Conceptualisation and Development of a values-based scale of emergency physicians' professional identities.

BACKGROUND: Physicians' values about what constitute their professional identities are integral in understanding how they ascribe meaning to their practice. However, there is no general consensus on the conceptualization and measurement of physicians' professional identities. This study developed and validated a values-based scale for measuring physicians' professional identities. METHODS: A hybrid research method was used to gather both qualitative and quantitative data. We employed literature review, semi-structured interview, Q-sorting exercise to examine the conceptualization of emergency physicians' professional identities and to initially develop a 40-item scale. A panel of five experts assessed the scale's content validity. Using 150 emergency physicians as our sample, we conducted Confirmatory Factor Analyses (CFA) to test the fit of our hypothesised four-factor model based on our preliminary findings. RESULTS: Initial CFA suggested revisions to the model. Following theoretical assumptions and modification indices, the model was revised and adjusted to a four-factor 20 item Emergency Physicians Professional Identities Value Scale (EPPIVS) with acceptable fit statistics χ2 = 389.38, df = 164, Normed χ2 = 2.374, GFI = 0.788, CFI = 0.862, RMSEA = 0.096. The Cronbach's alpha, McDonald's Omega reliability and composite reliability of the subscales ranged from α: 0.748 to 0.868, Omega: 0.759 to 0.868 and CR: 0.748 to 0.851, respectively. CONCLUSION: The results indicate that the EPPIVS is a valid and reliable scale for measuring physicians' professional identities. Further research on the sensitivity of this instrument to important changes over career progression in emergency medicine is warranted.

Medical Humanities Education and Its Influence on Students' Outcomes in Taiwan: A Systematic Review.

Background: Medical education has emphasized the importance of integrating medical humanities training into the curriculum to benefit medical and nursing students' future practice, featuring in the list of national funding priorities for healthcare education research in Taiwan for many years. However, the extent to which this drive has resulted in medical humanities training, what rationales underpin its inclusion, and its efficacy is largely unknown. This study aims to address these issues across medical humanities programs within the Taiwanese context. Methods: We conducted a systematic review. Inclusion criteria included studies in English or Mandarin reporting outcomes of medical humanities courses in healthcare education settings in Taiwan between 2000 and 2019. We searched across five electronic databases (PubMed, Embase, ERIC, PsycInfo, Web of Science), following PRISMA guidelines. The Best Evidence Medical Education (BEME) Global Scale and Kirkpatrick Levels are used for identifying the strength of evidence. Results: 17 articles were extracted from the 134 identified. Intrinsic and instrumental rationales for the inclusion of medical humanities education were common, compared with epistemological-based and critical-based approaches. Several positive impacts were identified in relation to participation including modification of attitudes, knowledge, and skills. However, the highest level (i.e., unequivocal) of evidence characterized by effects on students' behaviors or ongoing interaction with colleagues and patients is lacking. Conclusion: Findings suggest that although medical humanities education is widely implemented in Taiwan, no clear consensus has been reached regarding the rationale for inclusion or how it is localized from Western to Asian contexts. Future research still needs to explore the long-term impact of medical humanities education for medical and nursing students and its impact on patient care. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42019123967.

Clinical teachers' motivations for feedback provision in busy emergency departments: a multicentre qualitative study.

BACKGROUND: Feedback is an effective pedagogical tool in clinical teaching and learning, but the actual perception by learners of clinical feedback is often described as unsatisfactory. Unlike assessment feedback or teaching sessions, which often happen within protected time and space, clinical feedback is influenced by numerous clinical factors. Little is known about clinical teachers' motivations to provide feedback in busy clinical settings. We aimed to investigate the motivations behind feedback being given in emergency departments (EDs). METHODS: A qualitative analysis of semi-structured interview data was conducted between August 2015 and June 2016. Eighteen attending physicians were purposively sampled from three teaching hospital EDs in Taiwan. Data were thematically analysed, both inductively (from the data) and deductively (using self-determination theory (SDT)). Themes were mapped to the different motivation types identified by the SDT. RESULTS AND DISCUSSION: Despite working in busy clinical settings, Taiwanese ED clinical teachers reported being motivated to provide feedback when they felt responsible for their learners, when they understood the importance of feedback (patient safety and partner building), or simply because they were committed to following a tradition of passing on their clinical knowledge to their juniors. Suggestions to facilitate the internalisation of external motivations are proposed. CONCLUSIONS: In this qualitative study, motivations for clinical feedback were identified. Although the motivations are mostly extrinsic, the elicitation of internal motivation is possible once true satisfaction is fostered during the feedback-giving process. This understanding can be used to develop interventions to enable clinical feedback to be provided in a sustained manner.

Digitizing Scoring Systems With Extended Online Feedback: A Novel Approach to Interactive Teaching and Learning in Formative OSCE.

