Evidence-guided approach to portfolio-guided teaching and assessing communications, ethics and professionalism for medical students and physicians: a systematic scoping review
Abstract:ObjectivesGuiding the development of longitudinal competencies in communication, ethics and professionalism underlines the role of portfolios to capture and evaluate the multiple multisource appraisals and direct personalised support to clinicians. However, a common approach to these combined portfolios continues to elude medical practice. A systematic scoping review is proposed to map portfolio use in training and assessments of ethics, communication and professionalism competencies particularly in its inculc… Show more
“…This SSR in SEBA involved an expert team constituting a librarian from the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine (YLLSoM) and local educational experts and clinicians at YLLSoM, National Cancer Centre Singapore, Palliative Care Institute Liverpool, and Duke-NUS Medical School. Supporting SEBA methodology’s iterative process [ 75 , 83 – 85 ], the expert team guided each stage of SEBA (Fig. 1 ) [ 38 , 75 , 80 , 81 , 85 ] in order to foster a balanced, reproducible and accountable review.…”
Section: Methodsmentioning
confidence: 99%
“…Supporting SEBA methodology’s iterative process [ 75 , 83 – 85 ], the expert team guided each stage of SEBA (Fig. 1 ) [ 38 , 75 , 80 , 81 , 85 ] in order to foster a balanced, reproducible and accountable review. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…The PCC (Population, Concept, Context) format [ 86 ] and the PRISMA-ScR checklist (see Additional file 1 ) were used to map the use of storytelling over the wide realm of clinical practice and guide the primary and secondary research questions [ 36 , 37 , 39 , 75 , 79 , 81 , 85 ]. The primary research question identified was: “ What is known about storytelling in clinical practice amongst physicians?…”
Section: Methodsmentioning
confidence: 99%
“…Krishna’s ‘Split Approach’ was employed to strengthen the reliability of the data analysis process [ 40 , 87 , 89 – 92 ]. This saw one team of independent researchers using Braun and Clarke [ 93 ]’s approach to thematic analysis [ 34 , 85 , 94 – 96 ] and another team of independent researchers employing Hsieh and Shannon [ 97 ]’s approach to directed content analysis to draw ‘a priori coding categories” from Laskow et al [ 1 ]’s review [ 83 , 84 , 98 – 100 ].…”
Background
Patients’ stories provide Palliative Care physicians with a glimpse into the former’s lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients’ stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this ‘care influencing’ practice in medicine.
Methods
This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach’s concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion.
Results
Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns.
Conclusion
Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this ‘care influencing’ practice.
“…This SSR in SEBA involved an expert team constituting a librarian from the National University of Singapore’s (NUS) Yong Loo Lin School of Medicine (YLLSoM) and local educational experts and clinicians at YLLSoM, National Cancer Centre Singapore, Palliative Care Institute Liverpool, and Duke-NUS Medical School. Supporting SEBA methodology’s iterative process [ 75 , 83 – 85 ], the expert team guided each stage of SEBA (Fig. 1 ) [ 38 , 75 , 80 , 81 , 85 ] in order to foster a balanced, reproducible and accountable review.…”
Section: Methodsmentioning
confidence: 99%
“…Supporting SEBA methodology’s iterative process [ 75 , 83 – 85 ], the expert team guided each stage of SEBA (Fig. 1 ) [ 38 , 75 , 80 , 81 , 85 ] in order to foster a balanced, reproducible and accountable review. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…The PCC (Population, Concept, Context) format [ 86 ] and the PRISMA-ScR checklist (see Additional file 1 ) were used to map the use of storytelling over the wide realm of clinical practice and guide the primary and secondary research questions [ 36 , 37 , 39 , 75 , 79 , 81 , 85 ]. The primary research question identified was: “ What is known about storytelling in clinical practice amongst physicians?…”
Section: Methodsmentioning
confidence: 99%
“…Krishna’s ‘Split Approach’ was employed to strengthen the reliability of the data analysis process [ 40 , 87 , 89 – 92 ]. This saw one team of independent researchers using Braun and Clarke [ 93 ]’s approach to thematic analysis [ 34 , 85 , 94 – 96 ] and another team of independent researchers employing Hsieh and Shannon [ 97 ]’s approach to directed content analysis to draw ‘a priori coding categories” from Laskow et al [ 1 ]’s review [ 83 , 84 , 98 – 100 ].…”
Background
Patients’ stories provide Palliative Care physicians with a glimpse into the former’s lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients’ stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this ‘care influencing’ practice in medicine.
Methods
This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach’s concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion.
Results
Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns.
Conclusion
Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this ‘care influencing’ practice.
“…Developing altruistic, ethical, humanistic and accountable physicians pivots on nurturing a medical student's professional identity formation (PIF) [1,2]. However, medical education continues to struggle to understand and shape how medical students feel, act and think as professionals [3].…”
Evolving individual, contextual, organizational, interactional and sociocultural factors have complicated efforts to shape the professional identity formation (PIF) of medical students or how they feel, act and think as professionals. However, an almost exclusive reliance on online learning during the COVID-19 pandemic offers a unique opportunity to study the elemental structures that shape PIF and the environmental factors nurturing it. We propose two independent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA)s to map accounts of online learning environment and netiquette that structure online programs. The data accrued was analysed using the clinically evidenced Krishna-Pisupati Model of Professional Identity Formation (KPM) to study the evolving concepts of professional identity. The results of each SSR in SEBA were evaluated separately with the themes and categories identified in the Split Approach combined to create richer and deeper ‘themes/categories’ using the Jigsaw Perspective. The ‘themes/categories’ from each review were combined using the Funnelling Process to create domains that guide the discussion. The ‘themes/categories’ identified from the 141 included full-text articles in the SSR in SEBA of online programs were the content and effects of online programs. The themes/categories identified from the 26 included articles in the SSR in SEBA of netiquette were guidelines, contributing factors, and implications. The Funnelling Process identified online programs (encapsulating the content, approach, structures and the support mechanisms); their effects; and PIF development that framed the domains guiding the discussion. This SSR in SEBA identifies the fundamental elements behind developing PIF including a structured program within a nurturing environment confined with netiquette-guided boundaries akin to a Community of Practice and the elemental aspect of a socialisation process within online programs. These findings ought to be applicable beyond online training and guide the design, support and assessment of efforts to nurture PIF.
Ethical dilemmas are common in the practice of medicine and can lead to an array of seemingly reasonable decisions unless policies or regulations mandate certain actions. Choosing the appropriate solution requires not only biomedical evidence, but also requires the balancing of possibly divergent preferences, values, contextual factors and ethical theories. These include utilitarianism, which aims to optimise happiness for the largest number of people; versus deontology, which promotes actions based on rules and duties even if these actions do not result in the greatest common good. The inability to find common ground can both delay appropriate care and trigger moral distress among health professionals.1 However, training in ethical reasoning or obtaining ethics consultations may not be universally available. How then can frontline healthcare teams navigate ethical dilemmas?
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