Professional identity is defined as the internalized values of a profession as a representation of the self, and is formed through a process of socialization, or how a student learns to become a member of their profession. As medical students transition to residency, new social environments, clinical experiences, and curricular emphases can impact how they identify as professionals. The purpose of this thesis is to investigate how professional identity formation (PIF) occurs in surgical residents over their first year of postgraduate training. Twenty-four surgical residents were interviewed at the start of their postgraduate training. Questions explored participants’ understanding of what it means to be a medical professional. Six months later, residents completed a follow-up interview to investigate how their experiences in their training programs have influenced their professional identity. Thematic analysis was utilized to identify themes in responses. Central to participants’ understanding of their professional identity was their relationships with patients and the public, other healthcare professionals, their training program, and their own expectations for themselves. After six months, less emphasis was placed on the influence of the public and one’s own personal expectations. Factors such as patient encounters, a team-based work environment, time constraints and high volumes of work, and being prepared for all situations were all identified as crucial to professional development. It is important for medical education programs to consider their impact on the development of students, especially regarding the transition to competency-based medical education (CBME) that is currently occurring in medical education. This change could impact the social environment and formal curricula of these programs. The explicit study of PIF is important not only for students as they develop into independent health professionals, but also to ensure the proper care of the patients these surgeons will be working with. / Thesis / Master of Science (MSc)

Background: Over 50% of Canadian medical students report experiencing mistreatment, yet only a small proportion of students report these concerns to administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide about formally reporting these experiences. Improved understanding of this phenomenon will facilitate changes at the administrative and institutional levels to better support students. Methods: This Constructivist Grounded Theory study interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Anonymized transcripts were reviewed, coded and theory was developed. Results: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Discussion: This study revealed institutional mistrust from students especially as it related to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organizational trust and organizational compassion between students and the medical school. Students volunteered mechanisms of support and to improve the reporting process. Medical school administration should consider how they can increase trust with their learners while identifying areas of concern and procedures for intervening and providing more transparent resolutions. / Thesis / Master of Science (MSc) / More than half of all Canadian medical student experience mistreatment during their medical school but very few choose to formally report it. In this study we explored how students experienced mistreatment and their decisions about reporting it as well as what supports would be most helpful for them. To better understand this issue, 19 medical students were interviewed about their experiences. The interviews were analyzed through constructivist grounded theory and the identified themes were used to develop a theory of how students experience mistreatment and make decisions around reporting. Students go through five phases: Situating themselves in their learning environment, Experiencing and Appraising mistreatment, Reacting to that mistreatment, Deciding about reporting and the risks and benefits and Moving Forward within the same medical school as they continue. Students showed mistrust towards the medical school and suggested changes the medical school could make to better support them.

No / Patient safety is a major priority for health services. It is a multi-disciplinary problem and requires a multi-disciplinary solution; any education should therefore be a multi-disciplinary endeavour, from conception to implementation. The starting point should be at undergraduate level and medical education should not be an exception. It is apparent that current educational provision in patient safety lacks a systematic approach, is not linked to formal assessment and is detached from the reality of practice. If patient safety education is to be fit for purpose, it should link theory and the reality of practice; a human factors approach offers a framework to create this linkage. Learning outcomes should be competency based and generic content explicitly linked to specific patient safety content. Students should ultimately be able to demonstrate the impact of what they learn in improving their clinical performance. It is essential that the patient safety curriculum spans the entire undergraduate programme; we argue here for a spiral model incorporating innovative, multi-method assessment which examines knowledge, skills, attitudes and values. Students are increasingly learning from patient experiences, we advocate learning directly from patients wherever possible. Undergraduate provision should provide a platform for continuing education in patient safety, all of which should be subject to periodic evaluation with a particular emphasis on practice impact.

