pages: 353 - 369 Abstract: Over the past 2 decades, as part of reforms to the National Health Service and with it organizational changes to ambulance work in the UK, paramedic education has undergone a process of academisation and a shift from in-house, apprenticeship weeks-long occupational training, to university-based undergraduate programs. While the professional regulation and standardization of Allied Health Professionals’ education in high-income countries has captured scholarly attention, the study of paramedic practice is still in its infancy and there is a need to explore its evolvement in relation to the fluid societal–political circumstances affecting its provision and demand. Based on interviews with front-line paramedics, paramedic educators and paramedic science students in the South of England, this article examines how the reforms to paramedic education have impacted the professionalization of paramedics and their discourse of professionalism. Framed within to the ‘new’ sociology of professions, the case of British paramedics demonstrates the complex nature of the relationship between the university and professional practice. It appears that universities, the providers of paramedic education, are caught between two opposing discourses of professionalism: on the one hand, that of providing a platform for students’ socialization and engagement with professionalism ‘from within’ practice which is based on students’ common goals and mutual experiences, and, on the other hand, serving as a conduit for managerial/organizational strategies of professionalism which appear to undermine the role of university socialization. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9802-1 Issue No:Vol. 23, No. 2 (2018)
Authors:S. Barradell; T. Peseta; S. Barrie Pages: 387 - 406 Abstract: Health science courses aim to prepare students for the demands of their chosen profession by learning ways appropriate to that profession and the contexts they will work and live in. Expectations of what students should learn become re-contextualised and translated into entry-level curriculum, with students operating as a connection between what is intended and enacted in curriculum, and required in the real world. Drawing on phenomenology, this paper explores how students understand practice—the collective, purposeful knowing, doing and being of a community—in entry-level physiotherapy programs. Ways of thinking and practising (WTP)—a framework attentive to the distinctive nature of a discipline, its values, philosophies and world-view (McCune and Hounsell in High Educ 49(3):255–289, 2005)—provides the conceptual lens. Six themes describing how students see the WTP of physiotherapy practice emerged from the analysis: discovery of new knowledge; problem solving client related contexts; adopting a systems based approach to the body; contributing to a positive therapeutic alliance; developing a sense of self and the profession; and the organisation of the workforce. The study produces knowledge about practice by focusing on physiotherapy students’ experiences of disciplinary learning. Including students in educational research in this way is an approach that can help students realise their potential as part of a community of practice. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9804-z Issue No:Vol. 23, No. 2 (2018)
Authors:Kristin Lo; Jamie Waterland; Paula Todd; Tanvi Gupta; Margaret Bearman; Craig Hassed; Jennifer L. Keating Pages: 413 - 447 Abstract: Effects of interventions for improving mental health of health professional students has not been established. This review analysed interventions to support mental health of health professional students and their effects. The full holdings of Medline, PsycINFO, EBM Reviews, Cinahl Plus, ERIC and EMBASE were searched until 15th April 2016. Inclusion criteria were randomised controlled trials of undergraduate and post graduate health professional students, group interventions to support mental health compared to alternative education, usual curriculum or no intervention; and post-intervention measurements for intervention and control participants of mindfulness, anxiety, depression, stress/distress or burnout. Studies were limited to English and short term effects. Studies were appraised using the PEDro scale. Data were synthesised using meta-analysis. Four comparisons were identified: psychoeducation or cognitive-behavioural interventions compared to alternative education, and mindfulness or relaxation compared to control conditions. Cognitive-behavioural interventions reduced anxiety (−0.26; −0.5 to −0.02), depression (−0.29; −0.52 to −0.05) and stress (0.37; −0.61 to −0.13). Mindfulness strategies reduced stress (−0.60; −0.97 to −0.22) but not anxiety (95% CI −0.21 to 0.18), depression (95% CI −0.36 to 0.03) or burnout (95% CI −0.36 to 0.10). Relaxation strategies reduced anxiety (SMD −0.80; 95% CI −1.03 to −0.58), depression (−0.49; −0.88 to −0.11) and stress (−0.34; −0.67 to −0.01). Method quality was generally poor. Evidence suggests that cognitive-behavioural, relaxation and mindfulness interventions may support health professional student mental health. Further high quality research is warranted. PubDate: 2018-05-01 DOI: 10.1007/s10459-017-9770-5 Issue No:Vol. 23, No. 2 (2018)
