Column Editors: Craig Campbell, MD and Joseph Szot, MD
This issues offers a specially-curated selection of peer-reviewed articles on topics and issues of strong interest for our readers ranging from the controversial medical assistance in dying, the relevancy of faculty tenure today, improving a physician’s emotional intelligence and how faculty leaders can (must) help to promote organizational change for improved healthcare delivery.
Development of a Canadian Medical Assistance in Dying Curriculum for Healthcare Providers. –Shapiro GK, Hunt K, Braund H, Dalgarno N, Panjwani AA, Stevens S, Mulder J, Sheth MS, Stere A, Green S, Gubitz G, Li M.–J Med Educ Curric Dev. 2024 Aug 31;11:23821205241272376. doi: 10.1177/23821205241272376. eCollection 2024 Jan-Dec.–PMID: 39220358 Free PMC article
In 2016 Canada legalized Medical Assistance in Dying (MAiD) this necessitated the training for physicians and nurse practitioners in MAiD. To meet this need, a nationally accredited MAiD curriculum was developed. It was a comprehensive, bilingual, hybrid (synchronous and asynchronous) educational curriculum. This article describes the process of developing the Canadian MAiD Curriculum (CMC). Its guiding principles and framework are outlined its development was guided by adult learning theory, constructivism, a literature review, a needs assessment that identified five key principles. Seven modules were developed focusing on eight key topic areas. This curriculum ensures that information is available to healthcare providers concerning the practice of MAiD. This curriculum will be updated as MAiD policy and services evolve in Canada.
Enhancing an Experience-Based Patient-Initiated Mistreatment Training. –Fraley L, Sheffield V, Houchens N.–Acad Med. 2024 Sep 16. doi: 10.1097/ACM.0000000000005870. Online ahead of print.–PMID: 39283805
This article describes the evaluation of a curriculum to address mistreatment of healthcare workers and learners by patients and their families. Funding for the study was received from the Josiah Macy Jr Foundation Catalyst Award for Transformation in Graduate Medical Education. They designed and piloted a program that instructed on a framework for responding to mistreatment in the moment. It included a review of the literature as well as simulation with trained patient actors. Pre and post course surveys showed respondents self-reported plan to use skills demonstrated in the session and plan to address mistreatment with their team moving forward. The foundations of this curriculum could support the expansion to meet the needs of all patient facing health care workers at the pilot institution and beyond.
Intelligent play: How improv can improve clinician’s emotional intelligence. –Mehta A, Hendel-Paterson B, Shah N, Hemphill J, Adams N, Fredrickson M.–Clin Teach. 2024 Aug;21(4):e13730. doi: 10.1111/tct.13730. Epub 2024 Jan 21.–PMID: 38246854
In this article the authors describe the use of improv training and the impact on participant’s emotional intelligence (EI). There were four online improv workshops offered each lasting two hours. The participants were from varying levels of experience including residents, educators and practicing physicians. Self-reported EI scales were captured pre and post workshop. Participants showed statistically significant improvement in overall score, in the appraisal score, the regulation score and the utilization score. The others conclude that improv training is an innovative method to fill a crucial gap in EI training.
Promotion and Tenure Policies and Practices at U.S. Medical Schools: Is Tenure Irrelevant or More Relevant Than Ever? –Mallon WT, Cox N.–Acad Med. 2024 Jul 1;99(7):724-732. doi: 10.1097/ACM.0000000000005689. Epub 2024 Mar 14.–PMID: 38489477
In this article the authors seek to answer the questions regarding tenure and its relevance in today’s environment. Using a 2022 survey of 118 medical schools. A review of promotions and tenure policies from another 37 medical schools and an analysis of the Association of American Medical Colleges Faculty Roster Data the authors reviewed the prevalence of tenure systems at U.S. MD granting medical schools. They evaluated trends in their use for full-time basic science and clinical faculty. Models of including diversity, equity and inclusion (DEI) criteria in P&T standards and alterations to introduce greater flexibility into the P&T process were also evaluated. The authors evaluation showed that tenure remains well established but that the percentage of full-time faculty on tenure eligible tracks has declined over the last four decades. Gaps in tenure-eligible appointments between men and women and among faculty by race and ethnicity. Medical schools have begun to use a variety of tactics in the P&T process to address these inequities. Realist analysis is interpretive, it moves beyond description to explain generative causation employing reductive theory.
Realist analysis of qualitative data in health professions education research. –Rees CE, Proctor DW, Nguyen VNB, Ottrey E, Mattick KL.–Med Educ. 2024 Aug 19. doi: 10.1111/medu.15482. Online ahead of print.–PMID: 39157923 Review.
