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Descriptors:
Foreign Countries; Physician Patient Relationship; Interpersonal Communication; Individual Characteristics; Asian Culture; Social Distance; Interpersonal Relationship; Context Effect; Medical Education; Grounded Theory; Clinics; Internal Medicine; Interviews

Abstract:
Studies of doctor-patient communication generally advocate a partnership communication style. However, in Southeast Asian settings, we often see a more one-way style with little input from the patient. We investigated factors underlying the use of a one-way consultation style by doctors in a Southeast Asian setting. We conducted a qualitative study based on principles of grounded theory. Twenty residents and specialists and 20 patients of a low or high educational level were interviewed in internal medicine outpatient clinics of an Indonesian teaching hospital and two affiliated hospitals. During 26 weeks we engaged in an iterative interview and coding process to identify emergent factors. Patients were generally dissatisfied with doctors' communication style. The doctors indicated that they did not deliberately use a one-way style. Communication style appeared to be associated with characteristics of Southeast Asian culture, the health care setting and medical education. Doctor-patient communication appeared to be affected by cultural characteristics which fell into two broad categories representing key features of Southeast Asian culture, "social distance" and "closeness of relationships", and to characteristics categorized as "specific clinical context". Consideration of these characteristics could be helpful in promoting the use of a partnership communication style. (Contains 2 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Structural Equation Models; Academic Achievement; Motivation; Self Determination; Medical Education; Medical Students; Gender Differences; Grade Point Average; Statistical Analysis; Goodness of Fit; Foreign Countries

Abstract:
Few studies in medical education have studied effect of quality of motivation on performance. Self-Determination Theory based on quality of motivation differentiates between Autonomous Motivation (AM) that originates within an individual and Controlled Motivation (CM) that originates from external sources. To determine whether Relative Autonomous Motivation (RAM, a measure of the balance between AM and CM) affects academic performance through good study strategy and higher study effort and compare this model between subgroups: males and females; students selected via two different systems namely qualitative and weighted lottery selection. Data on motivation, study strategy and effort was collected from 383 medical students of VU University Medical Center Amsterdam and their academic performance results were obtained from the student administration. Structural Equation Modelling analysis technique was used to test a hypothesized model in which high RAM would positively affect Good Study Strategy (GSS) and study effort, which in turn would positively affect academic performance in the form of grade point averages. This model fit well with the data, Chi square = 1.095, df = 3, p = 0.778, RMSEA model fit = 0.000. This model also fitted well for all tested subgroups of students. Differences were found in the strength of relationships between the variables for the different subgroups as expected. In conclusion, RAM positively correlated with academic performance through deep strategy towards study and higher study effort. This model seems valid in medical education in subgroups such as males, females, students selected by qualitative and weighted lottery selection. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Immigrants; Teaching Methods; Surgery; Foreign Countries; Medical Services; Patients; Expertise; Physicians; Injuries; Diseases; Urban Areas; Competition; Medical Education; Networks; Moral Values; Experiential Learning; Standards; Educational History

