Tangrams: a simple visual tool for communicating the complexities of professionalism

Professionalism is vital for high quality healthcare and fundamental to health profession education. It is however complex, hard to define and can be challenging to teach, learn about and assess. We describe the development and use of an innovative visual tool, using a tangram analogy, to introduce and explore core professionalism concepts, which are often troublesome for both learners and educators. These include the hidden curriculum, capability, professional identity and the difference between unprofessionalism and high professional standards. Understanding these concepts can help individuals to see professionalism differently, encourage faculty to design professionalism programmes which focus on professional excellence, support assessors to feel more confident in identifying and addressing underperformance and facilitate learners to appreciate the complexity and uncertainty inherent in professionalism and to become more alert to the hidden curriculum and its potential impact. We have used the tangram model to educate for professionalism in multiple contexts with learners and educators. Participants regularly report that it leads to a deeper understanding and important new insights around professionalism and helps them identify ways of changing their practice. We believe this approach has relevance across the health professions and suggest ways it could be further developed to explore wider professionalism issues such as reflective practice, resilience and teamworking.

Semantic competency as a marker of clinical reasoning performance

Background: This study sought to explore the relationship between semantic competence (or dyscompetence) displayed during “think-alouds” performed by resident and attending physicians and clinical reasoning performance. Methods: Internal medicine resident physicians and practicing internists participated in think-alouds performed after watching videos of typical presentations of common diseases in internal medicine. The think-alouds were evaluated for the presence of semantic competence and dyscompetence and these results were correlated with clinical reasoning performance. Results: We found that the length of think-aloud was negatively correlated with clinical reasoning performance. Beyond this finding, however, we did not find any other significant correlations between semantic competence or dyscompetence and clinical reasoning performance. Conclusions: While this study did not produce the previously hypothesized findings of correlation between semantic competence and clinical reasoning performance, we discuss the possible implications and areas of future study regarding the relationship between semantic competency and clinical reasoning performance.

Developing a team-based assessment strategy: direct observation of interprofessional team performance in an ambulatory teaching practice

Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.

Racism in medicine: A qualitative study on the impact of discussion among medical students

Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities. Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions. Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001). Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education. Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.

Effect of resident and assessor gender on entrustment-based observational assessment in an internal medicine residency program

Background: Implicit gender bias leads to differences in assessment. Studies examining gender differences in resident milestone assessment data demonstrate variable results. The purpose of this study was to determine if observational entrustment scores differ by resident and assessor gender in a program of assessment based on discrete, observable skills. Methods: We analyzed overall entrustment scores and entrustment scores by Accreditation Council for Graduate Medical Education (ACGME) core competency for 238 residents (49% female) from 396 assessors (38% female) in one internal medicine residency program from July 2012 to June 2019. We conducted analyses at 1-12 months, 1-36 months, 1-6 months, 7-12 months, and 31-36 months. We used linear mixed-effect models to assess the role of resident and assessor gender, with resident-specific and assessor-specific random effect to account for repeated measures. Results: Statistically significant interactions existed between resident and assessor gender for overall entrustment at 1-12 months (p < 0.001), 1-36 months (p< 0.001), 1-6 months (p<0.001), 7-12 months (p=0.04), and 31-36 months (p<0.001). However, group differences were not statistically significant. In several instances an interaction was significant between resident and assessor gender by ACGME core competency, but there were no statistically significant group differences for all competencies at any time point. When applicable, subsequent analysis of main effect of resident or assessor gender independently of one another revealed no statistically significant differences. Conclusions: No significant differences in entrustment scores were found based on resident or assessor gender in our large, robust entrustment-based program of assessment. Determining the reasons for our findings may help identify ways to mitigate gender bias in assessment.

Health professionalism and health profession education in the 21st century

The dramatic, rapid and uncertain changes from the 20th to the 21st century are called global megatrends. Such trends are the emerging and re-emerging infectious diseases, an aging society, environmental hazards, behavioural risks, and more complicated lifestyles of humans in the digital age with advanced information technology (IT) that impact much on epidemiological transitions, health security and healthcare. Health professionals are the key persons for dealing with these challenging healthcare trends. The next generation of health professionals should be equipped with high professionalism especially for the components of humanism that artificial intelligence (AI) cannot replicate. Moreover, interprofessional collaborative teamwork among health professionals is a required skill for working in dynamic transitions such as the coronavirus disease 2019 (COVID-19) pandemic. Interprofessional education (IPE) is one of the essential strategies for enhancing teamwork skills in learners. Six previously reported trends in health profession education for the 21st century are summarized, including interprofessional education, longitudinal integrated clinical education, understanding partnerships and social determination of health in patients, life-long learning, competency-based skills changeable over time, and AI and IT integrated in education. The connection among megatrends, trends in healthcare, health professionalism and health professional’s education will be important issues in academia for both health educators and health professionals.

The changing face of MedEdPublish

MedEdPublish has come a long way since it was launched in 2016 by AMEE as an independent academic e-journal that supports scholarship in health professions education. Beginning as a relatively small, in-house publication on a web platform adapted for the purpose, we invited members of our community of practice to submit articles on any topic in health professions education, and encouraged a wide range of article types. All articles were published so long as they met editing criteria and where within scope. Reviews were welcomed from both members of our Review panel and the general readership, all published openly with contributors identified. Many articles attracted several reviews, responses and comments, creating interactive discussion threads that provided learning opportunities for all. The outcome surpassed our expectations, with over 500 articles submitted during 2020, beyond the capacity of our editing team and platform to achieve our promise of rapid publishing. We have now moved to a much larger and powerful web platform, developed by F1000 Research and within the Taylor and Francis stable, the home of AMEE’s other journal, Medical Teacher. Most of our innovations are supported by the new platform and there is scope for further developments. We look forward to an exciting new phase of innovation, powered by the F1000 platform.

One size doesn’t fit all: framework and resources for individualized interventions for struggling medical students

When helping struggling medical students, a “one size fits all” approach is often ineffective, as many different factors affect academic success. In our experience, these factors may overlap or be distinct for each student, and thus require individualized interventions based on student needs. We recommend an individualized model of academic support includes an intake interview, assessment, individualized interventions, and follow up to assess progress. This paper provides a recommended framework of resources for medical school faculty and staff who work with struggling students. Different issues that lead students to struggle are categorized in the main domains of Bloom’s taxonomy: cognitive, affective, and psychomotor. A discussion of the impact of the factors in each domain includes detailed tables with corresponding manifestations, assessments, and support strategies literature for each issue. An application of a proposed framework is presented on a case example. Individualized approaches to improving medical student success are presented to address the complex and interrelated areas of academic success, wellbeing, quality of life, career potential, and satisfaction with medical school.