OBJECTIVES: Objective structured clinical examinations (OSCEs) are common for formative assessment. We developed an Online Smart Communicative Education System and aimed to explore the factors that affect the perceptions of both teachers and students for teaching and learning. METHODS AND ANALYSIS: A two-year cross-sectional cohort study was undertaken. The program includes three parts. Part I Pre-OSCE: an online flipped class in preparation for task-related knowledge and skills. Part II OSCE-day: 10 tasks in one track formative OSCE. Part III Post-OSCE: extended online feedback for participants with further questions after the exam and raters with more feedback after reviewing their performance online. Principal component analysis with varimax rotation was performed to analyze the perceptions of students and teachers to the Online System by means of questionnaires. RESULTS: Seventy-six pharmacy students (male 32.9%) took the exam and 24 raters (male, 25%) participated in the scoring during the OSCEs. The mean G coefficient was 0.88. Seventy-six questionnaires from the students were obtained for the analysis. Results explained the cumulative variance of 73.9% for component (1) "Effects of extended online feedback": 40% and (2) "Facilitation of learning": 33.9%. Thirty-nine questionnaires from the raters who experienced the Online System were obtained for the analysis (male 23.1%). Results explained a cumulative variance of 77.3% for component (1) "Effects of extended online feedback": 36.6%, (2) "Facilitation of scoring and feedback": 24.5%, and (3) "Feasibility of online platform": 16.2%, respectively. CONCLUSION: We demonstrated good reliability for digitizing the scoring system with educational support to facilitate teaching. "Effects of extended online feedback" was the major aspect in explaining the variance from the perceptions of students and raters by factor analysis. In comparison with traditional formative OSCEs, extended online feedback is a novel approach, which extends the process of learning and teaching among the learners and raters and overcomes the barriers of time limitation and distance.

Clinical learning in the context of uncertainty: a multi-center survey of emergency department residents' and attending physicians' perceptions of clinical feedback.

BACKGROUND: Feedback is an essential part of clinical teaching and learning, yet it is often perceived as unsatisfactory in busy clinical settings. Clinical teachers need to balance the competing demands of clinical duty and feedback provision. The influence of the clinical environment and the mutual relationship between feedback giving and seeking has been inadequately investigated. This study therefore aimed to quantify the adequacy, perceptions, and influential factors of feedback provision during resident training in emergency departments (EDs). METHODS: A multicenter online questionnaire study was undertaken. The respondents comprised ED residents and clinical teachers from four teaching hospitals in Taiwan. The questionnaire was developed via an expert panel, and a pilot study ensured validity. Ninety clinical teachers and 54 residents participated. RESULTS: The respondents reported that the majority of feedback, which usually lasted 1-5 min, was initiated by the clinical teachers. Feedback satisfaction was significantly lower for the clinical teachers than for the residents (clinical teachers M = 13.8, SD = 1.83; residents M = 15.3, SD = 2.14; p < 0.0001), and positive feedback was provided infrequently in clinical settings (31.1%). Both groups of participants admitted hesitating between providing/seeking feedback and completing clinical work. Being busy, the teachers' clinical abilities, the learners' attitudes, and the relationship between both parties were reported as the most influential factors in feedback provision. CONCLUSION: ED clinical feedback provision is often short, circumstantial, and initiated by clinical teachers. Providing or seeking feedback appears to be an important part of clinical learning in the context of uncertainty. The importance of the relationship between the feedback seeker and the provider highlights the interactive, reciprocal nature of clinical feedback provision.

Healthcare professionals', students', patients' and donors' perceptions of stem cell research and therapy: a systematic review protocol.

INTRODUCTION: Stem cell research (SCR) and the biomedical potential of developing therapies are crucial topics in biomedicine. Like other biotechnologies, stem cells are context specific entities understood through local conceptualisations of culture, politics, nationhood, as well as their perceived therapeutic efficacy. There is a need to recognise how these developments are understood within the healthcare community and by those who may use them. This protocol describes a systematic literature review that aims to explore healthcare professionals', healthcare students', patients', and donors' perceptions of SCR and therapy (SCR/T) and the factors that influence their perceptions. METHODS AND ANALYSIS: Following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines a systematic review will be undertaken. Web of Science, Scopus, Medline+Journals @Ovid and Ariti Library will be systematically searched for studies on healthcare professionals', healthcare students', patients' and donors' perceptions of SCR and developing therapies. All articles will be screened by a researcher for inclusion and evaluation based on 12 criteria for evaluating qualitative research. At least 20% of articles will also be reviewed by a second researcher and any disagreement will be solved via consensus. Data extracted from the articles will be analysed using thematic synthesis enabling the identification of concepts across studies and the development of new theory. ETHICS AND DISSEMINATION: As part of a larger research project, ethical approval has been provided by the Institutional Research Board (IRB) at Chang Gung Memorial Hospital. This review will be able to determine the impact that certain perceptions of SCR/T will have on the development of future medical knowledge and practice. The results of the study will be published in a peer-reviewed journal and disseminated at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42018103627.