Abstract:
Due to its ascendancy as the administrative and commercial center of early modern England, London experienced sustained growth in the latter half of the sixteenth century, as waves of rural immigrants sought to enhance their material conditions by tapping into the city's bustling occupational and civic networks. The resultant crowded urban landscape fostered mounting demand for medical services, since injuries and ailments, ranging from consumption to contusions, proliferated within the city's teeming streets and markets. Due to consistently strong patient demand and the conventions of English common law, which stipulated that legal authorization to practice medicine was solely contingent upon patient consent, peddling medical services to the city's ill and infirm became an increasingly appealing--and potentially lucrative--venture. Consequently, London's largely unregulated medical marketplace--characterized by competition for patients, the mounting influence of print culture, and the emergence of small commercial networks--attracted a diverse array of practitioners, including university-educated physicians, guild-licensed surgeons, and a medley of specialist and itinerant practitioners. In the absence of effective institutional regulation, distinctions between medical practitioners and modes of treatment were often difficult to discern due to a lack of clearly defined legal demarcations. In response to such occupational fluidity, the Barber-Surgeons' Company--London's largest body of licensed medical practitioners and the city's only guilded branch of medicine before the advent of the Apothecaries' Company in 1617--endeavored to maintain exclusive control over the practice of surgery within the city. To prevent the encroachment of interlopers and foreign practitioners ineligible for guild membership, Company members devised an array of semiformal educational networks that reinforced their desire to train surgeons as proficient artisans, morally upright representatives of their occupational group, and agents of intellectual traditions ostensibly inaccessible to those excluded from the Company's ranks. Drawing inspiration from Andrew Abbott's notion of jurisdiction in the control of occupational skill and knowledge, this study argues that surgical education in early modern London was characterized by a synthesis of theoretical, experiential, and moral components that enabled members of the Barber-Surgeons' Company to bolster their expertise and erect occupational boundaries. By emulating prevailing paradigms of social disciplining--processes through which civic and guild authorities upheld order and stability within their communities by prescribing conventions of propriety and etiquette--the Company's self-conscious efforts to establish standards of occupational decorum and repress deviance not only mitigated the encroachment of interlopers, but also reinforced the nascent pre-professionalization of London's surgeons. (Contains 96 footnotes.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Transfer of Training; Physicians; Faculty Development; Fellowships; Medical Education; Medical School Faculty; Clinical Teaching (Health Professions); Grounded Theory; Interviews

Abstract:
The purpose of this qualitative study is to form a grounded theory of the process of long-term transfer. Eight physicians were interviewed to discover if, years later, they had used what they were taught in a faculty development training program. We found that these autonomous professionals continued to apply the teaching ideas they learned. Each, in a personal way, chose to use varied ideas in different ways in several contexts. They applied ideas using intellectual skills such as planning and analyzing. They continued their applications because they perceived supportive work conditions and positive consequences. In sum, over the long term, physicians acquired knowledge and mental skill, chose to use them, and attempted application. They reflected on outcomes, decided to reuse or revise, and tried again. Thus, the process of long-term transfer was learning to use and learning from use. We examine implications for research and training. (Contains 4 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Workplace Learning; Research Methodology; Expertise; Educational Practices; Eye Movements; Literature Reviews; Measurement Techniques; Evaluation Methods; Medicine; Brain; Medical Education; Competence; Learning Processes; Visual Perception; Visualization

Abstract:
Understanding how best to assess expertise, the situational variations of expertise, and distinctive qualities of expertise that arises from particular workplace experiences, presents an important challenge. Certainly, at this time, there is much interest in identifying standard occupational measures and competences, which are not well aligned with such variations and distinctiveness in performance. Therefore, this paper addresses the methodological issues posed by such a challenge through reviewing the expertise literature to identify ways forward. Based on the example of one target domain, medicine, and one criterion task, the comprehension of visualizations, the study identifies, elaborates, and evaluates assessments used to study qualitative changes in professional vision that occur as a result of extended periods of workplace learning experiences. It identifies the kinds of sample, materials, measures, and analysis methods used to assess the quality of expertise differences, as well as what elements of and differences in visual expertise are revealed in particular assessment processes. In doing this, the study seeks to illuminate how assessing the quality of expertise differences matured over the past 20 years, noting that strategies of scanning brain activity and tracking eye movements are now being used in ways that augment traditional approaches such as using verbal reports and observing representational practices. The findings demonstrate how the assessment of visual expertise has become more multidisciplinary over the past two decades. Implications for educational practice and future research directions on the development of professional vision are discussed. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Coaching (Performance); Reciprocal Teaching; Leadership Training; Transformative Learning; Reflection; Medical Education; Fellowships; Faculty Development; Medical School Faculty; Experience; Diaries; Interviews; Surveys

