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Clinical preceptorships that nurture virtual care competencies among family medicine residents or physicians in-training remain understudied. Guided by epistemological views of pragmatism and social constructivism, I designed and implemented a three-phase exploratory mixed-methods study to address the following research questions: • How is clinical preceptorship in virtual healthcare settings conceptualized within the field of postgraduate medical education? • What are the gaps in the way clinical preceptorship in virtual healthcare settings is conceptualized in the field of postgraduate medical education? • To what extent do preceptors involve, prepare, and assess family medicine residents in virtual healthcare settings? • How do preceptors assess and provide feedback to family medicine residents in virtual healthcare settings? In phase I, a scoping review identified 24 peer-reviewed articles (published before February 25, 2021) relevant to clinical precepting with postgraduate medical trainees in virtual healthcare settings. In a sequential manner, I then led a one-time online survey (phase II; n = 38) and key informant interviewing (phase III; n = 13) with preceptors of family medicine residents. National data confirmed that clinical precepting in virtual healthcare settings can be characterized by individual factors, preceptor-resident behaviors, and workplace artefacts. Additional insights supported preceptors’ ability to engage family medicine residents in virtual care activities, along with the constraints and strategies to supervise them effectively. Opportunities to assess competency are possible; however, preceptors identified gaps in assessment practices to identify underperformance in the virtual therapeutic frame. A key research deliverable is a thematic framework illustrating the experience of clinical precepting in virtual healthcare settings. Drawing on adaptive expertise, actor-network theory, and praxeology, the final article elucidates how this work contributes to educational solutions and research directions for competency-based family medicine education.

3D Organon VR Anatomy is a virtual reality program that allows individuals to interact with anatomy in a 3D environment. This column provides a brief overview of the product and its potential uses within a medical library.

BACKGROUND: Less than two decades into the 21st century, U.S. medical schools are experiencing substantial curricular reform affecting multiple aspects of teaching and learning. The pace of change is rapid when compared to that of the previous century. Little changed in medical education for 100 years after Abraham Flexner’s 1910 recommendations from his evaluation of North American medical schools. Using a case-study approach to examine a single medical school, this dissertation study explores pre-clerkship faculty perspectives of select curricular changes over a ten-year span at Boston University School of Medicine (BUSM). These changes include the adoption of educational technologies and student-centered pedagogical approaches, as well as curricular content integration designed for foundational science courses. PURPOSE: This study seeks to understand and document faculty experiences with change, factors influencing change, effective and challenging aspects of change, and recommendations for successful future changes. It also explores faculty change adoption tendencies and change leadership styles for those who led groups through a newly integrated curriculum. METHODS: This is a mixed-methods study using qualitative and quantitative inquiry in three phases of data collection with two subject sets. In the first phase, qualitative data was collected from interviews with a subset of 12 subjects to inform creation of a researcher-designed survey, which was used in the second phase collecting responses from a larger pool of 55 subjects. The third phase collected quantitative data from an externally-validated instrument, Change Intelligence (CQ) (Trautlein, 2013), which assessed change leadership styles of the subset of 12 subjects who experienced all changes studied. RESULTS: BUSM faculty members are motivated towards continuous improvement of the curriculum to foster students’ success. Faculty are challenged by compressed time to plan and implement change and when change is mandated without opportunity for pre-decision input. BUSM faculty adopt changes at higher rates than the normal curve defined in Diffusion of Innovations (Rogers, 2003). The subset of 12 subjects assessed for change leadership styles focus on people and process when leading change. CONCLUSION: Medical education change studies on the faculty perspective are limited. This study provides insight and recommendations for future study and successful change.

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There is strong evidence that certain neurophysiological processes link action and observation (Higuchi et al., 2012), which supports the idea that learning a motor skill is enhanced via skill observation (Hayes et al., 2010). Skill learning through observation is optimized when the observation includes a combination of expert and novice models (Rohbanfard and Proteau, 2011). The purported advantage lies in the two types of models’ dissimilar ability (Andrieux & Proteau, 2013). The novice model is characterized by larger margins of error that manifest as variable attempts. Increased variability has been shown to be beneficial in physical practice (Moxley, 1979). The purpose of the first study was to examine the observation of novice variability effect to explore whether it is Schmidt’s (1975) generalized motor programs or schema parameterization representations that is acquired when observing modeled performances. Participants engaged in an observational period in which they observed a criterion model with no variability, a model demonstrating absolute timing variability, a model demonstrating relative timing variability, or a model demonstrating variability in both relative and absolute timing. The results indicate that variability in relative timing information contributes to observational learning, which suggests that generalized motor programs are acquired through observation but not schematic parameterizations. The purpose of the second study was to apply the Rohbanfard and Proteau (2011) paradigm in the medical education context by exploring the impact of video-based observational practice on the clinical learning. First year medical students learned a common surgical skill by observing expert demonstrations of the skill, novice demonstrations, or demonstrations by both an expert and novice model. The study demonstrated a robust effect of observational learning in that all groups improved over time regardless of the type of model they observed. Both studies highlight that an expert model may be the most beneficial when engaging in observational practice. / Thesis / Master of Science (MSc)

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Indiana University-Purdue University Indianapolis (IUPUI) / Metacognition, the ability to self-regulate one’s learning and performance, is well-known to provide numerous academic and professional benefits for students, educators, and clinicians. However, few studies have studied metacognition specifically in the context of anatomical sciences education. Therefore, the overarching purpose of this dissertation was to explore the metacognition of students and educators who are learning and teaching the anatomical sciences. This dissertation investigated the metacognition of allied health students (physical therapy, physician assistant, and occupational therapy; n=109), first-year medical students (n=1802), and anatomy educators (faculty, associate instructors, and teaching assistants; n=13) in anatomy courses through three multiple-methods studies. Quantitative data were collected using assessment data and either the Metacognition Awareness Inventory (MAI), Practice-Based Learning and Improvement (PBLI) assignments, or Teacher Metacognition Inventory (TMI). These data were then analyzed using the appropriate descriptive and inferential statistics. Qualitative data were also collected through reflective writing activities (e.g., online discussion boards or reflective journals) and analyzed using thematic or framework analysis. Overall, both students and educators improved their metacognition across a semester of either learning or teaching anatomy, with certain subgroups demonstrating greater metacognitive ability or growth than others. Higher performing allied health and medical students were both more accurate at predicting their exam performances compared to their lower performing peers. Faculty also demonstrated the greatest teaching-specific metacognition, though teaching assistants exhibited the greatest growth in their teaching-specific metacognition. These improvements were primarily in their reflective ability and awareness of personal strengths and weaknesses as teachers. Several notable themes relating to metacognition were also identified such as student willingness to monitor learning diminishing over time due to competing academic or professional commitments. Additionally, novice educators were more inwardly-focused on personal traits and content mastery, whereas experienced educators were more outwardly-focused on interpersonal factors (e.g., student rapport and inclusive language). These insights into the metacognition of both students and educators can inform how to best support and improve teaching and learning in the anatomical sciences. Given the significance of metacognition, it may be beneficial to incorporate educational activities that can support the metacognition of both students and educators, simultaneously.