Abstract Introduction The authors aimed to investigate how medical students interpret the observation of a more experienced clinician modeling both exemplary and flawed behaviors as well as how that interpretation influences their subsequent clinical performance. Methods We presented a recorded patient sexual history to 11 medical students. The recording displayed both exemplary and flawed behaviors. Students then obtained a sexual history from a standardized patient themselves. Using an interview methodology and constructivist analytic approach, we explored the process of learning from clinical observations. Results Students attended to flawed modeled behaviors, challenges specific to the task, and how areas of their own personal development were accomplished. They took a piecemeal approach to classifying modeled behaviors as done well or poorly based on previous instruction, experience, or perceived downstream effects. When applying their observations, students choose to copy, adapt, or avoid modeled behaviors based on their classification of the behavior. Discussion To optimize learning from observation, faculty can identify task-specific challenges and a student’s personal goals, which naturally draw the student’s attention, before observation in order to develop a shared mental model. When debriefing observed encounters, faculty may consider natural targets of learner attention, challenges specific to learning from observation, and factors likely to influence a learner’s judgement of modeled behaviors.
Geriatric patients account for a growing proportion of dermatology clinic visits. Although their biopsychosocial needs differ from those of younger adults, there are no geriatrics training requirements for dermatology residency programs.This study explored the state of geriatrics education in dermatology programs in 2016.This constructivist study employed cross-sectional, mixed-methods analysis with triangulation of semistructured interviews, surveys, and commonly used curricular materials. We used purposive sampling of 5 US academic allopathic dermatology programs of different sizes, geographic locations, and institutional resources. Participants were interviewed about informal curricula, barriers, and suggestions for improving geriatrics education, and they also completed a survey about the geriatrics topics that should be taught. The constant comparative method with grounded theory was used for qualitative analysis. We identified formal geriatrics curricular content by electronically searching and counting relevant key texts.Fourteen of 17 participants (82%) agreed to be interviewed, and 10 of 14 (71%) responded to the survey. Themes of what should be taught included diagnosing and managing skin diseases common in older adults, holistic treatment, cosmetic dermatology, benign skin aging, and the basic science of aging. Topics currently covered that could be expanded included communication, systems-based challenges, ethical issues, safe prescribing, quality improvement, and elder abuse. Cosmetic dermatology was the most commonly taught formal geriatrics curricular topic.There were discrepancies among topics participants felt were important to teach about geriatric dermatology and curricular coverage of these areas. We identified challenges for expanding geriatrics curricula and potential solutions.
The sociopolitical and cultural context of graduate surgical education has changed considerably over the past 2 decades. Although new structures of graduate surgical training programs have been developed in response and the comparative value of formats are continually debated, it remains unclear how different time-based structural paradigms are preparing trainees for independent practice after program completion.To investigate the factors associated with trainees' and program directors' perception of trainee preparedness for independent surgical practice.This qualitative study used an instrumental case study approach and obtained information through semistructured interviews, which were analyzed using open-and-focused coding. Participants were recent graduates and program directors of vascular surgery training programs in the United States. The 2 training paradigms analyzed were the integrated vascular surgery residency program (0 + 5, with 0 indicating that the general surgery training experiences are fully integrated into the 5 years of overall training and 5 indicating the total number of years of training) and the traditional vascular surgery fellowship program (5 + 2, with 5 indicating the number of years of general surgery training and 2 indicating the number of years of vascular surgery training). All graduates completed their training in 2018. All interviews were conducted between July 1, 2018, and September 30, 2018.A conceptual framework to inform current and ongoing efforts to optimize graduate surgical training programs across specialties.A total of 22 semistructured interviews were completed, involving 7 graduates of 5 + 2 programs, 9 graduates of 0 + 5 programs, and 6 vascular surgery program directors. Of the 22 participants, 15 were men (68%). Participants described 4 interconnected domains that were associated with trainees' perceived preparedness for practice: structural, individual, relational, and organizational. Structural factors included the overall and vascular surgery-specific time spent in training, whereas individual factors included innate technical skills, confidence, maturity, and motivation. Faculty-trainee relationships (or relational factors) were deemed important for building trust and granting of autonomy. Organizational factors included features of the local organization, including patient population, case volume, and case mix.Findings suggest that restructuring training paradigms alone is insufficient to address the issue of trainees' perceived preparedness for practice. A framework was created from the results for evaluating and improving residency and fellowship programs as well as for developing graduate surgical training paradigms that incorporate all 4 domains associated with preparedness.
The authors sought to explore how a curriculum that uses a patient experience simulation followed by reflection can lead to clinical empathy in learners and whether this experience leads to behavioral change. Further, in response to critiques of common pragmatic approaches to clinical empathy teaching in which empathy is operationalized and taught through formal trainings and checklists, the study aimed to contribute insights regarding how clinical empathy may best be taught to health profession students.
