The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects.

Mapping Intimacies ◽

10.21203/rs.2.21655/v2 ◽

2020 ◽

Author(s):

Silvio Ndoja ◽

Saad Chahine ◽

Donald H. Saklofske ◽

Brent Lanting

Keyword(s):

Primary Care ◽

Medical Training ◽

Short Form ◽

Inverse Correlation ◽

First Year ◽

Clinical Clerkship ◽

Clinical Experiences ◽

Clinical Exposure ◽

Tolerance Of Ambiguity

Abstract Background: Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. Methods: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p=0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: We hypothesize that the decrease in TOA seen in this study may reflect an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

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The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate medical training: results from multiple samplings of a single cohort

BMC Medical Education ◽

10.1186/s12909-020-02345-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Silvio Ndoja ◽

Saad Chahine ◽

Donald H. Saklofske ◽

Brent Lanting

Keyword(s):

Medical Students ◽

Medical Training ◽

Short Form ◽

Inverse Correlation ◽

Full Time ◽

Clinical Clerkship ◽

Clinical Experiences ◽

Clinical Exposure ◽

Tolerance Of Ambiguity ◽

Single Cohort

Abstract Background Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students. Methods This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

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The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: Results from multiple samplings of a single cohort.

10.21203/rs.2.21655/v4 ◽

2020 ◽

Author(s):

Silvio Ndoja ◽

Saad Chahine ◽

Donald H. Saklofske ◽

Brent Lanting

Keyword(s):

Medical Students ◽

Medical Training ◽

Short Form ◽

Inverse Correlation ◽

Full Time ◽

Clinical Clerkship ◽

Clinical Experiences ◽

Clinical Exposure ◽

Tolerance Of Ambiguity ◽

Single Cohort

Abstract Background: Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.Methods: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results: From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p<0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship. Conclusion: Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

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The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: Results from multiple samplings of a single cohort.

10.21203/rs.2.21655/v3 ◽

2020 ◽

Author(s):

Silvio Ndoja ◽

Saad Chahine ◽

Donald H. Saklofske ◽

Brent Lanting

Keyword(s):

Primary Care ◽

Medical Students ◽

Medical Training ◽

Short Form ◽

Inverse Correlation ◽

Full Time ◽

Clinical Clerkship ◽

Tolerance Of Ambiguity ◽

Single Cohort

Abstract Background: Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.Methods: This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests. Results: From a total possible sample of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p<0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p>0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.Conclusion: Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. We discuss these findings in the context of an underlying anxiety cycle related to frequent rotation changes. Implications of the role of perfectionism and primary care is discussed. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

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The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate Medical training: A study of clerkship training effects.

10.21203/rs.2.21655/v1 ◽

2020 ◽

Author(s):

Silvio Ndoja ◽

Saad Chahine ◽

Donald H. Saklofske ◽

Brent Lanting

Keyword(s):

Psychological Factors ◽

Medical Training ◽

Short Form ◽

Inverse Correlation ◽

Educational Interventions ◽

Ambiguity Tolerance ◽

Clinical Experiences ◽

Demographic Information ◽

Tolerance Of Ambiguity ◽

Moderate Inverse Correlation

Abstract Background : Medicine is a field that is simultaneously factual and ambiguous. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with other psychological factors such as perfectionism is unknown. Methods: This was a single cohort study:174 Students in the first (pre) and last (post) 12 weeks of their 3 rd year comprising of 6 core rotations were invited to participate in an online anonymous survey. The survey included demographic information along with published and validated TOA and perfectionism scales. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons and correlations were used to detect the effect of clerkship on TOA, perfectionism and their relationship. Results: 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a decrease TOA (p<0.00) with pre-TOA scores at m=59.57 and post TOA at m=43.8. There was a moderate inverse correlation between TOA and perfectionism before clerkship (r=0.32) that increased slightly after clerkship (r=0.39). Clerkship was not significantly associated with levels of perfectionism (P>0.05). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre clerkship than those choosing other specialties, this difference was not found post clerkship. Conclusion: Clerkship does appear to influence student’s tolerance of ambiguity. However, perfectionism remained unchanged. Further work needs to be done exploring tailoring educational interventions to extremes of TOA and perfectionism.

