Med Ed Briefs

favicon

The Alliance for Clinical Education (ACE) has worked with Teaching & Learning in Medicine to provide these brief reviews.  ACE members review key articles and offer suggestions about how the work can be applied more broadly.  Busy schedules often limit the time to stay current on medical education literature.  Med Ed Briefs is a way to get a sense for what’s being published and entice you to read more!

Language, Philosophy, and Medical Education

Citation:

John R. Skelton (2021) Language, Philosophy and Medical Education, Teaching and Learning in Medicine, 33:2, 210-216, DOI: 10.1080/10401334.2021.1877712.  https://doi.org/10.1080/10401334.2021.1877712

What is this article about?

In this manuscript, Dr. Skelton reflects upon the use of language in medical education and clinical encounters, from the perspective of an academic applied linguist. Dr. Skelton uses examples drawn from a variety of sources, ranging from observed clinical encounters from John Locke to Jean Luc Picard, to demonstrate the role of language interpersonal communication. In particular, he emphasizes the function of language as “doing things with words,” which is framing that originates with Speech Act Theory. He emphasizes four points relevant to clinical educators: the meaning of language varies according to context; the importance of having defined aims when speaking; the ability of language to illuminate, but not eliminate, ambiguity; and the relationship between language and power in the clinical setting.

Why should you read the article?

Dr. Skelton’s reflections on the task-focused use of language are particularly germane to anyone who has struggled to perfect the art of communicating effectively with patients, or has attempted to teach students and trainees to do so. His discussion of the disparity between “what we appear to mean on the surface, what we actually intend to mean, and what others take us to mean” is especially pertinent to medical education. He goes on to introduce the concept of communicative competence, and relate it to clinical practice, education, and professionalism.

How can you use this article?

This article touches on several philosophical and linguistic concepts which may be valuable to clinician educators involved in teaching communications skills, and concludes with some recommendations for educators. These include reflecting upon the power of language to effect change, encouraging the discussion of ideas, and embracing ambiguity and complexity in simulated scenarios.

Published 2021-07-01

Review Author:  Angela Shapshak, M.D., Associate Professor, Department of Neurology, University of Alabama School of Medicine, Birmingham, AL. ACE Member Organization: Consortium of Neurology Clerkship Directors

—————————————————————————————————————————————-

Medical Student Attitudes toward USMLE Step 1 and Health Systems Science – A Multi-Institutional Survey

Citation:  J. Bryan Carmody, Lauren M. Green, Patti G. Kiger, Jared D. Baxter, Todd Cassese, Tonya L. Fancher, Paul George, Erin J. Griffin, Yolanda C. Haywood, David Henderson, Nancy A. Hueppchen, David J. Karras, Andrea N. Leep Hunderfund, Janet E. Lindsley, Paul G. McGuire, Mimoza Meholli, Chad S. Miller, Seetha U. Monrad, Kari L. Nelson, Kristin A. Olson, Amit K. Pahwa, Stephanie R. Starr, Allan R. Tunkel, Richard N. Van Eck, Julie H. Youm, Deborah J. Ziring & Senthil K. Rajasekaran (2021) Medical Student Attitudes toward USMLE Step 1 and Health Systems Science – A Multi-Institutional Survey, Teaching and Learning in Medicine, 33:2, 139-153, DOI: 10.1080/10401334.2020.1825962.
https://doi.org/10.1080/10401334.2020.1825962

What is this article about?

Discussions surrounding the transition of the USMLE Step 1 to a pass or fail grading criteria while improving American healthcare are polarizing topics. This article explores medical students’ perceptions of the importance of the USMLE Step 1’s current numerical scoring system and the de-emphasis on lower yield topics such as Health Systems Sciences. The authors define Health System Sciences as “health systems improvement, population health, systems-thinking, and health policy.” It provides potential areas for improvement in healthcare education.

Why should you read the article?

