Predicting homonegative behaviour : a cognitive or affective enterprise?

To date, there is a dearth of research examining the relationship between cognitive and affective aspects of prejudice and their ability to predict overt and covert homonegative behaviours. Research in this area is important as many gay men and lesbian women are the target of homonegative acts, and it is these behaviours that are important to understand. Therefore, the purpose of this thesis was to examine: 1) if modern homonegativity related to explicit affective measures; 2) if modern homonegativity related to implicit affective measures; 3) whether modern homonegativity related to implicit cognitive measures; 4) which measure was the best predictor of covert behaviour; and 5) which measure was the best predictor of overt behaviour. The four measures used as potential predictors were: 1) the Modern Homonegativity Scale (MHS), an explicit, cognitive measure; 2) the Implicit Association Test (IAT), an implicit, cognitive measure; 3) a feeling thermometer, an explicit, affective measure; and 4) facial electromyographic reactions, an implicit affective measure. This study consisted of three phases: in Phase I, 171 male undergraduates completed an online survey consisting of explicit measures of homonegativity. Fifty-five participants were recalled to participate in Phases II and III, which consisted of a behavioural component and the facial EMG and IAT components. Results indicated that modern homonegativity was associated with implicit cognitive measures as well as explicit measures of affect. However, modern homonegativity was not associated with implicit measures of affect. Additionally, positive affect in the form of cheek activity and negative affect toward images of couples kissing in the form of brow activity, measured through facial EMG, were associated with covert behaviour, with cheek activity being the better predictor. Brow activity toward images of gay couples kissing, indicative of negative affect, was the only measure associated with overt behaviour. Limitations and potential future directions for conducting research using implicit measures of homonegativity are discussed

Problem-based learning for inter-professional education: evidence from an inter-professional PBL module on palliative care

Introduction: The objective of this article was to analyze the theory and pedagogical basis of the use of problem-based learning (PBL) for inter-professional education (IPE) in undergraduate health science education and present evidence from a palliative care iPBL (inter-professional PBL) module that confirms the importance of the two methodologies being used together. Methods: More than 1000 student surveys collected over 4 years were analyzed for components of usefulness, enjoyment and facilitator effectiveness. A retrospective self-assessment of learning was used for both content knowledge of palliative care and knowledge of the other professions participating in the module. Results: Statistically significant gains in knowledge were recorded in both areas assessed. Medical students reported lower gains in knowledge than those in other programs. Scores were moderately high for usefulness and facilitator effectiveness. Scores for enjoyment were very high at 5.19 out of a total score of 6.0. Conclusion: There is strong theoretical and empirical evidence that PBL is a useful method to deliver IPE for palliative care education. With the evidence presented from the palliative care iPBL it is our contention that PBL inter-professional cases should be utilized more often, incorporated into IPE programs generally, and researched more rigorously

Amélioration des compétences en matière d’échographie au point d’intervention grâce à la rétroaction supplémentaire fournie par des patients simulés instructeurs

Background: Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience.  Methods: Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation. Results: Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly.  Conclusions: Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.Contexte : L’enseignement de l’échographie au point d’intervention (POCUS) dans les programmes de médecine de premier cycle au Canada est en pleine expansion. Jusqu’à présent, les patients simulés (PS) de notre programme ne fournissaient que des commentaires sur le confort et le professionnalisme. La participation de patients simulés en tant qu’instructeurs (PS-instructeurs) pour les compétences POCUS offre une occasion d’apprentissage supplémentaire. Dans cette étude pilote, nous avons exploré l’effet de l’intervention des PS-instructeurs dans le cadre d’une séance de formation en POCUS. Les résultats sont intéressants en ce qui concerne le niveau de compétences atteint par les stagiaires à la suite de la séance et sur le plan de leur satisfaction à l’égard de cette expérience d’apprentissage. Méthodes : Des étudiants en deuxième année de médecine ont été répartis au hasard entre un groupe qui a reçu une formation traditionnelle et un groupe qui a reçu la formation avec l’intervention de PS-instructeurs. Les deux groupes ont eu accès au même tutoriel, aux mêmes conseils de l’instructeur et à une rétroaction de base de la part des PS (confort et professionnalisme). Les apprenants du groupe travaillant avec des PS-instructeurs ont reçu des commentaires supplémentaires de la part de ces derniers (repères, technique du transducteur et dépannage) pendant que les instructeurs assistaient d’autres stagiaires. Les étudiants ont évalué la séance et ont ensuite fait l’objet d’une évaluation par observation directe. Résultats : Les étudiants qui ont bénéficié de l’intervention de PS-instructeurs ont obtenu des résultats nettement plus élevés en ce qui concerne l’acquisition d’images (p=0,029, d=1,26) et leur score de confiance global (p=0,002, d=1,75). Les deux groupes ont évalué leur séance de formation de manière très positive. Conclusions : On a constaté que les étudiants qui ont bénéficié de commentaires supplémentaires de la part des PS-instructeurs ont eu de meilleurs résultats en acquisition d’images et un score de confiance plus élevé. D’après cette étude pilote, les PS-instructeurs ont eu un effet positif sur l’acquisition de compétences en POCUS