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Student Reflections on the Queen’s Accelerated Route to Medical School Programme

Journal of Medical Education and Curricular Development ◽

10.1177/2382120519836789 ◽

2019 ◽

Vol 6 ◽

pp. 238212051983678 ◽

Cited By ~ 1

Author(s):

Jennifer J MacKenzie ◽

Denise Stockley ◽

Amber Hastings-Truelove ◽

Theresa Nowlan Suart ◽

Eleni Katsoulas ◽

...

Keyword(s):

Critical Thinking ◽

Focus Group ◽

Medical School ◽

Medical Training ◽

First Year ◽

School Of Medicine ◽

Group Data ◽

Focus Group Data ◽

Queen's University

Context: Since its inception more than 150 years ago, the School of Medicine at Queen’s University has aspired ‘to advance the tradition of preparing excellent physicians and leaders in health care by embracing a spirit of inquiry and innovation in education and research’. As part of this continuing commitment, Queen’s School of Medicine developed the Queen’s University Accelerated Route to Medical School (QuARMS). As Canada’s only 2-year accelerated-entry premedical programme, QuARMS was designed to reduce training time, the associated expense of medical training, and to encourage a collaborative premedical experience. Students enter QuARMS directly from high school and then spend 2 years enrolled in an undergraduate degree programme. They then are eligible to enter the first-year MD curriculum. The 2-year QuARMS academic curriculum includes traditional undergraduate coursework, small group sessions, and independent activities. The QuARMS curriculum is built on 4 pillars: communication skills, critical thinking, the role of physician (including community service learning [CSL]), and scientific foundations. Self-regulated learning (SRL) is explicitly developed throughout all aspects of the curriculum. Medical educators have defined SRL as the cyclical control of academic and clinical performance through several key processes that include goal-directed behaviour, use of specific strategies to attain goals, and the adaptation and modification to behaviours or strategies that optimize learning and performance. Based on Zimmerman’s social cognitive framework, this definition includes relationships among the individual, his or her behaviour, and the environment, with the expectation that individuals will monitor and adjust their behaviours to influence future outcomes. Objectives: This study evaluated the students’ learning as perceived by them at the conclusion of their first 2 academic years. Methods: At the end of the QuARMS learning stream, the first and second cohorts of students completed a 26-item, 4-point Likert-type instrument with space for optional narrative details for each question. A focus group with each group explored emergent issues. Consent was obtained from 9 out of 10 and 7 out of 8 participants to report the 2015 survey and focus group data, respectively, and from 10 out of 10 and 9 out of 10 participants to report the 2016 survey and focus group data, respectively. Thematic analysis and a constructivist interpretive paradigm were used. A distanced facilitator, standard protocols, and a dual approach assured consistency and trustworthiness of data. Results: Both analyses were congruent. Students described experiences consistent with curricular goals including critical thinking, communication, role of a physician, CSL, and SRL. Needs included additional mentorship, more structure for CSL, more feedback, explicit continuity between in-class sessions, and more clinical experience. Expectations of students towards engaging in independent learning led to some feelings of disconnectedness. Conclusions: Participants described benefit from the sessions and an experience consistent with the curricular goals, which were intentionally focused on foundational skills. In contrast to the goal of SRL, students described a need for an explicit educational structure. Thus, scaffolding of the curriculum from more structured in year 1 to less structured in year 2 using additional mentorship and feedback is planned for subsequent years. Added clinical exposure may increase relevance but poses challenges for integration with the first-year medical class.

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Investigating the attitudes of Canadian paramedic students towards homelessness

10.1101/19003483 ◽

2019 ◽

Author(s):

Alyson Cochrane ◽

Priya Pithia ◽

Emma Laird ◽

Kelly Mifflin ◽

Venessa Sonley-Long ◽

...