The aim of this paper is to aid readers to better critique, conduct and report qualitative research. Qualitative realist analysis is becoming more common in health professions education research (HPER). Its goal is to attempt to build/test theory about how, why, for whom, when and to what extent programs work using the context-mechanism-outcome configuration heuristic. The authors describe four fundamentals of qualitative realist analysis. They provide critical analysis of 15 HPER outputs in realist analysis. They also articulate three common analysis challenges and strategies to mitigate them.
The Role of Faculty Development in Advancing Change at the Organizational Level. –Steinert Y, O’Sullivan PS, Irby DM.–Acad Med. 2024 Jul 1;99(7):716-723. doi: 10.1097/ACM.0000000000005732. Epub 2024 Apr 8.–PMID: 38579264
The authors of this article propose that the traditional role of faculty development (FD) to enhance individual growth and development may no longer be enough to address the compelling changes facing faculty. This perspective piece describes a vision where FD leaders along with other educational leaders can bring about change at the organizational level to support excellence in innovation. The model the authors propose has four major goals, promoting individual and group development, advocating for infrastructure and resources, influencing policies and procedures, and contributing to organizational wide initiatives. In the model the four goals are interconnected and can impact the organizational culture. Their intent is to provide illustrative examples of how FD programs and leaders can their mission through broader engagement with their institution.
Using Community Engagement to Move Upstream to Address Social Determinants of Health.
Jones R, Bilello L, Knight AM, Livingood WC, Whitner C, Webb F.–Acad Med. 2024 Jun 4. doi: 10.1097/ACM.0000000000005780. Online ahead of print.–PMID: 38838196 ––
The authors of this article describe the creation of an Urban Health Alliance to facilitate the University of Florida’s mission to improve community health using community-focused, self-sustainable strategies and solutions to impact social determinants of health. The Urban Health Alliance is the organizational structure that facilitates empowering community partners to affect changes in policy and systems across multiple pillars including education. This approach, utilized increasingly in undergraduate medical education, may have applicability for CME offices considering strategies for how to impact regional or community health needs.
Virtual Care Integration: Balancing Physician Well-Being.
LaPlante G, Babenko O, Neufeld A.–PRiMER. 2024 Jun 11;8:32. doi: 10.22454/PRiMER.2024.690812. eCollection 2024.–PMID: 38946752
The authors of this article used self-determination theory to explore workplace needs satisfaction and frustration of 158 family physicians, their subjective well-being and the frequency of virtual care use post COVID 19 pandemic. More frequent use of virtual care was associated with lower relatedness satisfaction these physician’s frustration related to autonomy and competence needs negatively affected their perceived well-being and relatedness needs. This study opens a window into understanding the importance of physician’s basic psychological needs who continue to work to integrate virtual care within clinical practice. How to help physicians reflect on their own sense of autonomy, competence and relatedness is worthy of further exploration.
Chua JS, van Diepen M, Trietsch MD, Dekker FW, Schönrock-Adema J, Bustraan J.–Can Med Educ J. 2024 Jul 12;15(3):18-25. doi: 10.36834/cmej.77580. eCollection 2024 Jul.–PMID: 39114774.
The authors of this article address the common challenges of using surveys with standard Likert scales to evaluate the impact or outcomes of medical courses. Borrowing from work developed in undergraduate medical education, the authors randomly assigned 597 participants of a large CME course to either express their personal opinions on a five-point Likert Scale (opinion-based method), or to predict the percentage of their peers who would choose each of the options on the same Likert scale (prediction-based method). The overall response rate was 47%. The prediction-based method required fewer respondents to achieve stable average responses and resulted in fewer extreme responses than the opinion-based methods. For CPD providers who are struggling with low response rates of surveys to evaluate CME courses, this article may be helpful to consider as the authors provide practical considerations for how to apply this method in practice.
Hodge E, Sandford A.–Int J Med Educ. 2024 Jun 15;15:59-65. doi: 10.5116/ijme.6639.1a23.–PMID: 38879880
The authors of this article used an online cross-sectional survey with qualitative and quantitative measures to assess the workplace drivers of professional fulfilment, burnout and perceived impact of workplace issues on the well-being of physicians practicing in a regional healthcare setting in Australia. The results of the survey completed by 124 physicians (including residents to specialists in practice) identified 6 workplace issues that were related to overall reported professional fulfilment and burnout. Although not all of these factors may be generalizable to all practice settings or types of practices, the findings suggest the transformative potential of addressing workplace issue that reduce or nurture physician professional fulfilment and reduce burnout risks.
Joseph Szot, MD is the Associate Dean for CME and Integrative Education, Carver College of Medicine, University of Iowa.
Craig Campbell, MD is Director of Curriculum, Faculty of Medicine, University of Ottowa.
