Undesirable features of the medical learning environment: a narrative review of the literature

Benbassat, Jochanan

doi:10.1007/s10459-012-9389-5

Cited by 78 publications

(95 citation statements)

References 75 publications

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“…This supported participation in an immersive experience, while not without risk (ten Cate, 2014b), seems to have resulted in the development of both clinical competence and a confident professional identity as a doctor (Dornan, Boshuizen, King, & Scherpbier, 2007), with a sense of self-efficacy (confidence) and authenticity in the role realized as a result (Benbassat, 2013;Yeung, Li, Wilson, & Craven, 2014). Resilience-grit (Salles, Cohen, & Mueller, 2014) is a necessary survival attribute for postgraduate training, and seemed to be produced in these participants by their rural LIC experience.…”

Section: Discussionmentioning

confidence: 84%

“…This and a supportive environment, allowing students to assume some of the decision making and clinical aspects of the doctors role under supervised conditions ("acting up"), and treating medical students as junior colleagues, have demonstrated advantages in medical education (Benbassat, 2013), and thus produce junior doctors who are likely to fare better in developing their professional identity (Jarvis-Selinger, Pratt, & Regehr, 2012). Lack of this acting up component, which is sometimes provided as a pre-internship " PRINT" term (Scicluna, Grimm, Jones, Pilotto, & McNeil, 2014) or shadowing (Van Hamel & Jenner, 2014), in or immediately following the senior years of medical education, tends to produce interns who feel insecure in their decision-making, time management, and administrative skills (Kellett et al, 2014;Van Hamel & Jenner, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

2015

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Background: We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful. Methods: In-depth interviews. Results: Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level. Conclusion: The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

2015

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“…Otro estudio de los médicos residentes en los Estados Unidos mostró que, durante su formación, el 69.8 % experimentó agresión en su lugar de trabajo (Benbassat, 2013 …”

Section: Introductionunclassified

Exposición a la violencia durante la formación profesional de los residentes médicos

Montes-Villaseñor¹,

González²,

Blázquez-Morales³

et al. 2018

CienciaUAT

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CIENCIAS SOCIALES RESUMENLas residencias médicas garantizan la formación y preparación de los futuros especialistas, no solo académica, sino también humana. Sin embargo, existe evidencia de maltrato, discriminación y abusos en los residentes médicos. El objetivo de este trabajo fue identificar experiencias de violencia física, psicológica o sexual de los residentes médicos del estado de Veracruz, México. Se realizó un estudio transversal descriptivo, mediante una metodología cuantitativa, de una población conformada por 656 médicos residentes de 16 unidades receptoras durante el año 2014. El 87 % reportó por lo menos una experiencia de agresión en su tiempo de formación como especialistas y hasta el 50.46 % refirió violencia psicológica. Sus principales agresores fueron jefes de servicio (33.5 %) y compañeros residentes (33.5 %), viéndose más afectados en el turno matutino (34.76 %). De la población total, 51.52 % son hombres y 48.48 % mujeres. En relación al análisis bivariado se obtuvieron los siguientes resultados: correlación entre sexo y violencia psicológica: X 2 = 9.740 6, P = 0.004; violencia físi-ca: X 2 = 4.876 4, P = 0.003; y violencia sexual: X 2 = 4.868 4, P = 0.001. Los varones presentaron tasas de agresión más altas en el grupo de médi-cos residentes sometidos a mayor nivel de violencia psicológica, física y sexual. Con este estudio se enfatiza la importancia de forjar valores institucionales en la práctica médica, como el respeto y la dignidad, entre los médicos residentes, superiores y/o profesionales que intervienen en la formación y perfeccionamiento de sus especialidades.PALABRAS CLAVE: residencias médicas, estrés, violencia física, psicológica y sexual. ABSTRACTThe Medical residencies guarantee the academic and human apprenticeship and training of the future medical specialists. Nevertheless, there is evidence of maltreatment, discrimination and abuse against the medical residents. The purpose of this work was to identify experiences of physical, psychological or sexual violence of medical residents in the state of Veracruz, Mexico. A cross-sectional quantitative analysis was carried out focusing on a population of 656 residents from 16 receiving medical centers during 2014. Results indicate that 87% reported at least one experience of physical violence during their medical internship as specialists. Additionally, and up to 50.46% it reported psychological violence. The main aggressors were reported to be chiefs of service (33.5 %) and resident partners (33.5 %) and participants were more affected during the morning shift (34.76 %). 51.52 % of the participating population are males and 48.48 % are females. As regards The bivariate analysis revealed the following results: correlation between gender and psychological violence: X 2 = 9.740 6, P = 0.004; physical violence: X 2 = 4.876 4, P = 0.003; and sexual violence: X 2 = 4.868 4, P = 0.001. Males reported higher aggression rates in their medical internships since they were subject to higher levels of psychological, physical and sexual violen...

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“…Similarly personal beliefs affect their resiliency in the face of challenge (Yeager and Dweck 2012). Students take on bigger challenges when they feel emotionally safe (Daloz 1986;Haidet and Stein 2006;Dornan et al 2007;Benbassat 2013), particularly at an early stage in their clinical education. These factors were intrinsic in the design of the SECO clinic.…”

Section: Introductionmentioning

confidence: 99%

“…In a broad overview of the educational environment, Hutchinson (2003) identified a safe environment as one that allows students to feel able to experiment, speak up about concerns they have, recognise knowledge gaps and test their limits. Other researchers have examined the social and psychological elements of the LE (Kendall et al 2005;Boor et al 2008;Benbassat 2013). It has also been the focus of literature reviews (Genn 2001;Roff 2005).…”

Section: Introductionmentioning

confidence: 99%

Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic

Young

Williamson

Egan

2015

Adv in Health Sci Educ

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Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students' reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students' sense of safety in the learning environment (LE), the resulting learning challenge with which they could cope and their positive reports of the experience itself. Our students worked in a unique simulation of General Practice, the Safe and Effective Clinical Outcomes clinic, where they consistently reported positive experiences of learning. We analysed 77 essays from 2011 and 2012 using an immersion/crystallisation framework. Half of the students referred to the safety of the learning environment spontaneously. Students described deep learning experiences in their simulated consultations. Students valued features of the LE which contributed to a psychologically safe environment. Together with the provision of constructive support and immediate, individualised feedback this feeling of safety assisted students to find their own way through clinical dilemmas. These factors combine to make students feel relaxed and able to take on challenges that otherwise would have been overwhelming. Errors became learning opportunities and students could practice purposefully. We draw on literature from medical education, educational psychology and sociology to interpret our findings. Our results demonstrate relationships between safe learning environments, learning challenge and powerful learning experiences, justifying close attention to the construction of learning environments to promote student learning, confidence and motivation.

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Undesirable features of the medical learning environment: a narrative review of the literature

Cited by 78 publications

References 75 publications

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

Exposición a la violencia durante la formación profesional de los residentes médicos

Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic

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