The roles of attachment and resilience in perceived stress in medical students

Background: Medical students are susceptible to high levels of psychological stress, while being equipped with lower levels of resilience, especially females. Adult attachment is a known risk factor for a broad range of mental health difficulties and poor coping. The purpose of this study is to examine relationship attachment style, perceived stress, and resilience in medical students.Methods: Data was collected via an online survey using self-report measures from University of Saskatchewan undergraduate medical students (n = 188). Attachment was assessed with the Relationship Questionnaire and Experiences in Close Relationships Scale. Resilience and stress were assessed with the Connor-Davidson Resilience Scale and Perceived Stress Scale, respectively.Results: Approximately half of our sample endorsed secure attachment style (49.4%). Females reported significantly more attachment insecurity, higher attachment anxiety, higher perceived stress, and lower resilience compared to males, as expected. As predicted, attachment anxiety and avoidance were predictors of perceived stress. Mediation analyses supported the hypothesis that resilience acted as a partial mediator between attachment insecurity and perceived stress.Conclusion: These findings suggest attachment plays a role in perceived stress in medical students. In addition, the role of resiliency in protecting against this effect highlights potential areas for intervention to improve medical student well-being and provides a foundation for longitudinal follow-up.

Tutor Experiences with Facilitating Interprofessional Problem-Based Learning

Background: This article describes tutors’ experiences with facilitating interprofessional problem-based learning (iPBL), a topic rarely discussed in the literature. We examined tutors’ perceptions of what it was like to tutor iPBL, including the rewarding and challenging aspects. We also reported differences between new and experienced tutors.Methods and Findings: The data presented in this article were collected using three versions of a paper-and-pencil survey (N = 77, N = 99, and N = 97 for each version of the survey, respectively) and six focus groups. Surveys were completed at the conclusion of iPBL modules. Both quantitative and qualitative results indicated that tutors found the experience of facilitating iPBL to be rewarding and encountered few challenges. Tutors felt the training they received prepared them well to tutor. They also felt that facilitating iPBL increased their knowledge in the topic area of the iPBL module and of other professional roles, that it enhanced their skills as facilitators, and that they enjoyed observing students learn. New tutors reported significantly more learning and skill development than experienced tutors.Conclusions: Four lessons were derived from our research: 1) use iPBL to offer IPE; 2) invest in tutor training and support; 3) help tutors trust the process; and 4) consider tutor recruitment and retention strategies

The Effect of Senior Medical Student Tutors Compared to Faculty Tutors on Examination Scores of First- and Second-Year Medical Students in Two Problem-Based Learning Courses

At the University of Hawaii John A. Burns School of Medicine, senior medical student volunteers are used as tutors for some problem-based learning groups in both the first and second years. Previous studies on the advantages and disadvantages of student tutors compared to faculty tutors have been equivocal. This study expected to answer the following question: Are there differences in examination scores for learners in their first or second year tutored by fourth-year medical students compared to those tutored by faculty members on two different types of examinations? Students were assessed using more clinically relevant, modified essay question examinations and multiple-choice question examinations. Student grades for eight consecutive years were sorted for year and type of examination into those tutored by a faculty member and those tutored primarily by a senior medical student. The only difference favored faculty tutors on second-year examinations that contained more clinically relevant questions. This phenomenon may be explained by the clinical expertise of faculty tutors making a difference in the second year but not the first year

La valeur prédictive des éléments du dossier d’admission pour déterminer le lieu de pratique futur des diplômés de la faculté de médecine de l’Université de la Saskatchewan

