Interprofessional education (IPE) is a critical component of medical education and is affected by the characteristics of the clinical teams in which students and residents train. However, clinical teams are often shaped by professional silos and hierarchies which may hinder interprofessional collaborative practice (IPCP). Narrative medicine, a branch of health humanities that focuses on close reading, reflective writing, and sharing in groups, could be an innovative approach for improving IPE and IPCP. In this report, we describe the structure, feasibility, and a process-oriented program evaluation of a narrative medicine program implemented in interprofessional team meetings in three academic primary care clinics. Program evaluation revealed that a year-long narrative medicine program with modest monthly exposure was feasible in academic clinical settings. Staff members expressed engagement and acceptability as well as support for ongoing implementation. Program success required administrative buy-in and sustainability may require staff training in narrative medicine. Electronic supplementary material The online version of this article (10.1007/s40037-019-0497-2) contains supplementary material, which is available to authorized users.
To establish a research and development agenda for Entrustable Professional Activities (EPAs) for the coming decade, the authors, all active in this area of investigation, reviewed recent research papers, seeking recommendations for future research. They pooled their knowledge and experience to identify 3 levels of potential research and development: the micro level of learning and teaching; the meso level of institutions, programs, and specialty domains; and the macro level of regional, national, and international dynamics. Within these levels, the authors categorized their recommendations for research and development. The authors identified 14 discrete themes, each including multiple questions or issues for potential exploration, that range from foundational and conceptual to practical. Much research to date has focused on a variety of issues regarding development and early implementation of EPAs. Future research should focus on large-scale implementation of EPAs to support competency-based medical education (CBME) and on its consequences at the 3 levels. In addition, emerging from the implementation phase, the authors call for rigorous studies focusing on conceptual issues. These issues include the nature of entrustment decisions and their relationship with education and learner progress and the use of EPAs across boundaries of training phases, disciplines and professions, including continuing professional development. International studies evaluating the value of EPAs across countries are another important consideration. Future studies should also remain alert for unintended consequences of the use of EPAs. EPAs were conceptualized to support CBME in its endeavor to improve outcomes of education and patient care, prompting creation of this agenda.
The day-to-day rigors of medical education often preclude learners from gaining a longitudinal perspective on who they are becoming. Furthermore, the current focus on competencies, coupled with concerning rates of trainee burnout and a decline in empathy, have fueled the search for pedagogic tools to foster students' reflective capacity. In response, many scholars have looked to the tradition of narrative medicine to foster "reflective spaces" wherein holistic professional identity construction can be supported. This article focuses on the rationale, content, and early analysis of the reflective space created by the narrative medicine-centered portfolio at the Columbia University Vagelos College of Physicians and Surgeons. In January 2015, the authors investigated learning outcomes derived from students' "Signature Reflections," end-of-semester meta-reflections on their previous portfolio work. The authors analyzed the Signature Reflections of 97 (of 132) first-year medical students using a constant comparative process. This iterative approach allowed researchers to identify themes within students' writings and interpret the data. The authors identified two overarching interpretive themes-recognition and grappling-and six subthemes. Recognition included comments about self-awareness and empathy. Grappling encompassed the subthemes of internal change, dichotomies, wonder and questioning, and anxiety. Based on the authors' analyses, the Signature Reflection seems to provide a structured framework that encourages students' reflective capacity and the construction of holistic professional identity. Other medical educators may adopt meta-reflection, within the reflective space of a writing portfolio, to encourage students' acquisition of a longitudinal perspective on who they are becoming and how they are constructing their professional identity.
The pervasive violence of racism has been revealed vividly in the past year. The response to the COVID-19 pandemic exacerbated undeniable inequities in health care. Across the globe, people responded to the continual assault on Black life, crystallized by the death of George Floyd and others, by participating in mass uprisings. People have had to reckon, in unanticipated ways, with the unflinching disparities in opportunities, including access to equitable education, health care, and social infrastructure, and the complexity of race in our justice systems. 1 Institutions, especially those of higher learning, also have had to reckon with their means of confronting structural racism within their own systems. Public letters of apology, reading lists, online panels, addenda to curriculum in medical schools, and statue removals have permeated our institutional news. The medical education research community is not immune to a need for reckoning. We too must answer the question: What steps have we taken to advance scholarship that dismantles systems of oppression and brings marginalized voices to the forefront?The Research in Medical Education (RIME) committee members are conscious of the role we play in amplifying voices and drawing attention to systems of oppression, such as policies that result in the overrepresentation of White individuals matriculating to medical schools, 2 who proceed to train in higher-paid specialties, 3 progress faster up the academic ladder, and are more likely to be found in leadership positions. 4 As practical evidence of continued efforts to push against these systems, the committee released a call encouraging both work about underrepresented perspectives and by authors that are underrepresented in medical education literature. Here, to undergird these efforts, we have relied on the definition of underrepresented in medicine put forth by the AAMC, which refers to those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. 5 We are pleased to highlight the papers that responded to the call and are included in the RIME supplement: Anderson et al, 6 Bullock et al, 7 Hamza and Regehr, 8 Mickleborough and Martimianakis, 9 Ortega et al, 10 and Wyatt et al. 11 As further evidence, RIME will be recognizing outstanding work in this category through the introduction of an award at the Learn Serve Lead meeting in November 2021. We challenge the RIME community to engage with underrepresented voices and perspectives in medical education and encourage our community to submit work for consideration for the RIME program on these important issues. In this year's Foreword, we-the past, present, and future RIME chairs-highlight the importance of and need to question traditional research practices and provide overarching principles for medical education scholars looking to study equity and inclusion, particularly for those using critical race theory. [12][13][14][15]
PurposeResearch on how entrustment decisions are made identifies 5 influential factors (supervisor, trainee, supervisor-trainee relationship, context, task). However, this literature primarily represents the perspective of supervisors in graduate medical education and is conducted outside of an assessment framework where entrustment decisions have consequences for trainees and for patients. To complement the literature, the authors explored how medical students in a pilot program that used an entrustable professional activity (EPA) assessment framework perceived factors influencing entrustment decisions.
BACKGROUND AND OBJECTIVE: Although nonphysician reentry transitions have been characterized in literature, little is known about the reentry physicians in general, or residents in particular. We conducted a qualitative study to explore pediatric residents' reentry, using reverse culture shock as a conceptual framework.METHODS: Eighteen pediatric residents who completed global health experiences in Africa (9 categorical residents with 1-month elective, 9 global child health residents with 12-month training) participated in interviews that included a card-sort to solicit emotional responses consistent with the conceptual framework. Data in the form of interview transcripts were coded and analyzed according to principles of grounded theory.RESULTS: All pediatric residents, despite variable time abroad, reported a range of emotional responses on reentry to residency. Global child health residents felt disconnection and frustration more intensely than categorical residents, whereas categorical residents felt invigoration more intensely than global child health residents. Although residents met with program leadership after their return, no resident described these meetings as a formal debriefing, and few described a deliberate strategy for processing emotions on reentry.CONCLUSIONS: Consistent with reverse culture shock, pediatric residents felt a range of emotions as they move toward a steady state of acculturating back into their residency program. Residency programs might consider creating safety nets to help cultivate support for residents when they reenter training. WHAT'S KNOWN ON THIS SUBJECT:Although nonphysician reentry transitions have been characterized in the literature, little is known about the reentry of residents after either shortterm (1-month elective) or long-term (12-month training) global health experiences abroad. WHAT THIS STUDY ADDS:Reverse culture shock may be a useful conceptual framework for understanding the range of emotions felt by pediatric residents when they reenter residency after global health experiences, particularly if these experiences were long term.
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