<p>The rise in popularity of smartphones and tablets has sparked substantial interest among healthcare providers. Increasing number of medical schools have launched curricula targeted for mobile tablets. A mobile tablet that facilitates clinical documentation can enhance the mobility of residents and physicians by eliminating the need to be tethered to a workstation. Considering the popularity of Apple’s iPad, a clinical evaluation tool for syncope was implemented on an iPad to test its usability in this environment.</p> <p>The primary objective of this thesis is to develop a mobile tablet app for clinical evaluation and to assess its usability. The contents of the app are based on clinical practice guidelines. The app facilitates clinical evaluation using structured, pre-populated items and unstructured free-text narratives. The participants of this study used the app and paper in pre-determined sequences to document clinical evaluation of a given scenario. A System Usability Scale (SUS) questionnaire was used to gather feedback on usability. A comparison questionnaire gathered participant preferences between app and paper.</p> <p>This study showed that evidence-based app could be developed, with an emphasis on usability during design and development. During the study, participants recorded more ‘structured’ than ‘unstructured’ free-text information on the tablet. The SUS scores indicated an above average usability score for the app. However, participants rated paper above the app in overall comparison. Future studies are needed to determine whether the level of detail of clinical information presented in mobile tablet apps have a negative effect on participant acceptance.</p> / Master of Science (MSc)

The Centers for Disease Control and Prevention defines intimate partner violence (IPV) as abuse or aggression including physical and sexual violence, stalking, and psychological aggression in romantic relationships between current and former spouses and dating partners. In the United States alone, about 41% of women and 26% of men experience IPV incidences during their lifetimes, emphasizing the importance of IPV screening by healthcare providers across all specialties. Learning how to mitigate the past experiences of IPV survivors in healthcare settings requires a trauma-informed lens that starts in and includes those in the medical education classroom. Establishing a trauma-informed educational framework requires recognizing the risk of generating secondary traumatic stress in learners while mitigating the risk of retraumatization among unknown IPV survivors within the classroom. This thesis provides insights into a workshop that involved the participation of fourth-year medical students at an academic medical center that used a multidisciplinary approach to teaching about intimate partner violence. / Urban Bioethics

Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational experience when compared to the traditional orthopedics rotation. All SC residents successfully completed their sports medicine rotation, had completed postrotation evaluations by attending physicians, and had no duty hour violations while on sports medicine. In our experience, a sports medicine rotation is an effective alternative to the traditional orthopedics rotation for EM residents.

Asthma cannot be cured, but it can be managed. Asthma management is a public health issue that is complex. Medication, asthma triggers, age, and the environment are all factors that impact asthma management. There is a gap in research in terms of what lifestyle characteristics need to be in place in order for adults to manage asthma. Shaw found that posture care is a lifestyle variable that should be explored as it relates to asthma management in older adults. The Life University Clinic (Marietta, GA) sees asthmatic patients daily and teaches them about a posture care routine through a program called Straighten Up. Based on the health belief model, this study explored how the Straighten Up routine exercises impacted asthma management in adult asthmatic patients with severe asthma (n =304 ). Ordinal regression and logistic regression was used to analyze the relationships between using the Straighten Up posture exercises (independent variable) for 3 months with 3 dependent variables: patients' sleep patterns (night time awakenings due to asthma), use of quick relief medication, and hospitalizations (ER Visits) due to asthma. Straighten Up posture exercises reduced night time sleep interruptions, but not hospitalizations due to asthma or the use of quick relief medications. For persons with asthma, Straighten Up could be an additional tool to manage their asthma and reduce the known impacts of sleep deprivation including accidents, memory loss, and heart disease. For organizations who serve asthmatics, Straighten Up could be an additional resource to share with the population they serve. As a result of this study, Straighten Up exercises are recommended for adult asthmatics with severe asthma as part of their asthma management plan.

This case study examines the emergence of an autonomy-oriented assessment culture in Pediatric residency education in the School of Medicine at Queen’s University. Through a case study approach this research explores how an assessment system to capture residents’ performance in the clinical environment was initiated, how that process supported a shift in assessment cultural, and how assessment innovation is eclipsing departmental boundaries. The case has instrumental value in illuminating how an autonomy-oriented assessment system and culture can be cultivated in residency education. The analytic frame for the case was constructed based on research literature that identified weaknesses in assessment practices in residency education more generally. The approach was theoretical, with the intent to explain how a shift in assessment culture is emerging in Pediatrics. A longitudinal approach was adopted to expose shifts in the culture. The narrative structure distills the journey into a manageable story. Three watershed events that exemplified change were systematically selected from data collected over a three-year period and constitute the findings of this research. The central contribution this research makes is that it is possible to shift the culture of assessment within a Pediatric residency program. That shift can be understood to unfold over a prolonged period through a process of mediating both social and regulatory requirements. Beginning to shift the assessment culture in Pediatrics was achieved by: recognizing the need for change in assessment practice, re-conceptualizing and realizing that change, and engaging and empowering the community to support a shift in assessment culture. Strong leadership, widening community engagement and the Rubric Descriptor Bank supported this process. Five theoretically informed principles guided the emergence of the autonomy-oriented assessment culture in Pediatrics including: (a) conceptualizing learning as a social, active process: (b) focusing attention on residents’ multidimensional growth; (c) moving away from a high-stakes orientation to assessment based on the false dichotomy between formative and summative assessment and embracing it as a tool for supporting and monitoring growth over time and across contexts; (d) actively supporting residents’ learning strategy and assessment skill development; and (e) fostering a growth orientation to learning, embracing the concept of graduated autonomy. / Thesis (Ph.D, Education) -- Queen's University, 2012-12-19 21:04:59.344