Academic medicine faces difficulty recruiting and retaining a diverse workforce. The proportion of medical students who are underrepresented in medicine (URiM) is smaller than the proportion of URiMs in the general population, and these numbers worsen with each step up the academic medicine ladder. Previously known as the "leaky pipeline," this phenomenon may be better understood as disparate "pathways with potholes," which acknowledges the different structural barriers that URiM trainees and faculty face in academic medicine. This critical scoping review analyzed current literature to determine what variables contribute to the inequitable "pathways and potholes" URiM physicians experience in academic medicine.The authors combined scoping review methodology with a critical lens. The comprehensive search strategy used terms about academic medicine, underrepresented groups, and leaving academic medical careers. One reviewer conducted screening, full-text review, and data extraction while in consultation with members of the research team. Data extraction focused on themes related to pathways and potholes, such as attrition, recruitment, and retention in academic medicine. Themes were iteratively merged, and quality of contribution to the field and literature gaps were noted.Included papers clustered into attrition, recruitment, and retention. Those pertaining to attrition noted that URiM faculty are less likely to get promoted even when controlling for scholarly output, and a hostile work environment may exacerbate attrition. Recruitment and retention strategies were most effective when multipronged approaches changed every step of the recruitment and promotion processes.These studies provide examples of various "potholes" that can affect representation in academic medicine of URiM trainees and faculty. However, only a few studies examined the link between isolating and hostile work environments, the so-called "chilly climate," and attrition from academic medicine. Understanding these concepts is key to producing the most effective interventions to improve diversity in medicine.
Tokenism is the symbolic inclusion of numerical minorities within a group, usually for the sake of appearances rather than for inclusiveness or true diversity. Tokens (due to their race, gender, or other social group membership) experience myriad issues related to their token status, particularly heightened visibility, exaggeration of their differences, and role encapsulation. In addition, tokens are often expected to do extra work due to their identity or face extra pressure to perform well. All of these difficulties may result in stress, depression, and challenges and work.
Abstract This complete research paper will describe a qualitative study conducted at a large midwestern university exploring the motivations rural students cite as the reason they pursue engineering. Rural communities account for 21.3% of students in the United States (1), however, only 27.1% of these students will continue their education and enroll in a college or university by the time they turn 24 (1). This is well below the national average of 34.7% (1). Although there are no specific numbers available for the proportion of students from rural communities in engineering, there is evidence that suggests rural students are not pursuing engineering degrees in comparable numbers to their peers from urban or suburban communities. Case studies suggest that rural populations are underrepresented in engineering programs at institutions throughout the Midwest, with some institutions having no rural representation (2). Other recent work has investigated the impact of rurality on engineering persistence and graduation rates, with one model showing that rural students in engineering are 7% less likely to graduate than students coming from a suburban area (3). However, these studies do not tell the whole story of the experiences of rural students who enter the engineering field. Educators are aware that there are unique challenges that rural students face when transitioning to institutions of higher learning (4) such as limited advanced STEM curricula in high school, lack of engineering mentors or roles models, and lower expectations and confidence. There has also been work that suggests the reasons rural students pursue engineering is different from their urban and suburban peers (5). By digging deeper into the experiences of rural students in their first year, we can learn more about the unique challenges and motivations that rural students possess, which can help educators better support these students. The work presented here is part of a larger study exploring the experience of rural students in their first year of study as they transition into an engineering course of study at a large university. The work is guided by one research question: what factors motivate rural students to attend university and enroll in an engineering major? Using native inquiry (6), we are investigating the lived experiences of students and how rural culture influences their motivation, perceptions, and expectations in their first year of an engineering course study. To explore this research question, structured interviews were conducted with first-year students in their first semester of an engineering course of study. Seven students were interviewed in fall 2019, and currently, more are being recruited for the 2020 cohort. The interview questions have been designed to probe specific aspects of each research question and have been divided into six broad categories: descriptions of home, mentorship/relationships, expectations, transition to the university environment, identity, and choices/motivation for pursuing an engineering education. The theoretical framework of self-determination Theory will be used to analyze the data (7). Previous work has focused on the challenges that rural students encounter when starting as an engineering student; in this paper, we will focus specifically on students’ choices/motivation for pursuing engineering education, analyzing the factors that motivate rural students to pursue engineering and investigating how their rural cultural background shapes their experiences in college. We believe that by better understanding the lived experiences of rural students, instructors can have better insight into how to support them in the transition from high school to an engineering course of study. 1. Provasnik S, KewalRamani A, McLaughlin Coleman M, Gilbertson L, Herring W, Xie Q. 2007. Status of Education in Rural AmericaU.S. Department of Education. Washington, DC. 2. Versypt JJ, Ford Versypt AN. 2013. Mapping Rural Students ’ STEM Involvement : Case Studies of Chemical En- gineering Undergraduate Enrollment in the States of Illinois and Kansas Mapping Rural Students ’ STEM Involvement : Case Studies of Chemical Engineering Undergraduate Enrollment in ASEE Annual Conference and Exposition, Conference Proceedings. American Society for Engineering Education, Atlanta, GA. 3. Zahedi L, Ross M, Batten J. 2019. Pathways and Outcomes of Rural Students in Engineering. 4. Ganss KM. 2016. The college transition for first-year students from rural Oregon communities. J Stud Aff Res Pract 53:269–280. 5. Felder RD, Mohr PH, Dietz EJ, Baker-Ward L. 1994. A Longitudinal Study of Engineering Student Performance and Retention II . Rural / Urban Student Differences. J Eng Educ 209–217. 6. Clandinin DJ, Rosiek J. 2012. Mapping a Landscape of Narrative Inquiry: Borderland Spaces and TensionsHandbook of Narrative Inquiry: Mapping a Methodology. 7. Deci EL, Ryan RM. 2008. Self-determination theory: A macro theory of human motivation, development, and health. Can Psychol 49:182–185.
