The American medical profession has publicly pondered its roles and duties since its inception in the 18th century. Recently, that discussion has included whether or not advocacy by physicians is a responsibility of the profession. The following work is an argument and plan to support the ethical, professional imperative of physician advocacy. The historical underpinnings of the American medical profession suggest a responsibility to patients and interactions with society. In addition, there is a strong bioethical argument in favor of physician advocacy as an essential duty. Although there is a well-recognized set of barriers to physician advocacy, this article details solutions to help implement advocacy as a daily practice in the lives of all physicians. This piece will describe a way forward for physicians to take on their professional responsibility to advocate. / Urban Bioethics

Competency-based medical education (CBME) is a paradigm of assessing resident performance through well-defined tasks, objectives and milestones. A large number of data points are generated during a five-year period as a resident accomplishes the assigned tasks. However, no tool support exists to process this data for early identification of a resident-at-risk failing to achieve future milestones. In this thesis, the implementation of CBME at McMaster's Royal College Emergency Medicine residency program was studied and the development of a machine learning algorithm (MLA) to identify patterns in resident performance was reported. The adaptivity of multiple MLAs to build a tool support for monitoring residents' progress and flagging those who are in most need of assistance in the context of emergency medicine education was evaluated. / Thesis / Master of Science (MSc)

We conduct an evaluation of the cross-cultural ‘export’ of the Objective Structured Clinical Examination (OSCE), a well-established Western medical education assessment tool that is in keeping with Competency-Based Medical Education (CBME) principles, into the new socio-economic setting of Rwanda. The evaluation framework of ‘assessment utility’ is applied, where the utility of an assessment is described conceptually as the multiplicative function of its validity (V), reliability (R), educational impact (E), cost/feasibility (C) and acceptability (A). A mixed-methods approach of both quantitative and qualitative data analysis is used. The quantitative findings support high content and face validity, high reliability, high acceptability and achievable cost and feasibility of the OSCE, all of which would suggest high utility. The analysis of qualitative data identifies some important threats to validity, namely perceived significant gaps in training in the internship program that were thought to likely be the underlying reason for the low mean assessment scores. This threat to the validity of the results appears to influence and limit the acceptability of the assessment in this context. While it is believed that it would be suitable as a formative assessment, primarily for the purpose of ‘assessment for learning’, it was not felt that it was currently acceptable as a summative or high-stakes ‘assessment of learning’, until and unless training deficits are addressed. Currently, the OSCE is seen to have greatest value in its potential for educational impact by acting as both a driver and a marker for change both at the individual and programmatic levels. Many principles of CBME and the concept of ‘entrustability’ as a criterion-referenced assessment standard were well-received cross-culturally, when training and assessment were viewed in tandem. Our study highlights the importance of using a comprehensive evaluation framework that includes both quantitative and qualitative methods to accurately characterize the utility of an assessment. / Thesis / Master of Science (MSc) / This is a case-study where the Objective Structured Clinical Examination (OSCE), a well-established, performance-based and resource-intensive Western medical education assessment tool, was introduced to the culturally different, resource-limited setting of Rwanda. What we wanted to evaluate is how the OSCE was received in the Rwandan medical training system. What we found is that generally, the OSCE was received in a positive way. Both examiners and participants thought it was a relevant, realistic, feasible, valuable test for doctors in training. However, examiners also felt that the candidates did not do as well as they could have on the test not because they were fundamentally bad doctors, but because there were major gaps in their training. The OSCE therefore demonstrated its usefulness by identifying these deficiencies in training. Examiners felt that addressing these gaps in training was most important and should be done before any institutional body uses the OSCE results to decide who should get a medical license or not.

Student motivation in medical education courses is essential for the development of life-long medical knowledge. Researchers have demonstrated that student learning in anatomy courses, fundamental to students' future medical learning, has suboptimal long-term outcomes. The purpose of this study was to investigate how medical students' motivation-related perceptions and course effort were different during the academic year through varied course content and elements of instruction. The study was guided by the MUSIC Model of Motivation theoretical framework and nested in the pragmatic paradigm. First-year medical students enrolled at a small, public allopathic medical school in the southeastern United States were surveyed and interviewed regarding their course perceptions. Quantitative data from 18 students and qualitative data from 14 students indicated that students' motivation-related perceptions and effort do vary over different course content and elements of instruction. Students consistently reported lower motivation-related perceptions and effort for prerecorded lectures, whereas they reported more positive motivation-related perceptions and effort for cadaver dissection. Results also indicated variability in motivation-related perceptions and effort among specific block content areas (e.g., musculoskeletal, cardiovascular, abdominopelvic). Study findings resulted in a variety of suggestions for course instructors on how anatomy course design and instructional practices could be intentionally adjusted in the interest of fostering student motivation and engagement. Implications for course design and instruction included general course guidance (e.g., clinical relevance, clear and broad understanding of course usefulness), prerecorded lecture recommendations (e.g., catalogued for easy reference, short and focused, effective use of visual and verbal elements), and cadaver lab instruction guidance (e.g., faculty and upper-level student engagement, student preparation expectations). / Doctor of Philosophy / The purpose of this study was to investigate how medical students' motivation-related perceptions and course effort were different during the academic year through varied course content and elements of instruction. The study was guided by the MUSIC Model of Motivation which is a resource course instructors can use to develop their courses in ways that support students' motivation and engagement. The MUSIC Model is an acronym (i.e., eMpowerment, Usefulness, Success, Interest, and Caring) and each letter represents one of five categories of strategies that teachers can use to motivate students. Instructors who use strategies in these categories can improve student motivation which can help encourage students to engage in their learning. First-year medical students enrolled in an anatomy course at a small, public medical school in the southeastern United States were surveyed and interviewed regarding their perceptions of the anatomy course. Information gathered from this study indicated that students' motivation and engagement vary over different course content and elements of instruction. Students consistently reported lower motivation-related perceptions and effort for prerecorded lectures. Students reported more positive motivation-related perceptions and effort for cadaver dissection. Results also indicated unevenness in motivation-related perceptions and effort among specific block content areas (e.g., musculoskeletal, cardiovascular, abdominopelvic). This study offered a variety of suggestions for course instructors on how anatomy course design and instructional practices could be intentionally adjusted in the interest of fostering student motivation and engagement.