Keyword(s):

Urban Areas ◽

Longitudinal Design ◽

Quality Of Healthcare ◽

First Year ◽

Clinical Experiences ◽

Negative Attitudes ◽

Convenience Sample ◽

Clinical Exposure ◽

Positive Attitudes ◽

Before And After

AbstractIntroductionWhen paramedics are dispatched, it is expected that every patient receives the same level of care regardless of variable factors. Homelessness is a growing social issue across Canada that is particularly prevalent in urban areas. The quality of healthcare delivered to individuals experiencing homelessness may be influenced by negative attitudes held by healthcare professionals. There is an absence of literature quantifying the perspectives of paramedics towards homelessness; therefore, the focus of this study was to identify the attitudes of paramedic students towards homelessness and to continue the conversation in regards to the evolving educational needs of paramedic students.MethodsThis study employed a longitudinal design of a convenience sample of first year paramedic students in a college program in Ontario, Canada. The ‘Health Professional’s Attitude Towards the Homeless Inventory’ (HPATHI) was distributed to participants before and after placement and clinical exposure. The questionnaire includes 19 statements which participants respond to on a Likert scale. Mean scores were calculated, and statements were categorized into attitudes, interest, and confidence. Data were collected post-placement on interactions with persons experiencing homelessness.ResultsA total of 52 first year paramedic students completed the HPATHI pre-placement and 47 completed the questionnaire post-placement. Mean scores for attitudes (pre 3.64, SD 0.49; post 3.85, SD 0.38, p=0.032), interest (pre 3.91, SD 0.40; post 3.84, SD 0.39,p=0.51) and confidence (pre 4.02, SD 0.50; post 3.71, SD 0.67, p=0.004) were largely positive, but there was a demonstrated decreasing trend in confidence with, and interest in, working with those experiencing homelessness. Participants reported an average of 60 hours of placement, during which 15 participants (32%) reported interactions with people experiencing homelessness.ConclusionFirst year paramedic students demonstrate overall positive attitudes towards those experiencing homelessness, and the mean score for attitudes improved over the surveys. However, there were demonstrable decreases in confidence and interest over time, which may be related to the type and frequency of interactions during clinical placement. Paramedic education programs may benefit from the inclusion of focused education on homelessness, specific clinical experiences, and education related to social determinants of health.

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Introduction

Risk and Reason in Clinical Diagnosis ◽

10.1093/med/9780190944001.003.0001 ◽

2019 ◽

pp. 1-6

Author(s):

Cym Anthony Ryle

Keyword(s):

Primary Care ◽

Patient Safety ◽

Clinical Practice ◽

Medical Training ◽

Diagnostic Error ◽

Diagnostic Reasoning ◽

Human Cognition ◽

Postgraduate Medical Training ◽

Clinical Encounters

This chapter briefly describes the author’s background in primary care and the origins of his interest in diagnostic reasoning and error. It introduces the key themes of the book: the central role of diagnosis in medicine; the nature of diagnostic terms and classifications; the characteristics of human cognition; diagnostic reasoning; common types of diagnostic error; the implications for patient safety; the potential for changes in education, postgraduate medical training, and clinical practice to reduce diagnostic error; and possible obstacles to the implementation of the proposed changes. Also addressed is actual clinical encounters and how they are addressed by new clinicians and experienced physicians.

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A Response Evocation Program for /ɝ/

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.4001.92 ◽

1975 ◽

Vol 40 (1) ◽

pp. 92-105 ◽

Cited By ~ 19

Author(s):

Lawrence D. Shriberg

Keyword(s):

Service Delivery ◽

Motor Skills ◽

Task Analysis ◽

Professional Issues ◽

Clinical Experiences ◽

Program Outcomes ◽

Program Step ◽

Skills Learning ◽

Learning Principles

A response evocation program, some principles underlying its development and administration, and a review of some clinical experiences with the program are presented. Sixty-five children with developmental articulation errors of the /ɝ/ phoneme were administered the program by one of 19 clinicians. Approximately 70% of program administrations resulted in a child emitting a good /ɝ/ within six minutes. Approximately 10% of children who were given additional training on program step failures emitted good /ɝ/'s in subsequent sessions. These preliminary observations are discussed in relation to the role of task analysis and motor skills learning principles in response evocation, clinician influences in program outcomes, and professional issues in service delivery to children with developmental articulation errors.

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