The do’s, don’ts and don’t knows of redressing differential attainment related to race/ethnicity in medical schools

Introduction Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. Methods Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do’s, Don’ts and Don’t Knows. Results We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). Conclusions Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.

How preceptors develop trust in continuity clinic residents and how trust influences supervision: A qualitative study

Introduction To advance in their clinical roles, residents must earn supervisors’ trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision. Methods In this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018–June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust. Results Sixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care. Discussion The continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents’ provision of between-visit care may improve resident continuity clinic learning and patient care.

Bibliometrics: Methods for studying academic publishing

Bibliometrics is the study of academic publishing that uses statistics to describe publishing trends and to highlight relationships between published works. Likened to epidemiology, researchers seek to answer questions about a field based on data about publications (e.g., authors, topics, funding) in the same way that an epidemiologist queries patient data to understand the health of a population. In this Eye Opener, the authors introduce bibliometrics and define its key terminology and concepts, including relational and evaluative bibliometrics. Readers are introduced to common bibliometric methods and their related strengths and weaknesses. The authors provide examples of bibliometrics applied in health professions education and propose potential future research directions. Health professions educators are consumers of bibliometric reports and can adopt its methodologies for future studies.

An undergraduate medical curriculum framework for providing care to transgender and gender diverse patients: A modified Delphi study

Introduction The lack of attention to transgender and gender diverse (TGD) people in undergraduate medical education (UME) is a point of concern, particularly among medical students. A project was undertaken to develop a UME curriculum framework for teaching the healthcare needs of TGD people. Methods Using a modified Delphi methodology, four rounds of surveys were presented to an expert stakeholder group that included content experts, generalist physicians, UME teaching faculty, and medical students. Questions covered what content should be taught, who should teach the content, and how much time should be dedicated for this teaching. Once the Delphi process was complete, feedback on the provisional framework was sought from members of the TGD community to ensure it represented their needs and perspectives. Results 71 panel members and 56 community members participated in the study. Core values included the scope of the framework, and topics such as inclusivity, and safety in practice and in teaching. The framework included terminology, epidemiology, medical and surgical treatment, mental health, sexual and reproductive health, and routine primary care. There was also guidance on who should teach, time to be allocated, and the learning environment. Discussion There is a clear need to train tomorrow’s doctors to provide competent and respectful healthcare services to and for TGD patients. Although local factors will likely shape the way in which this framework will be implemented in different contexts, this paper outlines a core UME-level curriculum framework for Canada and, potentially, for use in other parts of the world.

Video-assisted self-reflection of resuscitations for resident education and improvement of leadership skills: A pilot study

Introduction One of the most challenging aspects of Emergency Medicine (EM) residency is mastering the leadership skills required during a resuscitation. Use of resuscitation video recording for debriefing is gaining popularity in graduate medical education. However, there are limited studies of how video technology can be used to improve leadership skills in the emergency department. We aim to evaluate the utility of video-assisted self-reflection, compared with self-reflection alone, in the setting of resuscitation leadership. Methods This was a prospective, randomized, controlled pilot study conducted in 2018 at an urban level 1 trauma center with a three-year EM residency program. The trial included postgraduate year (PGY) 2 and 3 residents (n = 10). Each resident acted as an individual team leader for a live real-time resuscitation in the emergency department. The authors classified a patient as a resuscitation if there was an immediate life- or limb-threatening disease process or an abnormal vital sign with an indication of hypoperfusion. Each resident was recorded as the team leader twice. Both control and intervention groups produced written self-reflection after their first recording. The intervention group viewed their resuscitation recording while completing the written reflection. After their reflection, all participants were recorded for a second resuscitation. Two faculty experts, blinded to the study, scored each video using the Concise Assessment of Leader Management (CALM) scale to measure the leadership skills of the resident team leader. Results Five PGY‑3 and five PGY‑2 residents participated. The weighted kappa between the two experts was 0.45 (CI 0.34–0.56, p < 0.0001). The median gain score in the control group was −1.5 (IQR) versus 0.5 in the intervention group (IQR). Discussion Video-assisted self-reflection showed positive gain score trends in leadership evaluation for residents during a resuscitation compared with the non-video assisted control group. This tool would be beneficial to implement in EM residency.

The application of the tracer method with peer observation and formative feedback for professional development in clinical practice: a scoping review

Introduction The tracer method, commonly used for quality assessment, can also be used as a tool for peer observation and formative feedback on professional development. This scoping review describes how, by whom, and with what effect the tracer method is applied as a formative professional development instrument between healthcare professionals of equal status and aims to identify the types of scientific evidence for this use of the tracer method. Methods The authors searched four electronic databases for eligible articles, which were screened and assessed for eligibility by two independent researchers. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings. Results The electronic search yielded 1757 unique studies, eight of which were included as valid and relevant to our aim: five qualitative, two mixed methods, and one quantitative study. Seven studies took place in hospitals and one in general practice. The tracer method was used mainly as a form of peer observation and formative feedback. Most studies evaluated the tracer method’s feasibility and its impact on professional development. All but one study reported positive effects: participants described the tracer method generally as being valuable and worth continuing. Discussion Although the body of evidence is small and largely limited to the hospital setting, using the tracer method for peer observation and formative feedback between healthcare professionals of equal status appears sufficiently useful to merit further rigorous evaluation and implementation in continuous professional development in healthcare.

Rethinking implementation science for health professions education: A manifesto for change

Implementation science approaches the challenges of translating evidence into practice as a matter of scientific inquiry. This conceptual paper uses an implementation science lens to examine the ways in which evidence from health professions education research is brought to bear on decision-making. The authors describe different decision-making contexts and the kinds of evidence they consider, and from this, they outline ways in which research findings might be better presented to support their translation into policy and practice. Reflecting on the nature of decision-making in health professions education and how decisions are made and then implemented in different health professions education contexts, the authors argue that researchers should align their work with the decision-making contexts that are most likely to make use of them. These recommendations reflect implementation science principles of packaging and disseminating evidence in ways that are meaningful for key stakeholders, that stem from co-creation of knowledge, that require or result in meaningful partnerships, and that are context specific and relevant.

Caring from behind the face mask in healthcare: Learning from the dramatic arts

The COVID-19 pandemic has made its impact across the globe with great voracity. New routines have displaced older more established ones with ruthless efficiency—no more so than in healthcare. In meeting these challenges, many healthcare workers have had to prepare for and enact many new ways of working. Regardless of their speciality or stage of training, health professions educators (HPEs) have helped train our healthcare workforce in developing new skills with great tempo. Throughout all of these efforts one constant has guided our endeavours—the humane connection with those that provide and those that seek healthcare.However, with COVID-19 we have had to distance ourselves from our patients, and colleagues, and clad ourselves in various items of personal protection equipment (PPE). The protective barrier also acts as a barrier to personal interaction and therefore presents challenges in how we connect with each other on a humane level. Few disciplines have engaged with the complexities of verbal and gestural communication as thoroughly and consistently as the dramatic arts. Actors in Ancient Greece would perform wearing masks and used oratory as well as gestural communication to enrapture the audience.Drawing upon the dramatic arts, we aim to explore the relationship between face and mask and thereby provide reflective insights for HPEs to help guide healthcare workers in their communication from behind the face mask.