Background: The physician workforce in Saskatchewan depends upon the retention of locally trained physicians. Characteristics collected at the time of medical school application may predict future practice location, but these associations have not been explored. Methods: We identified the current practice location of University of Saskatchewan College of Medicine graduates who matriculated between 2000 and 2013 and extracted data from their admission applications including gender, age, high school, previous university, and current location at the time of application. We then conducted univariate and multivariate analyses to evaluate associations between these characteristics and rural- and Saskatchewan-based practice. Results: We identified the current practice location of 1,001 (98.9%) of the graduates of the included cohorts. Attending a Saskatchewan high school (p < 0.001), a high school in a smaller population center (p < 0.01), and a Saskatchewan university (p < 0.001) were predictive of Saskatchewan-based practice. Attending a high school outside of Saskatchewan (p < 0.05), a high school in a smaller population center (p < 0.001), and living in a small population centre at the time of application (p < 0.05) were predictive of rural-based practice within or outside of Saskatchewan. Conclusion: Demographic characteristics collected at time of medical school application are associated with future Saskatchewan- and rural-based practice. These findings will guide admissions policies in Saskatchewan and may inform admission practices of other medical schools.Contexte : La main-d’œuvre médicale en Saskatchewan dépend de la rétention des médecins formés dans la province. Les informations recueillies au moment de la demande d’admission à la faculté de médecine peuvent permettre de prédire le lieu de pratique futur, mais ces liens n’ont pas été explorés. Méthodes : Nous avons trouvé le lieu de pratique actuel des diplômés de la faculté de médecine de l’Université de la Saskatchewan qui se sont inscrits entre 2000 et 2013 et avons extrait de leurs demandes d’admission les données concernant le sexe, l’âge, l’école secondaire et l’université précédente fréquentées, et le lieu de résidence au moment de la demande. Nous avons ensuite effectué des analyses univariées et multivariées pour évaluer les liens entre ces éléments et la pratique en milieu rural et en Saskatchewan. Résultats : Nous avons trouvé le lieu de pratique actuel de 1 001 (98,9 %) des diplômés des cohortes incluses. La fréquentation d’une école secondaire de la Saskatchewan (p<0,001), d’une école secondaire dans une petite agglomération (p<0,01) et d’une université de la Saskatchewan (p<0,001) étaient des facteurs prédictifs de la pratique en Saskatchewan. La fréquentation d’une école secondaire à l’extérieur de la Saskatchewan (p < 0,05), d’une école secondaire dans une petite agglomération (p < 0,001) et le fait de vivre dans une petite agglomération au moment de la demande d’admission (p < 0,05) étaient des facteurs prédictifs d’une pratique en milieu rural à l’intérieur ou à l’extérieur de la Saskatchewan. Conclusion : Les caractéristiques démographiques recueillies au moment de la demande d’admission à la faculté de médecine sont corrélées à la pratique future en Saskatchewan et en milieu rural. Ces résultats guideront les politiques d’admission en Saskatchewan et pourraient éclairer les pratiques d’admission d’autres facultés de médecine

L’Initiative sur les compétences cliniques des quasi-pairs : Un projet pilote de mentorat pour les étudiants en médecine

Implication Statement  We created a near-peer mentoring program in pre-clerkship, which gave medical students the opportunity to work together, teach others, and practice their clinical skills. It uniquely connects first year “learner-mentees” and second year “instructor-mentors” in semi-structured learning environments, from October to April. Beyond supporting intrinsic motivation, skills development, and collaboration, students gained experience in teaching, an important skill for physicians.Énoncé des implications de la recherche Nous avons créé un programme de mentorat par les pairs au préexternat, qui a donné aux étudiants en médecine l’occasion de travailler ensemble, d’enseigner aux autres et d’améliorer leurs habiletés cliniques. Ce programme met en contact de façon unique les « apprenants-mentorés » de première année et les « instructeurs-mentors » de deuxième année et les placent dans des environnements d’apprentissage semi-structurés tout au long de l’année universitaire. En plus de favoriser la motivation intrinsèque, le développement des habiletés et la collaboration , ce programme a permis aux étudiants de se pratiquer à enseigner , une importante habileté pour les médecins. 

Student perceptions of the care of children: impacts of pre-clerkship pediatric and primary care clinical teaching

Background: Pediatric clinical skills teaching sessions provide an early opportunity for students to be exposed to the medical care of children. This report describes second and third year medical students’ perceptions of and attitudes towards working with children before and after the pediatric clinical skills teaching sessions, and the experiences of those students precepted by pediatricians only compared to those students working with a combination of pediatricians and family physicians.Method: A 13 question survey was voluntarily completed before and after teaching sessions.  Written reflective assignments were qualitatively analyzed for key themes. Response rate averaged 68% with class sizes of 84 and 85 students.Results: Students’ perceptions of the care of children were generally very positive.  Some differences were found based on gender, phase of study and prior clinical exposure to pediatric care.  Pre and post responses were similar, regardless of preceptor specialty. Students with family physician preceptors identified the themes of prevention, health promotion and multidisciplinary care in their reflections. Conclusions: Students had already formed positive attitudes toward the medical care of children and intended to care for children in their future practice. Further research is needed into the effects of pre-clerkship experiences in the care of children on choice of medical specialty

Law and Psychiatry Seminar: An Advanced Intervention in Interprofessional Education and Attitudinal Improvement

Background: The tenuous relationship between psychiatrists and lawyers does not serve mental health patients in conflict with the law or society well. The characteristic miscommunication that occurs, though premised on differential pedagogical constructs, presents an opportunity to intervene from the pre-licensure educationalstage with the hope of positively affecting future practice.Methods: Law students and psychiatric residents were brought together to interact with each other and with instructors from the two fields through the Law and Psychiatry interprofessional seminar series. We examined the attitudes and perceived co-operation of learners in this seminar in comparison to a control group of law students (Human Rights class) who did not have any interprofessional interaction.Findings: Learners in the interprofessional seminar series reported more positive attitudes toward members of the other profession after completing the course. Additional positive changes in the level of perception of and actual co-operation with the other profession were noted with high satisfaction among participants.Conclusions: Learning activities that can foster positive interactions with and understanding of other professions may improve relations and collaboration in interprofessional education. The potential impact and benefit for the patient and the system are worthwhile