Abstract:
Billions of dollars are spent annually on programs to develop organizational leaders, yet the effectiveness of these programs is poorly understood. Scholars advise that value is enhanced by the development of individual leadership plans at program completion, followed by implementation experience with subsequent coaching and reflection. The literature discusses coaching on specific skills in individual plans; research is lacking regarding coaching's value for the individual plan implementation process as a whole. In addition, there is scant literature concerning the use of reciprocal peer coaching in leadership development. This article presents the findings of research aimed at understanding the experience of individuals who completed a leadership development program, prepared individual leadership plans at completion, and then engaged in a process that included reciprocal peer coaching to help them implement their plans. The major contributions of the study concern the importance of the support structure provided, the nature of the benefits identified from giving as well as receiving coaching, and the specification of a transformational learning process regarding both the implementation of individual leadership plans and engagement in reciprocal peer coaching. While the study was conducted in a medical educational setting, the findings have implications for leadership development programs in other areas of education, as well as other organizational settings. (Contains 4 tables and 3 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Student Needs; Medical Education; Cultural Context; Foreign Countries; Student Experience; Medical Students; Performance Factors; Articulation (Education); Alignment (Education); Institutional Cooperation; Foreign Students; Semi Structured Interviews; Focus Groups; Student Attitudes; Teacher Attitudes; Cross Cultural Studies; International Education

Abstract:
This study was conducted to identify key issues for students in an undergraduate medical course with cross border delivery and the impact of these issues on the students' ability to learn. Data relating to the student experience and perceived student needs were collected from transnational students and teaching staff from Australia and Malaysia. The results highlight the complexities of migration from one learning environment to another and suggest the need for a cohesive institutional approach to support medical student movement between culturally diverse settings as well as the translation of medical curriculum from one cultural context to another. We describe how the particular needs of transnational students moving across borders align with Maslow's hierarchy of unmet needs and can be met through low cost, long reach institutional initiatives. These must be supplemented by interpersonal approaches in which institutions can also foster. The outcomes will benefit local as well as transnational students and staff. (Contains 4 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Assistive Technology; Experiential Learning; Older Adults; Medical Education; Research Methodology; Nonverbal Communication; Nursing Homes; Clinical Diagnosis; Student Attitudes; Longitudinal Studies; Patients; Barriers; Medical Students; Outcomes of Education; Educational Gerontology

Abstract:
The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living) was piloted in 2006 as an experiential medical education learning model. Since its inception, medical and other health professions students have been "admitted" into nursing homes to live the life of an older adult nursing home resident for approximately 2 weeks--24 hours a day/7 days a week--complete with a medical diagnosis and "standard" procedures of care. The Learning by Living Project applies qualitative ethnographic/autobiographic research methods to collect students' perspectives and experiences about life lived as an older adult with functional challenges in a residential setting. To date, all students have completed their extended stay successfully and felt that this experiential learning project provided life-altering medical education. Longitudinal data reveals that students' maintain patient-centered attitudes and skills such as the use of eye contact, touch, body position, and voice cadence. Barriers to working with older adults are decreased; understanding is gained by "wheeling a mile in an older person's wheelchair." Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Continuing Education; Medical Education; Foreign Countries; Electronic Learning; Online Courses; Educational Resources; Barriers; Delivery Systems; Educational Development; Educational Opportunities; Program Effectiveness; Performance Factors; Achievement Need

Abstract:
As the largest country in the Middle East, Saudi Arabia and its health care system are well positioned to embark on an online learning intervention so that health care providers in all areas of the country have the resources for updating their professional knowledge and skills. After a brief introduction, online continuing medical education is explored. Benefits and barriers of using online continuing education are noted and logistical concerns are highlighted. The article ends with lessons learned and implications for the future. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Instructional Effectiveness; Psychological Patterns; Hospitals; Hidden Curriculum; Emotional Response; Role; Medical Education; Teacher Student Relationship; College Faculty; Health Services; Physician Patient Relationship; Transformative Learning

Abstract:
This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more attention to be paid to the role of emotion within medical education and within health care provision. What is already known about the role of emotion in learner-teacher encounters and in patient-doctor encounters will be used to develop the concept of emotional congruence within these two types of encounter as a challenge to clinical teachers to examine their own practice. The reasons why emotional congruence is not always apparent in the learning environment of the teaching hospital will be discussed using the model of the "hidden curriculum". It will be suggested that explicit strategies to counteract the hidden curriculum in relation to emotion can bring about transformative change in individual practice and the health care environment that has the potential to improve both learning and health outcomes. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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