Participants performed significantly better at follow-up than they did at baseline assessment, with the most notable improvements observed in the group that watched both community and knowledge videos. The results suggest that short, simple, culturally, and linguistically appropriate interventions can promote knowledge gain about asthma and improve inhaler use that can be sustained over the short term. Such interventions that provide authentic learning materials that draw on patients' life experiences and sociocultural context can overcome certain limitations of conventional patient education approaches.
Purpose Psychological safety (PS) is recognized as key in health professions education. However, most studies exploring PS in medical education have focused on mistreatment, thus focusing on what PS is not. The authors set out to explicitly explore learners’ concept of PS in the context of medical education to better understand and define PS and its educational consequences for medical students. Method This descriptive exploratory study was conducted in the context of a pilot peer-assisted learning (PAL) program. The program brought together residents and medical students for 16 semiformal learning sessions. Eight medical students from a PAL program were recruited for semistructured interviews to explore their experiences of PS. Transcripts were thematically analyzed using an inductive approach, and social ecological theory was integrated in the later stages of analysis. Results Students described PS as not feeling judged. Having supportive relationships with peers and mentors improved PS. Students’ sense of PS appeared to free them to focus on learning in the present moment without considering the consequences for their image in the eyes of others. Feeling safe also seemed to facilitate relationship building with the mentors. Conclusions A sense of PS appears to free learners from constantly being self-conscious about projecting an image of competence. This enables learners to be present in the moment and concentrate on engaging with the learning task at hand. The authors propose that the term “educational safety” be used to describe a relational construct that can capture the essence of what constitutes PS for learners.
BackgroundModern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.MethodsThirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.ResultsThe analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.ConclusionsAlthough the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.
SummaryUnderstanding the nature and impact of health literacy is a priority in health promotion and chronic disease prevention and treatment. Health literacy comprises the application of a broad set of skills to access, comprehend, evaluate, communicate and act on health information for improved health and well-being. A complex concept, it involves multiple participants and is enacted across a wide variety of contexts. Health literacy's complexity has given rise to challenges achieving a standard definition and developing means to measure all its dimensions. In May 2013, a group of health literacy experts, clinicians and policymakers convened at an Expert Roundtable to review the current state of health literacy research and practice, and make recommendations about refining its definition, expanding its measurement and integrating best practices into chronic disease management. The four-day knowledge exchange concluded that the successful integration of health literacy into policy and practice depends on the development of a more substantial evidence base. A review of the successes and gaps in health literacy research, education and interventions culminated in the identification of key priorities to further the health literacy agenda. The workshop was funded by the UBC Peter Wall Institute for Advanced Studies, Vancouver.
Context Transitions in medical education are dynamic, emotional and complex yet, unavoidable. Relationships matter, especially in times of transition. Using qualitative, social network research methods, we explored social relationships and social support as medical students transitioned from pre‐clinical to clinical training. Methods Eight medical students completed a social network map during a semi‐structured interview within two weeks of beginning their clinical clerkships (T0) and then again four months later (T1). They indicated meaningful interactions that influenced their transition from pre‐clinical to clinical training and discussed how these relationshipsimpacted their transition. We conducted mixed‐methods analysis on this data. Results At T0, eight participants described the influence of 128 people in their social support networks; this marginally increased to 134 at T1. People from within and beyond the clinical space made up participants’ social networks. As new relationships were created (eg with peers and doctors), old relationships were kept (eg with doctors and family) or dissolved over time (eg with near‐peers and nurses). Participants deliberately created, kept or dissolved relationships over time dependent on whether they provided emotional support (eg they could trust them) or instrumental support (eg they provided academic guidance). Conclusions This is the first social networks analysis paper to explore social networks in transitioning students in medicine. We found that undergraduate medical students’ social support networks were diverse, dynamic and deliberate as they transitioned to clerkships. Participants created and kept relationships with those they trusted and who provided emotional or instrumental support and dissolved relationships that did not provide these functions.
The objectives of this study were to investigate how asthma patients from new immigrant groups are being informed and educated about asthma and its management, and to identify barriers to knowledge transfer. Four focus groups (n = 29) from Latino, Chinese, Iranian and Punjabi cultural communities were conducted with asthmatic patients in the Greater Vancouver Area. Our results from the focus group discussions can be summarized in four broad areas (a) perceptions of and ways of coping with asthma, (b) perceptions of whether the healthcare system is culturally competent, (c) perceptions of language barriers in regards to accessing the healthcare system, and (d) perceptions of how to access reliable asthma information. The results of this study highlight the importance of diverse cultural beliefs and practices as factors that should be taken into consideration when tailoring interventions to improve asthma outcomes in vulnerable populations, including patients from ethno-cultural communities.
BackgroundA coordinated stroke rehabilitation care team is considered optimal for supporting stroke survivors from diagnosis to recovery. Despite this recognition, many stroke survivors cannot access essential rehabilitation services. Furthermore, there is a lack of understanding of stroke patients’ and their caregivers’ rehabilitation needs and wishes. We sought to gain insight into healthcare and social structures from the perspective of patients and caregivers that can better support long-term stroke recovery.MethodsWe conducted individual interviews with 24 participants comprised of stroke survivors, spousal caregivers, stroke support group coordinators, and speech pathologist. Participants were recruited through three stroke survivor support groups. An empowerment lens was integrated into data analysis and data interpretation.ResultsTwo dominant themes captured participants’ experiences through stroke survivors’ trajectory of care. 1) Experiences of managing stroke. This theme identified stroke survivors and spousal caregivers’ experiences with stroke recovery, rehabilitation, and fulfilling unmet needs. 2) Resources of support. This theme described the social and financial support structures drawn upon to assist with stroke rehabilitation.ConclusionsThe study highlighted a lack of teamwork between stroke survivors, spousal caregivers, and health professionals. This fragmented care was compounded by inequities in rehabilitation programs and health services resulting in what appeared to be a disempowering rehabilitation process. Although stroke recovery groups were a significant source of support for stroke survivors and spousal caregivers, participants perceived they were overlooked, by stroke recovery healthcare providers, as a site for stroke recovery healthcare services. An empowerment approach to stroke rehabilitation involves collaboration between stroke survivors, caregivers, healthcare providers, health services, and existing community stroke support structures. Framing stroke based care through an empowerment lens may serve to address stroke rehabilitation inadequacies and inequities.
As part of the Philosophy of Science series of Invited Commentaries, this article on critical theory describes the origins of this research paradigm and its key concepts and orientations (ontology, epistemology, axiology, methodology, and rigor). The authors frame critical theory as an umbrella term for different theories, including feminism, antiracism, and anticolonialism. They emphasize the structural analysis that critical scholars conduct to uncover and sometimes address the role that social, political, cultural, economic, ethnic, and gender factors play in health professions education. They note the importance of acknowledging one’s social location when doing critical research and highlight the core values of democracy and egalitarianism that underpin critical research. Methodologically, the authors stress how critical scholars reject singular truths in favor of more nuanced portraits of concepts and events, mobilize inductive approaches over deductive ones, and use critical theory to develop their projects and analyze their data. Following upon this elucidation of critical theory, the authors apply this paradigm to analyze the sample case of Lee, a medical resident who was involved in a medication error. The authors conclude that research conducted in the critical tradition has the potential to transcend individualistic accounts by revealing underlying structural forces that constrain or support individual agency.
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