Surveying a large sample of students at major academic centers across the US allows the authors to identify the motivations of medical students’ areas of emphasis of study. The article discusses the potential benefits on healthcare education with the transition to a USMLE Step 1 pass or fail system. It highlights the viable areas to restructure healthcare education and improve population health equity by implementing courses such as the Health Systems Sciences.

How can you use this article?

The article does not draw definitive evidence that restructuring healthcare education will improve population health; it does reflect on students’ motivational drives to emphasize specific topics over others. Traditionally, Health System Sciences and other related issues have been less of a focus for students because they are considered lower yield. The article provides a different perspective to support integrating these previous lower yield topics into the current curriculum.

Published 2021-06-04

Review Author:  Mila D. Shah-Bruce, M.D.; Assistant Professor and Director Ob/Gyn Clerkship; Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. ACE Member Organization: Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Applying the Theory of Gendered Organizations to the Lived Experience of Women with Established Careers in Academic Medicine 

Citation:  Dorene F. Balmer, Kelly A. Courts, Bridget Dougherty, Lucy Wolf Tuton, Stephanie Abbuhl & Laura E. Hirshfield (2020) Applying the Theory of Gendered Organizations to the Lived Experience of Women with Established Careers in Academic Medicine, Teaching and Learning in Medicine, 32:5, 466-475.   DOI: 10.1080/10401334.2020.1767106.
https://www.tandfonline.com/doi/full/10.1080/10401334.2020.1767106

What is this article about?

The authors use the Theory of Gendered Organizations as a framework for investigating gender bias in academic medicine.  Interview data from thirty women in mid-to advanced-level careers (associate or full professorship) were examined under the lens of interactions that were intentionally or unintentionally gendered.  Initial questioning did not include gender bias, specifically, though the issue was brought forth by the interviewees as they discussed authenticity in their careers, thus a specific line of questioning was added.  Their findings suggest that while overt measures have been taken to offset gender bias in formal processes within academic medicine, informal experiences include pervasive elements of bias that are deeply embedded in departmental culture.

Why should you read the article?

Gaps in gender inequity in academic medicine have been identified in attainment of leadership positions, academic advancement, and income. This article seeks to illustrate the difference between written policies and procedures supporting equity and women’s experiences in processes that lead to inequitable outcomes.  Many of the examples of experiences may unfortunately not be surprising; however, thinking about the enculturated process disparities, how deeply entrenched these attitudes may be in academic medicine, and how this perpetuates gender disparity is a powerful argument for systems change beyond simple policy rewriting.

The bright side of this study is the apparent dedication many of these physicians show in advocating for their junior female colleagues.  Inferentially, while advocacy alone may be of limited utility, the translational effect of essentially upstander behavior in gender advocacy may be a promising element of culture change.

How can you use this article?

Data are clear that gender disparity persists in salaries, academic promotion, and experiences.  The raw numbers may incite physicians to advocate for change, but this article digs a little deeper into the why’s.  Their qualitative findings highlight a need for more than just “lip service” policies and urge greater attention to culture and process.

Published 2021-05-06

Review Author:  Margaret Dow, M.D.; Director, Ob/Gyn Clerkship; Mayo Clinic Alix School of Medicine, Rochester, MN. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum 

Citation:  Mark R. Tonelli & Robyn Bluhm (2021) Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum, Teaching and Learning in Medicine, 33:1, 98-105, DOI: 10.1080/10401334.2020.1835666. https://www.tandfonline.com/doi/full/10.1080/10401334.2020.1835666

What is this article about?

Don’t shy away from the heady title!  The authors posit that epistemology, the philosophical branch dedicated to understanding knowledge itself, is an underemphasized element of medical education.  They argue that our recent emphasis on evidence-based medicine (EBM) has obscured the value and necessity of integrating clinical experience and underlying knowledge of pathophysiology in making sound clinical decisions.  They suggest that applying a metacognitive approach of applying EBM approaches to EBM itself may deepen learners’ understanding of the necessarily multifaceted nature of clinical medicine, as well as the potential pitfalls of using EBM as a sine qua non approach.  They conclude that teaching learners to think about how they are thinking improves their reasoning and contributes to sound decision-making.