Accrediting bodies for medical schools require that medical students be provided with formative assessment in all clerkship courses. The literature describes many strategies for formative assessment in clerkship settings, but qualitative studies of clerk and supervisor experiences with formative assessment are lacking. In this thesis, I describe a study that explores clerk and supervisor experiences with formative assessment in one internal medicine clerkship course. First, the literature was reviewed to determine current conceptions of formative assessment and learning in medical education. Then, novice and experienced clerks were recruited to participate. Prior to starting their Core Internal Medicine course, each clerk participated in an interview to understand his or her concepts of learning and assessment. During the six-week course, they replied to an electronic weekly questionnaire to describe and reflect on learning experiences. Finally, they participated in a focus group at the end of the course, to explore their experiences with formative assessment. Supervisors, (residents and attending physicians), who supervised clerks were recruited to participate in one interview to explore their approach to supervision and assessment of clerks, and to understand factors that influenced their ability to do this. All relevant artifacts (forms, policies, procedures) were collected for subsequent analyses. Four experienced clerks and eleven novice clerks participated, along with eight attending physicians and five residents. Participants identified four key themes as playing a significant role in assessment and learning: (a) the developing role of doctor, (b) the role of the team, (c) working and learning environments, and (d) educational strategies. Data analysis revealed the participants had unclear formal concepts of formative assessment, even though they could all describe the key concepts about how assessment affects learning, and were quite clear about what factors supported learning, and which ones were barriers to learning. The study contributes to our understanding of clerks’ and supervisors’ experiences with assessment and learning in a workplace-based learning setting. Finally, the study led to recommendations about how to better support formative assessment in the Core Internal Medicine course, and for further research. / Thesis (Master, Education) -- Queen's University, 2012-12-24 07:06:24.439

"Widening access" (WA) policies are designed to increase the participation of underrepresented groups into Higher Education generally, and specifically into professions such as medicine. The interpretation, negotiation and enactment of WA policies is determined by key stakeholders, including medical schools, school teachers and potential applicants. In the UK, measurable progress in WA to medicine has been low. This thesis argues this may partly be due to stakeholders' conflicting values, ideologies and interests. The thesis thus aims to explore, analyse and better understand the complex motivations, perceptions and values underlying key stakeholders' behaviour in WA to medicine. Data includes medical school websites, interviews with high school teachers and focus groups with pupils. Analytical methods are qualitative (critical discourse analysis; thematic analysis) and are enriched by discursive and sociological theories (Foucault, Sen, Bernstein and Bourdieu). Analysis focuses on the pathways of mutual influence and communication between key stakeholders. Findings indicate that UK medical schools predominantly situate WA within ideas of social mobility for the individual rather than benefit to the workforce. Medical school webpages frame WA as a 'requirement', a 'value', or a 'service' and communicate distinct impressions of institutional stance to other stakeholders. High school teachers perceive medical school applications as 'risky' and this appears to limit their ability to engage as greater advocates for WA. Pupils in WA high schools perceive medicine as increasingly culturally inclusive and negotiate cultural differences through reference to role models in the profession. High academic entry requirements within a context of substantial educational inequality may now be the largest perceived 'barrier' to medicine. Overall, this thesis identifies the reasons underlying stakeholders' behaviour and evaluates whether these may be helping/hindering WA to medicine. It demonstrates the benefit of including diverse stakeholder's voices in WA research and provides practical recommendations for future research, policy and practice.