Authors:Virginie F. C. Servant-Miklos Abstract: This paper sheds light on an intellectual dispute on the purpose of problem-based learning that took place in the 1970s between two major figures in the history of PBL: Howard S Barrows from McMaster University and Henk Schmidt from Maastricht University. Using historical evidence from archive materials, oral history accounts and contemporary publications, the paper shows that at the core of the dispute was their divergent understanding of cognitive psychology. On the one hand, Barrows espoused hypothetico-deduction, and on the other, Henk Schmidt was a proponent of constructivism. The paper shows how the dispute played out both in the scientific literature and in the divergent practice of PBL at McMaster and Maastricht and continues to affect the way PBL is done today. PubDate: 2018-05-30 DOI: 10.1007/s10459-018-9835-0
Authors:Yanting Zhang; Siqin Dong; Wenjie Fang; Xiaohui Chai; Jiaojiao Mei; Xiuzhen Fan Abstract: Academic procrastination has been a widespread problem behavior among undergraduates. This study aimed to examine the prevalence of academic procrastination among undergraduates in health professions, and explore the mediation effects of self-efficacy for self-regulation and fear of failure in the relationship between self-esteem and academic procrastination. A cross-sectional design was used to study 1184 undergraduates in health professions from China. Participants completed measures of academic procrastination, self-esteem, self-efficacy for self-regulation and fear of failure. We used Pearson product-moment correlation to examine the bivariate correlations between study variables, and path analysis to examine mediation. Among the 1184 undergraduates, 877 (74.1%) procrastinated on at least one type of academic task. The total score for academic procrastination was negatively correlated with scores for self-esteem and self-efficacy for self-regulation, and positively correlated with the score for fear of failure. Moreover, the relationship between self-esteem and academic procrastination was fully mediated by self-efficacy for self-regulation (indirect effect: β = − .15, 95% bootstrap CI − .19 to − .11) and fear of failure (indirect effect: β = − .06, 95% bootstrap CI − .09 to − .04). These findings suggest that interventions targeting the enhancement of self-efficacy for self-regulation and the conquest of fear of failure may prevent or reduce academic procrastination among undergraduates in health professions, especially for those with lower self-esteem. PubDate: 2018-05-29 DOI: 10.1007/s10459-018-9832-3
Authors:Kevin W. Eva; Colleen Brady; Marion Pearson; Katherine Seto Abstract: Information is generally more memorable after it is studied and tested than when it is only studied. One must be cautious to use this phenomenon strategically, however, due to uncertainty about whether testing improves memorability for only tested material, facilitates learning of related non-tested content, or inhibits memory of non-tested material. 52 second-year Pharmacy students were asked to study therapeutic aspects of gastroesophageal reflux disease and peptic ulcer disease. One group was given 30 min to study. Another was given 20 min to study and 10 min to complete a 10-item test. Two weeks later a 40-item test was delivered to both groups that contained (a) the 10 learning phase questions, (b) 10 new questions drawn from the studied material, (c) 10 new questions about therapeutics in different disease states, and (d) 10 new questions drawn from more general pharmaceutical knowledge (e.g., basic physiology and drug characteristics). Moderate to large retrieval-enhanced learning effects were observed for both questions about material that was tested (22.9% difference in scores, p < 0.05, d = 0.60) and questions about material that was studied without being tested (18.9% difference, p < 0.05, d = 0.75). Such effects were not observed for questions that were not part of the study material: therapeutic questions that addressed different disease states (1.8% difference, p > 0.7, d = 0.08) or generic pharmaceutical questions (7.4% difference, p > 0.2, d = 0.32). Being tested made it more likely that students would report reviewing the material after the initial learning session, but such reports were not associated with better test performance. The benefit of mentally retrieving information from studied material appears to facilitate the retrieval of information that was studied without being tested. Such generalization of the benefit of testing can increase the flexibility of test-based pedagogic interventions. PubDate: 2018-05-26 DOI: 10.1007/s10459-018-9831-4