Why should you read the article?

This article walks through defining epistemology, clarifying its value in medical education, and then breaking down a three-tiered approach to integrating its central tenets.  The authors encourage education on different types, levels, and hierarchies of evidence in the preclinical years, evolving to an understanding of how to assess evidence in undergraduate medical education, and culminating in an appreciation of integrating basic scientific knowledge, research findings, and clinical experience in graduate training and beyond.  In a refreshing turn, they emphasize the importance of considering lessons learned from the clinical realm as a valid and essential element of the art of medicine.

How can you use this article?

While the title might be frighteningly philosophical, the take home message is to encourage a much broader education on how to think about what we do and how to incorporate the value of basic sciences, research, and clinical experience into a more comprehensive approach.  They recommend utilizing case-based studies to explore these elements, and we as educators are positioned to benefit from this exercise as well.  Thinking about how we think may allow us to shape learners’ development even further by meting out what parts of our own approaches stem from underlying pathophysiology, from research, and from our experience.  The last of these can be difficult to identify clearly, and by doing so we model a broader, more integrated approach for the next generation to aspire to.

Published 2021-04-06

Review Author:  Margaret Dow, M.D.; Director, Ob/Gyn Clerkship; Mayo Clinic Alix School of Medicine, Rochester, MN. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change

Citation: James Dalton, Kimberley Ivory, Paul Macneill, Louise Nash, Jo River, Paul Dwyer, Claire Hooker, David Williams & Karen M. Scott (2020) Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change, Teaching and Learning in Medicine, 32:5, 531-540, DOI: 10.1080/10401334.2020.1768099 https://doi.org/10.1080/10401334.2020.1768099

What is this article about?

This article describes the use of Verbatim Theater (VT) to facilitate awareness and discussion of the hierarchy within the medical education and clinical environments, particularly related to mistreatment of learners and junior health professionals.  In VT, a script is created and performed using only the spoken words of informants for the purpose of attitudinal change.  In Australia, the Sydney Arts and Health Collective recruited and interviewed inter-professional healthcare students to create a play in the VT genre.  A month after performance of the play, open to the lay public, a subset of the audience comprising healthcare students and professionals reflected on training culture and potential for change.  Participants were able to recognize portrayals of their own experiences and propose antidotes to systemic issues, such as harassment and bullying.

Why should you read the article?

This article brings together 3 timely topics of interest to medical educators:  1) addressing trainee mistreatment 2) using the arts and humanities 3) incorporating inter-professional education.  Over the past decade, identification of the longstanding problem of medical student mistreatment has garnered increased attention. Bullying and harassment of trainees is not unique to Australia, and crosses the boundaries of disciplines beyond medicine to nursing and other healthcare disciplines.  Simultaneously, the American Association of Medical Colleges initiatives encourage the integration of the arts in medical education and inter-professional education.  This article describes a specific example of the use of the arts to promote cultural change in healthcare training and the reflection and discussion it generated.

How can you use this article?

As the COVID pandemic shines a spotlight on disparities and systemic racism in society, healthcare and medical education, medical students are eager to participate and lead efforts in reform.  Consider this exemplar of a theatrical genre to create and implement educational experiences integrating the arts to promote attitudinal and social change in your own curriculum.

