Advances in health sciences education : theory and practice
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Adv Health Sci Educ Theory Pract · Dec 2017
Comparative StudyComparison study of judged clinical skills competence from standard setting ratings generated under different administration conditions.
When the safety of the public is at stake, it is particularly relevant for licensing and credentialing exam agencies to use defensible standard setting methods to categorize candidates into competence categories (e.g., pass/fail). The aim of this study was to gather evidence to support change to the Comprehensive Osteopathic Medical Licensing-USA Level 2-Performance Evaluation standard setting design and administrative process. Twenty-two video recordings of candidates assessed for clinical competence were randomly selected from the 2014-2015 Humanistic domain test score distribution ranging from the highest to lowest quintile of performance. ⋯ The two one-sided test procedure established equivalence between panel group means at the 0.05 confidence level, controlling for rater errors within each panel group. From a practical cost-effective and administrative resource perspective, results from this study suggest it is possible to diverge from typical panel groups, who are sequestered the entire time onsite, to larger numbers of panelists who can make their judgments offsite with little impact on judged samples of qualified performance. Standard setting designs having panelists train together and then allowing those to provide judgments yields equivalent ratings and, ultimately, similar cut scores.
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Adv Health Sci Educ Theory Pract · Oct 2017
ReviewClinician behaviors in telehealth care delivery: a systematic review.
Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider-patient interaction during care in telehealth delivery. ⋯ Six themes were identified: HCP-based support for telehealth delivery; provider-patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.
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Adv Health Sci Educ Theory Pract · Oct 2017
Observational StudySelf-entrustment: how trainees' self-regulated learning supports participation in the workplace.
Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees' learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees' development, and to explore supervisor's role herein. ⋯ Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees' increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees' self-regulated learning.
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Adv Health Sci Educ Theory Pract · Aug 2017
Integrating the teaching role into one's identity: a qualitative study of beginning undergraduate medical teachers.
Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A qualitative study was performed, involving 18 beginning medical teachers at a Dutch medical school. ⋯ The teachers used five different identity narratives in order to integrate the teacher role into their identity, in which the positions of teacher and doctor or researcher were found to be combined, adopted or rejected in diverse ways. The five identity narratives were: (1) coalition between the I-position of teacher and other I-positions; (2) no integration of the I-position of teacher: holding on to other I-positions; (3) construction of the I-position of teacher and other I-positions as opposites; (4) coalition between the I-position of teacher and a third position of coordinator; and (5) meta-position: trivialising the importance of status. These identity narratives offer starting points for supporting undergraduate teachers during their early professional years.
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Adv Health Sci Educ Theory Pract · May 2017
Taiwanese medical students' narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture.
In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. ⋯ Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.