Authors:Patricia Thille; Barbara E. Gibson; Thomas Abrams; Laura C. McAdam; Bhavnita Mistry; Jenny Setchell Abstract: For those with chronic, progressive conditions, high quality clinical care requires attention to the human dimensions of illness—emotional, social, and moral aspects—which co-exist with biophysical dimensions of disease. Reflexivity brings historical, institutional, and socio-cultural influences on clinical activities to the fore, enabling consideration of new possibilities. Continuing education methodologies that encourage reflexivity may improve clinical practice and trainee learning, but are rare. We piloted a dialogical methodology with a children’s rehabilitation team to foster reflexivity (patient population: young people with Duchenne’s or Becker’s muscular dystrophy). The methodology involved three facilitated, interactive dialogues with the clinical team. Each dialogue involved clinicians learning to apply a social theory (Mol’s The Logic of Care) to ethnographic fieldnotes of clinical appointments, to make routine practice less familiar and thus open to examination. Discourse analyses that preserve group dynamics were completed to evaluate the extent to which the dialogues spurred reflexive dialogue within the team. Overall, imagining impacts of clinical care on people’s lives—emphasized in the social theory applied to fieldnotes—showed promise, shifting how clinicians interpreted routine practices and spurring many plans for change. However, this reflexive orientation was not sustained throughout, particularly when examining entrenched assumptions regarding ‘best practices’. Clinicians defended institutional practices by co-constructing the metaphor of balancing logics in care delivery. When invoked, the balance metaphor deflected attention from emotional, social, and moral impacts of clinical care on patients and their families. Emergent findings highlight the value of analysing reflexivity-oriented dialogues using discourse analysis methods. PubDate: 2018-05-24 DOI: 10.1007/s10459-018-9834-1
Authors:W. Dale Dauphinee; John R. Boulet; John J. Norcini Abstract: Educational assessment for the health professions has seen a major attempt to introduce competency based frameworks. As high level policy developments, the changes were intended to improve outcomes by supporting learning and skills development. However, we argue that previous experiences with major innovations in assessment offer an important road map for developing and refining assessment innovations, including careful piloting and analyses of their measurement qualities and impacts. Based on the literature, numerous assessment workshops, personal interactions with potential users, and our 40 years of experience in implementing assessment change, we lament the lack of a coordinated approach to clarify and improve measurement qualities and functionality of competency based assessment (CBA). To address this worrisome situation, we offer two roadmaps to guide CBA’s further development. Initially, reframe and address CBA as a measurement development opportunity. Secondly, using a roadmap adapted from the management literature on sustainable innovation, the medical assessment community needs to initiate an integrated plan to implement CBA as a sustainable innovation within existing educational programs and self-regulatory enterprises. Further examples of down-stream opportunities to refocus CBA at the implementation level within faculties and within the regulatory framework of the profession are offered. In closing, we challenge the broader assessment community in medicine to step forward and own the challenge and opportunities to reframe CBA as an innovation to improve the quality of the clinical educational experience. The goal is to optimize assessment in health education and ultimately improve the public’s health. PubDate: 2018-05-18 DOI: 10.1007/s10459-018-9833-2
Authors:G. Bordage; G. Page Abstract: The key-features (KFs) approach to assessment was initially proposed during the First Cambridge Conference on Medical Education in 1984 as a more efficient and effective means of assessing clinical decision-making skills. Over three decades later, we conducted a comprehensive, systematic review of the validity evidence gathered since then. The evidence was compiled according to the Standards for Educational and Psychological Testing’s five sources of validity evidence, namely, Content, Response process, Internal structure, Relations to other variables, and Consequences, to which we added two other types related to Cost-feasibility and Acceptability. Of the 457 publications that referred to the KFs approach between 1984 and October 2017, 164 are cited here; the remaining 293 were either redundant or the authors simply mentioned the KFs concept in relation to their work. While one set of articles reported meeting the validity standards, another set examined KFs test development choices and score interpretation. The accumulated validity evidence for the KFs approach since its inception supports the decision-making construct measured and its use to assess clinical decision-making skills at all levels of training and practice and with various types of exam formats. Recognizing that gathering validity evidence is an ongoing process, areas with limited evidence, such as item factor analyses or consequences of testing, are identified as well as new topics needing further clarification, such as the use of the KFs approach for formative assessment and its place within a program of assessment. PubDate: 2018-05-17 DOI: 10.1007/s10459-018-9830-5