Published 2021-03-05

Review Author:  Mary Blazek, M.D.; Clinical Associate Professor and Director, Geriatric Psychiatry Clinic; University of Michigan Medical School, Ann Arbor, MI. ACE Member Organization:  Association of Directors of Medical Student Education in Psychiatry

—————————————————————————————————————————————-

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Citation: Michelle E. Kiger, Caylin Riley, Adrienne Stolfi, Stephanie Morrison, Ann Burke & Tai Lockspeiser. (2020). Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students, Teaching and Learning in Medicine, 32:4, 399-409, DOI: 10.1080/10401334.2020.1713790 https://www.tandfonline.com/doi/abs/10.1080/10401334.2020.1713790

What is this article about?

This article is studying the use of individualized learning plans (ILP) in pediatric clerkships at two different institutions to evaluate if sharing learner ILPs affects the feedback students receive from faculty and resident preceptors.  The authors’ hypothesis was that sharing the learners’ ILP with the preceptor would improve the quality of feedback, would enhance the specificity of the feedback related to the ILP and improve the feedback as perceived by the learner.

Why should you read the article?

This article discusses the feedback loop between faculty/resident preceptors and medical students using ILPs to help promote and strengthen that circular relationship.  As educators, we know that specific timely feedback enables medical students to make behavioral changes that improve their performance.  This article shows how ILPs have the potential to focus preceptor attention to a student’s specific learning goal and plan which could potentially allow students to progress their learning in those specific goals.

Additionally, this study shows that faculty and student engagement and buy in is important when incorporating ILPs into the curriculum. Students who had significant progress on their learning goals found the ILP exercise to be more useful.

How can you use this article?

The learning environment with long term relationships between students and preceptors are situations where ILPs can take advantage of the strong interpersonal relationship between student and teacher. Incorporating preceptors in the process of the student developing their ILP could also be beneficial in helping students form meaningful ILPs and help faculty focus feedback and learner progress.

Published 2021-02-05

Review Author:  Corinne A Bazella, M.D.; Associate Professor and Director, Ob/Gyn Clerkship; Case Western Reserve University School of Medicine, Cleveland, OH. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

—————————————————————————————————————————————-

Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education

Citation: Jed D. Gonzalo, Christopher Davis, Britta M. Thompson & Paul Haidet (2020) Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education, Teaching and Learning in Medicine, 32:3, 250-258, DOI: 10.1080/10401334.2019.1704765  https://www.tandfonline.com/doi/full/10.1080/10401334.2019.1704765

What is this article about?

The authors evaluate, qualitatively, one institution’s learner evaluations of an integrated health systems science curriculum. This third pillar to medical education, in addition to the basic and clinical sciences, includes competencies devoted to interprofessional collaboration, population health, and high value care. Any significant change in medical education brings the challenge of faculty and learner buy-in, development of content experts and course leadership, and identification and retention of resources. Exploring learners’ perceptions helps identify challenges and solutions.

Why should you read the article?

This article highlights a central tension in medical education: are we preparing learners to become future physicians, or are we focusing on preparing learners for high-stakes factual examinations? The hidden curriculum creates pressure on the learner to see these non-tested topics as a waste of time. Learners may fail to see these health system sciences competencies as encompassing their professional identities as physicians, and more of a “somebody else’s” problem.

The other important takeaway here is the power of the data we routinely collect to evaluate our curricula. The importance of identifying and understanding the perceptions of the consumers of the curriculum, the learners, is vital to future modifications. This is not the tail wagging the dog; instead harnessing learners’ concerns may aid in highlighting why these competencies are important.

How can you use this article?

While not the main message of the article, the authors highlight the meaningful use of evaluation data in the continuous quality improvement of a curriculum. For an additional pillar of medical education to be successful, both faculty and learners need to buy in and accept it.  Specifically addressing learner perceptions can lead to increased acceptance and engagement in new curricula.

Published 2020-09-24

Review Author:  Scott Graziano, M.D., MS; Professor of Obstetrics & Gynecology and Assistant Dean for for Clinical Development and Third Year Curricular Director for Loyola University Chicago, Stritch School of Medicine, Chicago, IL.  ACE member organization:  Association of Professors of Gynecology and Obstetrics