This dissertation examined the extent to which medical educational institutions adapt their curriculum to meet the needs of a marginalized patient population, lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Because LGBTQ populations experience significant health and health care disparities in comparison to heterosexual and cisgender populations, medical education and medical curriculum about LGBTQ health has been described as a key area of intervention for improving doctor-patient interactions and health system structures to better accommodate these populations. Through a 10-month long ethnography of a medical school, I examined the formal, informal, and hidden curricula surrounding LGBTQ health to explore how medical schools train and thus adequately prepare medical students to provide care to these patients. To investigate these issues, I conducted over 100 hours of participant observation of medical classes and clinical rotations, with particular attention to clinical case studies and online learning modules that are relevant to LGBTQ health, and LGBTQ health initiatives on the academic medical center campus. I also conducted 46 semi-structured interviews with faculty, students, administrators, LGBTQ Health Center employees, and LGBTQ patients about LGBTQ health care at the medical school and about how these groups define and implement LGBTQ health at the institution. Findings suggest that the content, placement, and delivery of LGBTQ health in the curriculum influence how medical students learn to see themselves as capable of providing care to these patients. In particular, the nebulous nature of LGBTQ health makes it difficult for students to learn to enact it in practice. This research asserts that to create medical curriculum about LGBTQ health that will help alleviate health care disparities, medical schools cannot simply add LGBTQ health into their curriculum without fundamentally changing how they teach sex/gender and sexuality to their students as well as centering intersecting inequalities in their teaching. As such, this dissertation calls for a shift to queer health to decentralize sex/gender and sexuality binaries and focus on the practice of learning about LGBTQ health rather than fulfilling a competency. Ultimately, this research theorizes medical education as a space for the enactment of LGBTQ health whereby the complexity of sex, gender, sexuality, and identity gets negotiated by medical faculty, students, administrators, and LGBTQ community members. / Doctor of Philosophy / This research examined how medical schools change their curriculum to incorporate health topics related to lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Because LGBTQ populations experience worse health and in comparison, to heterosexual and cisgender populations, medical education about LGBTQ health has been described as a key area for medical educators to adapt the curriculum to meet the needs of these patients. Medical educators hope to improve doctor-patient interactions and health system structures to provide better care to these populations. Through a 10-month long ethnography of a medical school, I examined the teachings surrounding LGBTQ health to explore how medical schools train and thus adequately prepare medical students to provide care to these patients. To investigate these issues, I observed over 100 hours of medical classes and clinical rotations, with particular attention to clinical case studies and online learning modules that are relevant to LGBTQ health, and LGBTQ health initiatives on the academic medical center campus. I also interviewed 46 people, including faculty, students, administrators, LGBTQ Health Center employees, and LGBTQ patients, about LGBTQ health care at the medical school and about how these groups define LGBTQ health. Findings suggest that where LGBTQ health is located in the curriculum as well as who teaches the subject influences how medical students learn to see themselves as able to provide care to these patients. In particular, the broadly defined nature of LGBTQ health makes it difficult for students to learn how to provide this care to patients. This research asserts that to create medical curriculum about LGBTQ health that will help alleviate health care disparities, medical schools cannot simply add LGBTQ health into their curriculum without fundamentally changing how they teach sex/gender and sexuality to their students as well as centering intersecting inequalities in their teaching. As such, this dissertation calls for a shift to queer health to focus less on sex/gender and sexuality binaries and to focus more on the practice of learning about LGBTQ health rather than fulfilling a competency. Ultimately, this research states that medical education is a space for the enactment of LGBTQ health whereby the complexity of sex, gender, sexuality, and identity gets negotiated by medical faculty, students, administrators, and LGBTQ community members

Interpreter services play an integral role in ensuring equity in healthcare for patients with limited English proficiency (LEP), whose language barrier places them at increased risk for healthcare disparities. Even with the growing number of non-English-speaking patients, a sizeable number being Spanish-speaking, and although such training leads to more culturally competent care with better patient outcomes, there is little curricular time during medical school devoted to effectively using interpreters. This study aimed to understand better how medical education prepares future physicians for their encounters with LEP patients and what experiences they would appreciate in their medical training. Temple LKSOM student from the class of 2024-2027 (M1-M4s), were recruited through flyers and educator announcements to participate in three virtual focus groups with a total of 26 participants. Qualitative data analysis resulted in five themes which were: students felt that interpreters were integral to culturally competent care, students who speak another language have the undue burden of interpreting even when not comfortable doing so, students felt that there was not enough training in medical school regarding various types of interpreters, how to reach them or how to use them properly, students are open to doctoring sessions or simulations with non-English speaking standardized patients and interpreters, and the final theme was that there mixed feelings amongst students regarding the desire to have OSCEs with non-English speaking standardized patients and interpreters. / Urban Bioethics

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by Simon Siu-man Tam. / Includes bibliographical references / Thesis (M.Ph.)--Chinese University of Hong Kong, 1986

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