Authors:Larissa den Boer; Marieke F. van der Schaaf; Koen L. Vincken; Chris P. Mol; Bobby G. Stuijfzand; Anouk van der Gijp Abstract: The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The current study aimed to gain deeper insight into the volumetric image interpretation process by examining this process in twenty radiology trainees who all completed four volumetric image cases. Two types of data were obtained concerning scroll behaviors and think-aloud data. Types of scroll behavior concerned oscillations, half runs, full runs, image manipulations, and interruptions. Think-aloud data were coded by a framework of knowledge and skills in radiology including three cognitive processes: perception, analysis, and synthesis. Relating scroll behavior to cognitive processes showed that oscillations and half runs coincided more often with analysis and synthesis than full runs, whereas full runs coincided more often with perception than oscillations and half runs. Interruptions were characterized by synthesis and image manipulations by perception. In addition, we investigated relations between cognitive processes and found an overall bottom-up way of reasoning with dynamic interactions between cognitive processes, especially between perception and analysis. In sum, our results highlight the dynamic interactions between these processes and the grounding of cognitive processes in scroll behavior. It suggests, that the types of scroll behavior are relevant to describe how radiologists interact with and manipulate volumetric images. PubDate: 2018-05-16 DOI: 10.1007/s10459-018-9828-z
Authors:Martina Kelly; Rachel H. Ellaway; Helen Reid; Heather Ganshorn; Sarah Yardley; Deirdre Bennett; Tim Dornan Abstract: Qualitative evidence synthesis (QES) is a suite of methodologies that combine qualitative techniques with the synthesis of qualitative knowledge. They are particularly suited to medical education as these approaches pool findings from original qualitative studies, whilst paying attention to context and theoretical development. Although increasingly sophisticated use is being made of qualitative primary research methodologies in health professions education (HPE) the use of secondary qualitative reviews in HPE remains underdeveloped. This study examined QES methods applied to clinical humanism in healthcare as a way of advancing thinking around the use of QES in HPE in general. A systematic search strategy identified 49 reviews that fulfilled the inclusion criteria. Meta-study was used to develop an analytic summary of methodological characteristics, the role of theory, and the synthetic processes used in QES reviews. Fifteen reviews used a defined methodology, and 17 clearly explained the processes that led from data extraction to synthesis. Eight reviews adopted a specific theoretical perspective. Authors rarely described their reflexive relationship with their data. Epistemological positions tended to be implied rather than explicit. Twenty-five reviews included some form of quality appraisal, although it was often unclear how authors acted on its results. Reviewers under-reported qualitative approaches in their review methodologies, and tended to focus on elements such as systematicity and checklist quality appraisal that were more germane to quantitative evidence synthesis. A core concern was that the axiological (value) dimensions of the source materials were rarely considered let alone accommodated in the synthesis techniques used. QES can be used in HPE research but only with careful attention to maintaining axiological integrity. PubDate: 2018-05-14 DOI: 10.1007/s10459-018-9829-y
Authors:Tania M. Jenkins; Jenny Kim; Chelsea Hu; John C. Hickernell; Sarah Watanaskul; John D. Yoon Abstract: While previous studies have considered medical student burnout and resilience at discrete points in students’ training, few studies examine how stressors and resilience-building factors can emerge before, and during, medical school. Our study focuses on students’ life stories to comprehensively identify factors contributing to student wellbeing. We performed a secondary analysis of life-story interviews with graduating fourth year medical students. These interviews were originally conducted in 2012 as part of the Project on the Good Physician, and then re-analyzed, focusing on student wellbeing. Respondents were encouraged to identify turning points in their life stories. De-identified transcripts were then coded using a consensus-based iterative process. 17 of 21 respondents reported feeling burned out at least once during medical school. Students identified three major stressors: negative role models, difficult rotations, and the United States Medical Licensing Examination Step 1. Two “motivational stressors”—financial concerns and personal life events—emerged as sources of stress that also motivated students to persevere. Finally, students identified four factors—positive role models, support networks, faith and spirituality, and passion—that helped them reframe stressors, making the struggle seem more worthwhile. These findings suggest that a life-story approach can add granularity to current understandings of medical student wellbeing. Initiatives to reduce stress and burnout should extend beyond the immediate medical school context and consider how past challenges might become future sources of resilience. This study also provides an example of secondary analysis of qualitative data, an approach which could be useful to future research in medical education. PubDate: 2018-05-05 DOI: 10.1007/s10459-018-9827-0
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